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Przybek-Skrzypecka J, Skrzypecki J, Suh L, Szaflik JP. Corneal ring infiltrate- far more than Acanthamoeba keratitis: review of pathophysiology, morphology, differential diagnosis and management. J Ophthalmic Inflamm Infect 2023; 13:55. [PMID: 38112842 PMCID: PMC10730498 DOI: 10.1186/s12348-023-00379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE Ring infiltrates usually accompany numerous infectious and sterile ocular disorders. Nevertheless, systemic conditions, drugs toxicity and contact lens wear may present with corneal ring infiltrate in substantial part. Considering its detrimental effect on vision, detailed knowledge on etiology, pathophysiology, differential diagnosis, and management should be considered essential for every ophthalmologist. METHODS The PUBMED database was searched for "corneal ring infiltrate" and "ring infiltrate" phrases, "sterile corneal infiltrate" and "corneal infiltrate". We analyzed articles written in English on risk factors, pathophysiology, clinical manifestation, morphological features, ancillary tests (anterior-segment optical coherence tomography, corneal scraping, in vivo confocal microscopy), differential diagnosis and management of corneal ring infiltrate. RESULTS Available literature depicts multifactorial origin of corneal ring infiltrate. Dual immunological pathophysiology, involving both antibodies-dependent and -independent complement activation, is underlined. Furthermore, we found that the worldwide most prevalent among non-infectious and infectious ring infiltrates are ring infiltrates related to contact-lens wear and bacterial keratitis respectively. Despite low incidence of Acanthamoeba keratitis, it manifests with corneal ring infiltrate with the highest proportion of the affected patients (one third). However, similar ring infiltrate might appear as a first sign of general diseases manifestation and require targeted treatment. Every corneal ring infiltrate with compromised epithelium should be scraped and treat as an infectious infiltrate until not proven otherwise. Of note, microbiological ulcer might also lead to immunological ring and therefore require anti-inflammatory treatment. CONCLUSION Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions. Clinical assessment is crucial for empirical diagnosis. Furthermore, treatment is targeted towards the underlying condition but should begin with anti-infectious regimen until not proven otherwise.
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Affiliation(s)
- J Przybek-Skrzypecka
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576, Warsaw, Poland.
- SPKSO Ophthalmic University Hospital, Warsaw, Poland.
| | - J Skrzypecki
- SPKSO Ophthalmic University Hospital, Warsaw, Poland
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland
| | - L Suh
- Cornea & Refractive Surgery, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, USA
| | - J P Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576, Warsaw, Poland
- SPKSO Ophthalmic University Hospital, Warsaw, Poland
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Zheng X, Xin Y, Wang C, Fan Y, Yang P, Li L, Yin D, Zhang E, Hong Y, Bao H, Wang J, Bao F, Zhang W, Chen S, Elsheikh A, Swain M. Use of Nanoindentation in Determination of Regional Biomechanical Properties of Rabbit Cornea After UVA Cross-Linking. Invest Ophthalmol Vis Sci 2023; 64:26. [PMID: 37850947 PMCID: PMC10593136 DOI: 10.1167/iovs.64.13.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose To evaluate the regional effects of different corneal cross-linking (CXL) protocols on corneal biomechanical properties. Methods The study involved both eyes of 50 rabbits, and the left eyes were randomized to the five intervention groups, which included the standard CXL group (SCXL), which was exposed to 3-mW/cm2 irradiation, and three accelerated CXL groups (ACXL1-3), which were exposed to ultraviolet-A at irradiations of 9 mW/cm2, 18 mW/cm2, and 30 mW/cm2, respectively, but with the same total dose (5.4 J/cm2). A control (CO) group was not exposed to ultraviolet-A. No surgery was done on the contralateral eyes. The corneas of each group were evaluated by the effective elastic modulus (Eeff) and the hydraulic conductivity (K) within a 7.5-mm radius using nanoindentation measurements. Results Compared with the CO group, Eeff (in regions with radii of 0-1.5 mm, 1.5-3.0 mm, and 3.0-4.5 mm) significantly increased by 309%, 276%, and 226%, respectively, with SCXL; by 222%, 209%, and 173%, respectively, with ACXL1; by 111%, 109%, and 94%, respectively, with ACXL2; and by 59%, 41%, and 37%, respectively, with ACXL3 (all P < 0.05). K was also significantly reduced by 84%, 81%, and 78%, respectively, with SCXL; by 75%, 74%, and 70%, respectively, with ACXL1; by 64%, 62%, and 61%, respectively, with ACXL2; and by 33%, 36%, and 32%, respectively, with ACXL3 (all P < 0.05). For the other regions(with radii between 4.5 and 7.5 mm), the SCXL and ACXL1 groups (but not the ACXL2 and ACXL3 groups) still showed significant changes in Eeff and K. Conclusions CXL had a significant effect on corneal biomechanics in both standard and accelerated procedures that may go beyond the irradiated area. The effect of CXL in stiffening the tissue and reducing permeability consistently decreased with reducing the irradiance duration.
