1. Poster produced by Faculty & Curriculum Support (FACS), Georgetown University School of Medicine LASIK Combined with Corneal Cross-linking in Eyes with Potentially Elevated Risk of Corneal Ectasia Michael Korchak, MD; Roxanne Littner, MS; Briana E. McFadden, MHA; MS; Tonoa Person, COT; William Trattler, MD; Roy Rubinfeld, MD Abstract Introduction Methods Discussion Conclusions References Financial Disclosures Georgetown University 1.Cheema AS, Mozayan A, Channa P. Corneal collagen crosslinking in refractive surgery. Curr Opin Ophthalmol. 2012 Jul;23(4):251-6. 2.Kanellopoulos AJ1, Kahn J. Topography-guided hyperopic LASIK with and without high irradiance collagen cross-linking: initial comparative clinical findings in a contralateral eye study of 34 consecutive patients. J Refract Surg. 2012 Nov;28(11 Suppl):S837-40. 3.Richoz O, Mavrakanas N, Pajic B, Hafezi F. Corneal collagen cross-linking for ectasia after LASIK and photorefractive keratectomy: long-term results. Ophthalmology. 2013 Jul;120(7):1354-9 Results Purpose: To evaluate laser in situ keratomileusis (LASIK) with corneal cross-linking (CXL) in eyes with potentially elevated risk of ectasia. Methods: 32 eyes were prospectively studied for up to 12 months. Risk factors included subtle irregular astigmatism on corneal imaging, corneal thickness 7 diopters (D)). Results: Mean LogMAR uncorrected visual acuity (UCVA) improved from 1.39 to 0.10 (n=32) at one month, 0.08 (n=24) at six months, and 0.08 (n=16) at one year. All eyes (100%) had at least UCVA 20/40 at latest follow-up; 93.5% were 20/30 or better; 83.9% were 20/25 or better. No enhancements were performed. Mean manifest spherical refractive equivalent (MRSE) improved from -6.38D to -0.125D (n=16) at one year. Conclusion: LASIK with CXL may permit safer vision correction in patients considered borderline candidates.  Patients with risk factors for corneal ectasia were enrolled in this nonrandomized, prospective study  All patients received LASIK with CXL, using a proprietary CXL system  Risk factors: some subtle degree of irregular astigmatism on topography/tomography, corneal thickness of 500 µm or less, age 18-25 years, or high myopia (greater than 7 diopters)  Visual and refractive outcomes as well as keratometric and topographic measurements were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively  Patients with incomplete follow-up were analyzed up to the last study visit Patient Characteristics 32 eyes of 17 patients were enrolled (11 female, 6 male) The average age was 35.6 years (range: 19-59 years), four patients were between 18-25 years of age 12 patients had high myopia, four patients had subtle irregular astigmatism, and one patient had prior RK with hyperopic shift Sixteen eyes had full 12-month follow-up, eight eyes had follow-up through the 6-month visit, and eight eyes were lost to follow-up after 1-month Post-operative Results Mean MRSE improved to -0.074 (n=32) at 1 month, -0.115 (n=24) at 6 months, and -0.125 (n=16) at 12 months No eyes lost two or more lines of BSCVA No patients developed corneal ectasia Fig 1. Mean LogMAR uncorrected visual acuity outcomes with sample size shown for each data point. Mean LogMAR uncorrected visual acuity (UCVA) improved from 1.39 preoperatively to 0.10 at one month, 0.14 at three months, 0.08 at six months, and 0.08 at one year. Eight eyes were lost after the 1-month visit; all had UCVA 20/25 or better with 5/8 with UCVA: 20/20.  In eyes with theoretical increased risk for corneal ectasia, LASIK with CXL appears to be safe and effective  This combination may permit patients previously considered borderline candidates for LASIK to be treated more safely Roy Rubinfeld has financial interests in CXLUSA and CXLO. William Trattler has financial interests in CXLO And is a consultant for CXLUSA. Uncorrected Visual Acuity Outcomes All eyes (100%) had at least UCVA 20/40 at latest follow-up; 93.5% were 20/30 or better; 83.9% were 20/25 or better In patients with 12 month follow-up, 81.3% (13/16) eyes had UCVA 20/25 or better with one eye 20/30 and two eyes 20/40 No enhancements were performed in this study group Corneal Cross-linking with UVA light application  Early results suggest LASIK with CXL appears to be safe and effective in patients with a theoretical increased risk for corneal ectasia  This combined procedure may allow for LASIK to be performed more safely in patients considered to be borderline candidates  Further studies are needed to further establish the safety and efficacy of this combination, such as a randomized control trial comparing LASIK to LASIK with CXL in borderline candidates  Corneal ectasia is an uncommon, but potentially severe and dreaded complication of LASIK  Some patients are thought to have an increased risk of corneal ectasia, for example patients with forme fruste keratoconus, high myopia, or younger age  CXL is thought to augment the tectonic strength of the cornea by using UVA light and the photo-mediator riboflavin  CXL has been shown to safely strengthen corneas in conditions such as keratoconus, pellucid marginal degeneration, and post-LASIK ectasia  We examined the safety and biomechanical stability of patients undergoing LASIK combined CXL in patients with a theoretical increased risk for corneal ectasia Pre-operative Assessment 26/32 eyes had UCVA of 20/800 Mean refraction: -7.11D SPH (-11.5D to +1.5D) + 1.46D CYL (0 to +5.5D) Mean MRSE: -6.38D (range: -11.125D to +2.75D) 24/32 eyes had high refractive error (greater than -7D) 13/32 eyes had cylinder greater than +1.5D Mean Baseline CCT: 531.9µm (range: 489–616) Eight eyes had CCT of 500µm or less