Clinical outcomes of femtosecond laser-assisted laser in situ keratomileusis combined with accelerated corneal cross-linking versus standard femtosecond laser-assisted laser in situ keratomileusis for the correction of myopia and myopic astigmatism.

PURPOSE: To investigate the long-term clinical outcomes of femtosecond laser-assisted laser in situ keratomileusis combined with accelerated corneal cross-linking (FS-LASIK Xtra) in patients with refractive error, evaluating its safety, efficacy, and stability.

METHODS

This retrospective comparative study included 80 eyes of 40 patients, divided into an FS-LASIK Xtra group (40 eyes) and a standard FS-LASIK group (40 eyes). Clinical outcomes, including visual acuity, refractive status, posterior corneal elevation, higher-order aberrations (HOAs), and corneal biomechanics, were evaluated preoperatively and up to 12 months postoperatively.

RESULTS

At 1 year, both groups achieved excellent uncorrected distance visual acuity (UDVA), although the median UDVA was statistically slightly better in the standard FS-LASIK group (P = 0.036). The spherical equivalent (SE) was comparable between the groups (P = 0.172). Regarding the posterior corneal surface, the standard FS-LASIK group demonstrated a significant progressive forward shift (P < 0.001), while the FS-LASIK Xtra group remained stable (P = 0.209). The change in the biomechanical integrated radius (ΔIR) was significantly smaller in the FS-LASIK Xtra group, indicating better biomechanical preservation (P = 0.032). While total higher-order aberrations increased in both groups, horizontal trefoil was significantly higher in the FS-LASIK Xtra group (P = 0.004).

CONCLUSION

FS-LASIK Xtra demonstrated advantages in maintaining posterior corneal surface stability and better preserving corneal biomechanical properties over a 1-year follow-up period. Combining FS-LASIK with accelerated corneal cross-linking may serve as an enhancement strategy, providing additional structural support following the procedure.