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Affiliation(s)
- Xiaobo Zheng
- School of Aeronautics, Northwestern Polytechnical University, Xi'an, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yue Xin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Dalian Medical University, Affiliated Dalian No. 3 People's Hospital, Dalian, China
| | - Chong Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yiwen Fan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Peng Yang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lingqiao Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Danping Yin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Erchi Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yuxin Hong
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Han Bao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Junjie Wang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fangjun Bao
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Weiwei Zhang
- School of Aeronautics, Northwestern Polytechnical University, Xi'an, China
| | - Shihao Chen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Michael Swain
- AMME, Biomechanics Engineering, The University of Sydney, Sydney, Australia
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Sabur H, Acar M. Dexpanthenol/sodium hyaluronate eye drops for corneal epithelial healing following corneal cross-linking in patients with keratoconus. Int Ophthalmol 2023; 43:3461-3469. [PMID: 37306832 DOI: 10.1007/s10792-023-02751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 05/21/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate the effect of dexpanthenol 2%/sodium hyaluronate 0.15% eye drops on corneal epithelial healing and corneal microstructural changes following corneal cross-linking (CXL) in patients with keratoconus. METHODS The study included 42 eyes of 21 patients with keratoconus who underwent CXL on both eyes. One eye of each patient was instilled dexpanthenol 2%/sodium hyaluronate 0.15% eye drops (DP/SH group) and the fellow eye was instilled unpreserved sodium hyaluronate 0.15% eye drops (SH group). The epithelial healing process was assessed every day until complete reepithelialization was achieved. The in vivo confocal microscopy (IVCM) findings were also recorded. RESULTS The mean epithelial defect size 48.6 ± 6.7 mm2 for the DP/SH group and 48.2 ± 5.3 mm2 for the SH group. Complete reepithelialization was seen after 2.24 ± 0.44 days (range 2-4 days) in the DP/SH group and 3.43 ± 0.60 days (3 to 5 days) in the SH group. Posterior keratocyte density and endothelial cell density were similar in both groups. The mean subbasal nerve plexus density was significantly higher in the DP/SH group (postoperative 1 month: 1.13 ± 1.51, 3 months: 3.53 ± 2.55, 6 months: 7.07 ± 1.42) compared to the SH group (postoperative 1 month: 0.87 ± 1.43, 3 months: 2.89 ± 2.62, 6 months 6.33 ± 1.29). The DP/SH group revealed faster subbasal nerve regeneration and less edema compared to the SH group. CONCLUSION Dexpanthenol 2%/sodium hyaluronate 0.15% eye drops were effective and safe for corneal epithelial healing, and promoted faster corneal reepithelialization, nerve regeneration, and keratocyte repopulation with reduced corneal edema compared to sodium hyaluronate eye drops.
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Affiliation(s)
- Huri Sabur
- Department of Ophthalmology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Mutlu Acar
- Associate Professor of Ophthalmology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Borgardts K, Menzel-Severing J, Fischinger I, Geerling G, Seiler TG. Innovations in Corneal Crosslinking. Curr Eye Res 2023; 48:144-151. [PMID: 36458595 DOI: 10.1080/02713683.2022.2146725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
PURPOSE Corneal Crosslinking (CXL) strengthens the keratoconus cornea and prevents further disease progression. Modified crosslinking protocols and different riboflavin solutions have been proposed to optimize the procedure and improve treatment success. METHODS PubMed research of relevant publications and report of own experiences with different CXL protocols. RESULTS Accelerated CXL shows comparable efficiency with shorter surgery time and similar complication rates. Customized CXL provides improved results with faster epithelial healing. CXL in a hyperoxic environment seems to be a safe and effective transepithelial alternative with presumably less complications and fewer side effects. Thin corneas (<400 µm) can be treated safely by corneal swelling using hypoosmolar riboflavin solutions and reducing the applied UV-energy. The combination of CXL with photorefractive keratectomy (PRK) can be considered in patients with contact lens intolerance improving visual acuity, however, with increased risk of visual loss compared to CXL alone. Two-Photon (2Ph) CXL is a promising new technology enabling three-dimensional CXL. DISCUSSION Recently developed CXL protocols offer advantages over the standard "Dresden-protocol" and should be considered in patients with progressive keratectasia.
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Affiliation(s)
- Klara Borgardts
- Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Isaak Fischinger
- Institut für Refraktive and Ophthalmo-Chirurgie (IROC), Zürich, Switzerland.,Department of Ophthalmology, Kepler University Hospital, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Theo G Seiler
- Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany.,Institut für Refraktive and Ophthalmo-Chirurgie (IROC), Zürich, Switzerland.,Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
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Tillmann A, DanielKampik D, Borrelli M, Seidl M, Menzel-Severing J, Seiler TG, Geerling G. Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus. Am J Ophthalmol Case Rep 2022; 28:101705. [PMID: 36187442 PMCID: PMC9519437 DOI: 10.1016/j.ajoc.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To report two cases of acute corneal melting and perforation requiring emergency penetrating keratoplasty after corneal crosslinking (CXL) in advanced keratoconus. Observations Case 1 was a 34 and case 2 was a 16-year old male, both with progressive keratoconus, who underwent CXL (Dresden protocol). After riboflavin imbibition, patients had a minimal pachymetry of 337 μm and 347 μm, and therefore required stromal swelling by hypoosmolar riboflavin resulting in pachymetries of 470 μm and 422 μm, prior to the 30 minute UV-irradiation with 3mW/cm2. In case 1, on the 7th postoperative day a 4mm linear perforation occurred. Extensive post-hoc examinations revealed no infectious cause. In case 2, a corneal melting developed within 24 hours, from which Staphylococcus aureus was cultured. Conclusions and importance Acute corneal melting and perforation may occur after CXL. Dysfunctional collagen metabolism, atopia, thin preoperative pachymetry and the use of hypoosmolar substances may have initiated this complication in our cases.
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Affiliation(s)
- Anne Tillmann
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
- Corresponding author. University Hospital Duesseldorf, Department of Ophthalmology, Moorenstraße 5, D-40225, Duesseldorf, Germany.
| | | | - Maria Borrelli
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
| | - Maximilian Seidl
- Institute of Pathology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Theo Günter Seiler
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
- Department of Ophthalmology, University of Bern, Bern, Switzerland
- Institute for Refractive and Ophthalmic Surgery (IROC), Zurich, Switzerland
| | - Gerd Geerling
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
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Mohebbi M, Samavat B, Mohammadi A. One-year non-comparative observational study to evaluate corneal tomographic, densitometric, and aberrometric features following accelerated corneal cross-linking in progressive keratoconus. Int Ophthalmol 2022; 43:1721-1735. [PMID: 36418804 DOI: 10.1007/s10792-022-02572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the 12 months' changes in tomographic, densitometric, and aberrometric parameters in keratoconic eyes after accelerated corneal cross-linking (CCL) and classify a densitometric course in different stages of the keratoconus separately (mild, moderate, and severe). METHODS In a prospective observational study, 67 keratoconic eyes of 67 patients that underwent accelerated epithelium-off corneal cross-linking (9 mW/cm2 and 10 min) for treatment of progressive keratoconus were included. Corneal tomographic, densitometric, and aberrometric values obtained using the Pentacam HR were recorded at the baseline and 3, 6, and 12 months post-operatively. RESULTS One year after treatment, corrected distance visual acuity (CDVA) was improved, and maximum keratometry, thinnest pachymetry, higher order, and total root mean square (RMS) were significantly decreased (p < 0.001). Corneal densitometry values showed a significant elevation 3 months post-surgery compared to baseline and then decreased to baseline values at 1 year. Only the Anterior 0-2 mm zone densitometry at the 3rd month was different between the three groups. RMS at 1 year correlated with Anterior 0-2 mm, Anterior 2-6 mm, total corneal 0-2 mm, and total corneal 2-6 mm densitometry values in the 3rd month. Final CDVA at 12th month follow-up correlated with the Anterior 0-2 mm corneal densitometry in the 3rd month. CONCLUSION Anterior 0-2 mm zone densitometry at the 3rd-month post-accelerated CCL is different in various stages of keratoconus. Due to the correlation between final aberrometric and peak densitometric values in keratoconic eyes, peak densitometric values can be used as a prognostic factor for the final visual outcomes after accelerated CCL.
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Fuchs B, Wendelstein J, Mariacher S, Tetz K, Bolz M, Fischinger I. Late onset of a persistent, deep stromal and endothelial scarring after corneal collagen crosslinking for keratoconus: A case report. Eur J Ophthalmol 2022; 32:3195-3200. [PMID: 35786024 DOI: 10.1177/11206721221112140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To report a late onset, deep stromal and endothelial corneal scar in a keratoconus patient after corneal collagen cross-linking (CXL). CASE DESCRIPTION Observational case report. A 29-year-old man with bilateral keratoconus received an accelerated (A-CXL 10*9) epithelium-off CXL procedure in the left eye.6-months postoperatively, a 2.2 × 1.2 mm inferocentral corneal scar was detected, which was located in the posterior stroma ranging from approximately 350 µm until the endothelium, therefore was situated below the demarcation line. A topical corticosteroid treatment did not influence the magnitude or configuration of the scar. Visual acuity was never affected, which includes the examination 12 months postoperatively. CONCLUSIONS We report a case of a late onset deep stromal and endothelial corneal scar 6 months after accelerated CXL as postoperative complication without affecting visual acuity.
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Affiliation(s)
- Barbara Fuchs
- Department of Ophthalmology and Optometry, 571572Kepler University Hospital, Linz, Austria
- Medical Faculty, 507730Johannes Kepler University Linz, Linz, Austria
| | - Jascha Wendelstein
- Department of Ophthalmology and Optometry, 571572Kepler University Hospital, Linz, Austria
- Medical Faculty, 507730Johannes Kepler University Linz, Linz, Austria
| | - Siegfried Mariacher
- Department of Ophthalmology and Optometry, 571572Kepler University Hospital, Linz, Austria
- Medical Faculty, 507730Johannes Kepler University Linz, Linz, Austria
| | | | - Matthias Bolz
- Department of Ophthalmology and Optometry, 571572Kepler University Hospital, Linz, Austria
- Medical Faculty, 507730Johannes Kepler University Linz, Linz, Austria
| | - Isaak Fischinger
- Department of Ophthalmology and Optometry, 571572Kepler University Hospital, Linz, Austria
- Medical Faculty, 507730Johannes Kepler University Linz, Linz, Austria
- 535962Eye Clinic Spreebogen, Berlin, Germany
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Zhao Y, Yang H, Li Y, Wang Y, Han X, Zhu Y, Zhang Y, Huang G. Quantitative Assessment of Biomechanical Properties of the Human Keratoconus Cornea Using Acoustic Radiation Force Optical Coherence Elastography. Transl Vis Sci Technol 2022; 11:4. [PMID: 35666497 PMCID: PMC9185997 DOI: 10.1167/tvst.11.6.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Quantification of biomechanical properties of keratoconus (KC) corneas has great significance for early diagnosis and treatment of KC, but the corresponding clinical measurement remains challenging. Here, we developed an acoustic radiation force (ARF) optical coherence elastography technique and explored its potential for evaluating biomechanical properties of KC corneas. Methods An ARF system was used to induce the tissue deformation, which was detected by an optical coherence tomography system, and thus the localized point-by-point Young's modulus measurements were achieved. Then, two healthy rabbit eyes were imaged to test the system, after which the human keratoconus cornea was evaluated by using the same method. Three regions were selected for biomechanics analysis: the conical region, the transitional region, and the peripheral region. Results Young's moduli of transitional region ranged from 53.3 to 58.5 kPa. The corresponding values for the peripheral region were determined to be 58.6 kPa and 63.2 kPa, respectively. Young's moduli of the conical region were gradually increased by 18.3% from the center to the periphery, resulting in the minimum and maximum values of 44.9 kPa and 53.1 kPa, respectively. Furthermore, Young's moduli of the anterior and posterior of the center were determined to be 44.9 kPa and 50.7 kPa, respectively. Conclusions Differences in biomechanical properties between the three regions and slight variations within the conical region were clearly distinguished. Biomechanical weakening of the keratoconus cornea was mainly localized in the conical region, especially in the vertex position. Translational Relevance The system may provide a promising clinical tool for the noninvasive evaluation of local corneal biomechanics and thus may have potential applications in early keratoconus detection with further optimization.
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Affiliation(s)
- Yanzhi Zhao
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
| | - Hongwei Yang
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
| | - Yingjie Li
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
| | - Yongbo Wang
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
| | - Xiao Han
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Yirui Zhu
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Yubao Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Guofu Huang
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
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Borgardts K, Menzel-Severing J, Geerling G, Seiler TG. [Treatment indications for corneal crosslinking and clinical results of new corneal crosslinking techniques]. Ophthalmologe 2022; 119:350-357. [PMID: 35147774 DOI: 10.1007/s00347-022-01579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Corneal crosslinking (CXL) is used in keratoconus to strengthen and stabilize the cornea and to prevent further progression with subsequent visual loss and the possible need for keratoplasty. Correct treatment indications is crucial in this context. Since the introduction of the initial Dresden protocol, other modified CXL protocols have been proposed to optimize treatment success. OBJECTIVE The relevant parameters for treatment indications are explained and the clinical results of new CXL protocols are presented. METHODS The currently valid criteria with respect to the indications for CXL in keratoconus, PubMed search for relevant publications and own experiences with different CXL protocols are presented. RESULTS The reproducibility of topographic parameters depends on the stage of the keratoconus. Accelerated CXL as well as transepithelial CXL with a hyperoxic environment show comparable efficiency with shorter surgery time and possibly lower complication rates. Customized CXL with an individualized UV irradiation profile provides improved results with faster epithelial healing. Lower UV energy doses enable CXL to be conducted in eyes with minimal stromal pachymetry of less than 400 µm before irradiation. The combination of CXL with photorefractive keratectomy (PRK) provides visual acuity improvements but also increases the risk of visual loss. CONCLUSION Current indication rules for CXL neglect the reduced reproducability of topographic and tomographic measurements in keratoconus. The latest CXL protocols presented here provide a safe alternative with similar and/or better efficacy compared to standard CXL. The combination of CXL with PRK offers an option for visual rehabilitation in patients with contact lens intolerance.
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Affiliation(s)
- Klara Borgardts
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Johannes Menzel-Severing
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Gerd Geerling
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Theo G Seiler
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland. .,Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Stockerstr. 37, 8002, Zürich, Schweiz. .,Klinik für Augenheilkunde, Universitätsspital Bern, Inselspital Bern, 3010, Bern, Schweiz.
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10
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Seyyar SA, Mete A, Kimyon S, Tıskaoğlu NS. Outcomes of customized topographic guided epithelial debridement for corneal collagen cross-linking. Int Ophthalmol 2021; 42:1273-1280. [PMID: 34727264 DOI: 10.1007/s10792-021-02114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the outcomes of corneal collagen cross-linking performed with customized epithelial debridement technique in progressive keratoconic corneas. MATERIALS AND METHODS Forty eyes of 40 patients were included in the study. We performed an ophthalmologic examination and recorded the uncorrected visual acuity, best corrected visual acuity (BCVA), central corneal thickness at the thinnest point (t-CCT), flat meridian keratometry (K1), steep meridian keratometry (K2), endothelial cell density (ECC), hexagonal cells (HEX), and coefficient of variation of cell areas (CV) measured preoperatively and at the 1st, 3rd, 6th and 12th months postoperatively. RESULTS The mean UCVA and BCVA were increased (p < 0.05). The mean flattest and steepest K readings were decreased (p < 0.05). The mean t-CCT decreased in the first months after treatment and increased after 6 months. The mean t-CCT was thicker at 12 months compared to pretreatment status (p < 0.05). The mean ECC and CV were not significantly different between follow-up intervals (p > 0.05). The mean HEX was statistically increased (p > 0.05). CONCLUSIONS Corneal collagen cross-linking performed with customized epithelial debridement technique is a successful alternative method for stopping the progression of keratoconus after 12 months of treatment.
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Affiliation(s)
- Sevim Ayca Seyyar
- Kocaeli Derince Education and Research Hospital Ophthalmology Department, İbni Sina, Lojman Sk., 41900, Derince, Kocaeli, Turkey.
| | - Alper Mete
- Gaziantep University Hospital Ophthalmology Department, Gaziantep, Turkey
| | - Sabit Kimyon
- Gaziantep University Hospital Ophthalmology Department, Gaziantep, Turkey
| | - Nesime Setge Tıskaoğlu
- Ersin Arslan Education and Research Hospital Ophthalmology Department, Gaziantep, Turkey
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Seitz B, Daas L, Hamon L, Xanthopoulou K, Goebels S, Spira-Eppig C, Razafimino S, Szentmáry N, Langenbucher A, Flockerzi E. [Stage-appropriate treatment of keratoconus]. Ophthalmologe 2021; 118:1069-1088. [PMID: 34181061 PMCID: PMC8492599 DOI: 10.1007/s00347-021-01410-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
Keratoconus (KC) is a progressive cone-shaped corneal protrusion that causes paracentral thinning at the apex of the cone and typically occurs asymmetrically on both sides. After a careful anamnesis and classification of the degree of severity a targeted treatment appropriate to the stage of the disease is available. If the visual acuity is no longer sufficient, rigid gas-permeable contact lenses (CL) are fitted by a specialist. Riboflavin UVA cross-linking (CXL) is recommended in cases of progression and visual acuity that is still useful for the patient. Intracorneal ring segments (ICRS) are indicated for CL intolerance in cases of reduced visual acuity and a clear central cornea. If the stage is more advanced, deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) is recommended. A PKP is contraindicated in acute KC but deep stromal sutures for readaptation of the Descemet tear with gas filling of the anterior chamber can considerably shorten the course. Almost no other eye disease is nowadays as easily accessible for an early instrument-based diagnosis and stage-appropriate treatment as KC.
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Affiliation(s)
- B Seitz
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland.
| | - L Daas
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - L Hamon
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - K Xanthopoulou
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - S Goebels
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - C Spira-Eppig
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - S Razafimino
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - N Szentmáry
- Dr. Rolf M. Schwiete Zentrum für Limbusstammzellforschung und kongenitale Aniridie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - E Flockerzi
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
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12
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Kato N, Ide T, Kobashi H, Toda I. Infectious keratitis after corneal crosslinking for keratoconus caused by levofloxacin-resistant microorganisms. BMC Ophthalmol 2021; 21:317. [PMID: 34465309 PMCID: PMC8409002 DOI: 10.1186/s12886-021-02081-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/14/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction We present seven cases of infectious keratitis after corneal crosslinking (CXL) to attenuate keratoconus progression. Methods Of 524 consecutive patients who underwent CXL, 7 cases (4 males and 3 females; 21.5 ± 7.1 years) developed postoperative infectious keratitis were retrospectively reviewed. CXL was performed using the Dresden protocol or an accelerated protocol involving epithelial removal. Results All cases appeared normal on the day after surgery, but subsequently developed eye pain, blurred vision, corneal infiltration, inflammation of the anterior chamber, and ciliary injection on day 2 or 3. Methicillin-resistant Staphylococcus aureus was cultured from two eyes, methicillin-sensitive Staphylococcus aureus from two eyes, and Streptococcus pneumoniae from one eye. All detected bacteria were resistant to levofloxacin (LVFX). Five of the seven cases, especially four of the five severe cases with hypopyon, had a history of atopic dermatitis. All cases were observed after 2015. Conclusions Infectious keratitis after CXL caused by microbes resistant to LVFX is increasing. In addition to careful postoperative observation of the cornea, preoperative evaluation of bacteria within the conjunctival sac evident on nasal swab cultures may be useful to identify potentially problematic microbes and inform the selection of appropriate antibiotics.
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Affiliation(s)
- Naoko Kato
- Minamiaoyama Eye Clinic, Kitaaoyama 3-3-11, Minato-ku, 107-0061, Tokyo, Japan. .,Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.
| | - Takeshi Ide
- Tokyo Vision Eye Clinic Asagaya, Tokyo, Japan
| | - Hidenaga Kobashi
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | - Ikuko Toda
- Minamiaoyama Eye Clinic, Kitaaoyama 3-3-11, Minato-ku, 107-0061, Tokyo, Japan
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Murchison CE, Petroll WM, Robertson DM. Infectious keratitis after corneal crosslinking: systematic review. J Cataract Refract Surg 2021; 47:1075-1080. [PMID: 33769765 PMCID: PMC8298263 DOI: 10.1097/j.jcrs.0000000000000620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Abstract
Corneal crosslinking is a U.S. Food and Drug Administration--approved therapy to stiffen the cornea and prevent progression of corneal ectasia in patients with keratoconus. The standard procedure involves removal of the corneal epithelium (epithelial-off) prior to treatment. Variations to the standard procedure include accelerated crosslinking and transepithelial procedures. This study reviewed what is known regarding the risk for infection after epithelial-off crosslinking, the spectrum of pathogens, and clinical outcomes. 26 publications were identified. All eyes were fit with a bandage contact lens postoperatively. Available data indicate that the overall frequency of infectious keratitis after epithelium-off crosslinking is low. Bacterial infections are the most common, with a mean time of presentation of 4.8 days postoperatively. The use of steroids and bandage contact lenses in the immediate postoperative period and/or a history of atopic or herpetic disease were associated with infection. These patients require intense postoperative care with prophylactic antiviral therapy when appropriate.
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Affiliation(s)
- Caroline E Murchison
- From the Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas
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14
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Seiler TG, Komninou MA, Nambiar MH, Schuerch K, Frueh BE, Büchler P. Oxygen Kinetics During Corneal Cross-linking With and Without Supplementary Oxygen. Am J Ophthalmol 2021; 223:368-376. [PMID: 33227242 DOI: 10.1016/j.ajo.2020.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To measure and simulate oxygen kinetics during corneal cross-linking at different irradiances with and without supplementary oxygen. DESIGN Experimental, laboratory study. METHODS In de-epithelialized porcine eyes, a femtosecond-laser-generated tunnel was used to place a fiber probe in corneal depths of 100, 200, and 300 μm to measure the local oxygen concentration. After riboflavin imbibition, the corneas were irradiated at 3, 9, 18, and 30 mW/cm2 while the oxygen concentration was measured. All experiments were performed under normoxic (21%) and hyperoxic (>95%) conditions. The obtained data were used to identify parameters of a numerical model for oxygen consumption and diffusion. RESULTS The equilibrium stromal oxygen concentration under atmospheric oxygen at 3 mW/cm2 was 2.3% in 100 μm decreasing to <1% in 300 μm. With 9, 18, and 30 mW/cm2, no oxygen was available in 200 μm, respectively, 100 μm or deeper. Using a hyperoxic environment, the concentration was 50% using 3 mW/cm2 in 100 μm, decreasing to 40% in 300 μm. At 9 mW/cm2, the concentrations were 5%, 3%, and 1% in 100, 200 and 300 μm, respectively. Using 18 and 30 mW/cm2, all oxygen was depleted at 100 μm; however, oxygen half-lives were longer at 18 mW/cm2 than at 30 mW/cm2. The oxygen model was able to reproduce the experiments and indicated an exponential decay with increasing distance to the anterior surface. CONCLUSION Supplementary oxygen increases the oxygen availability during corneal cross-linking. At higher irradiances, supplementary oxygen is beneficial and eliminates the bottleneck of oxygen allowing a potentially more efficient cross-linking. The calibrated numerical model can quantify the spatial oxygen concentration related to different scenarios such as irradiance or environmental oxygen concentration.
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Affiliation(s)
- Theo G Seiler
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Universitätsklinik für Augenheilkunde, Inselspital, Universität Bern, Bern, Switzerland; Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Switzerland; Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Maria A Komninou
- Universitätsklinik für Augenheilkunde, Inselspital, Universität Bern, Bern, Switzerland
| | - Malavika H Nambiar
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Kaspar Schuerch
- Universitätsklinik für Augenheilkunde, Inselspital, Universität Bern, Bern, Switzerland
| | - Beatrice E Frueh
- Universitätsklinik für Augenheilkunde, Inselspital, Universität Bern, Bern, Switzerland
| | - Philippe Büchler
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Ondes Yilmaz F, Kepez Yildiz B, Tunc U, Kandemir Besek N, Yildirim Y, Demirok A. Comparison of topical omega-3 fatty acids with topical sodium hyaluronate after corneal crosslinking : Short term results. Ocul Immunol Inflamm 2021; 30:959-965. [PMID: 33560170 DOI: 10.1080/09273948.2020.1858117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To evaluate the effect of topical omega 3 on ocular surface following corneal crosslinking (CXL) in keratoconus and compare with topical sodium hyaluronate.Material methods: 50 patients who underwent CXL were divided into two groups. In addition to topical steroids and antibiotics, Group A was prescribed topical omega 3; Group B was prescribed 0.3% sodium hyaluronate. Postoperatively, epithelial defect was measured everyday and at the first month corneal staining, Schirmer test was performed, tear break up time (TBUT), tear meniscus height (TMH) were measured.Results: Preoperative keratometric values were similar between groups; there was no difference in terms of corneal staining, tear film stability; epithelial closure time (p: 0.052), and postoperative pain scores between groups. At 1st month, TBUT and TMH were significantly better in Group A than Group B(p: 0.001, p: 0.047).Conclusion: Topical omega 3 increases tear film stability more prominent than sodium hyaluronate following crosslinking.
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Affiliation(s)
- Fevziye Ondes Yilmaz
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Burcin Kepez Yildiz
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ugur Tunc
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Nilay Kandemir Besek
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yildirim
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Demirok
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Elmassry A, Said Ahmed OI, Abdalla MF, Gaballah K. Ten years experience of corneal collagen cross-linking : An observational study of 6120 cases. Eur J Ophthalmol 2020; 31:951-958. [PMID: 32498548 DOI: 10.1177/1120672120928921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To study the effect of corneal collagen cross-linking (CXL) using riboflavin and ultraviolet rays on cases of corneal ectasia in keratoconus cases, post-laser-assisted in situ keratomileusis ectasia, and pellucid marginal degeneration and to present its long-term results over many years. METHODS This study was conducted throughout 10 "years" experience in corneal collagen CXL, including 6120 cases. The study consists of two parts: a retrospective and a prospective part. All patients in the retrospective part were operated by epi-off, while in the prospective part, the epi-on procedure was used. Also, other machines were used as Peschke Vario, Peschke Phoenix, and different types of riboflavin. The results were analyzed using SPSS. RESULTS The study showed stabilization ectasia in 95% of cases using our standard protocol, and this was proved by topography, pachymetry, refraction, and visual acuity. The effect of CXL was continued in 20% of cases, over a period of 3-5 years, some cases needed to repeat CXL due to the progression of corneal ectasia after cross-linking, in six eyes, that were rubbing their eyes and/or hormonal disturbance. CONCLUSION Corneal collagen cross-linking CXL is an effective method to prevent the progression of corneal ectasia, whether primary or post-laser-assisted in situ keratomileusis, and the effect was stable over the years of study.
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Affiliation(s)
- Ahmed Elmassry
- Department of Ophthalmology, Faculty of Medicine, 54562Alexandria University, Alexandria, Egypt
| | | | - Moones F Abdalla
- Department of Ophthalmology, Faculty of Medicine, 54562Alexandria University, Alexandria, Egypt
| | - Karim Gaballah
- Department of Ophthalmology, 68900Helwan University, Helwan, Egypt
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17
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Korneales Crosslinking – Meine erste Operation. Ophthalmologe 2019; 116:687-688. [DOI: 10.1007/s00347-019-0932-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Abstract
CLINICAL ISSUE The reduced corneal mechanical stability in keratoconus and similar collagen diseases can lead to a progressive and irregular corneal shape and decrease of visual acuity. DIAGNOSTICS A progression of keratectatic diseases can be shown with corneal topography. TREATMENT Keratoconus can be treated by photo-oxidative cross-linking of the corneal collagen. In order to achieve a high absorption of irradiation energy in the cornea, riboflavin at a concentration of 0.1% and UVA light at a wavelength of 370 nm corresponding to the relative maximum absorption of riboflavin (vitamin B2) are used. Evidence for corneal cross-linking are the increase of biomechanical stiffness, the increased resistance against enzymatic degradation, a higher shrinkage temperature, a lower swelling rate and an increased diameter of collagen fibers. The currently available data demonstrate that the therapeutic cross-linking procedure is safe when respecting the important theoretical and clinical parameters and that a progression of the keratoconus can be avoided. In 80% of cases an average levelling of the curvature of approximately 2 dpt can be achieved, which leads not only to stabilization but also to an increase in visual acuity of approximately 1.2 lines. ASSESSMENT In a Cochrane review from 2015 publications about complications and results were reviewed. Complication rates ranged from 1-10% depending on the initial situation, comorbidities and stage of the keratoconus. The most important complications are early epithelial wound healing problems as well as extremely rare perforations. PRACTICAL RECOMMENDATIONS Corneal cross-linking is a well-established and safe procedure but is not free of complications.
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19
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Noor IH, Seiler TG, Noor K, Seiler T. Continued Long-term Flattening After Corneal Cross-linking for Keratoconus. J Refract Surg 2018; 34:567-570. [PMID: 30089189 DOI: 10.3928/1081597x-20180607-01] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/31/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE To report 3 cases with continued long-term flattening after corneal cross-linking (CXL) for keratoconus and to determine its prevalence. METHODS Case series. RESULTS Three eyes of three patients presented with an ongoing corneal flattening over 10 years after CXL in the absence of corneal opacities. Of the initial 433 eyes treated with CXL between 2005 to 2007, only 45 eyes completed the 10-year follow-up period, indicating a prevalence of 6.7%. CONCLUSIONS Besides continuous flattening due to scars and intense early flattening, a third entity of continuous flattening can be observed after CXL. Continuous long-term flattening after CXL seems to affect more patients than initially anticipated and should be considered as a late-onset complication of CXL. [J Refract Surg. 2018;34(8):567-570.].
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20
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Protection of Corneal Limbus from Riboflavin Prevents Epithelial Stem Cell Loss after Collagen Cross-Linking. J Ophthalmol 2018; 2018:6854298. [PMID: 29967694 PMCID: PMC6008863 DOI: 10.1155/2018/6854298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/29/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate whether the protection of corneal limbus from riboflavin exposure during collagen cross-linking (CXL) prevents limbal epithelial stem cell (LESC) loss. Methods Ten New Zealand white rabbits received an epithelium-off CXL using an accelerated protocol. Seven days before procedure, 5-bromo-2-deoxyuridine (BrdU) was intraperitoneally injected. During procedure, riboflavin was applied to the corneal surface within a 9 mm diameter retention ring in 5 rabbits, thereby preventing the limbus from riboflavin exposure. In other 5 rabbits, riboflavin was instilled every 2 min, allowing the spillover to the limbus. One day after UVA irradiation, corneas were subjected to histological and molecular assays. Results There were no differences in corneal thickness and epithelial healing between the groups. The numbers of BrdU-labelled and p63+ limbal epithelial cells were markedly reduced in the group without a ring, but significantly increased when a ring was used. Robust expression of CK3/12 was observed in the limbal epithelium in the group with a ring. The mRNA levels of ABCG2, FGF2, IL-1β, and IL-6 were significantly increased in the corneas with a ring. Conclusions Protection of limbus from riboflavin during CXL was effective in preserving LESCs. However, inflammation was increased in the cornea treated with riboflavin using a ring.
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21
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Fischinger I, Seiler TG, Santhirasegaram K, Pettenkofer M, Lohmann CP, Zapp D. Corneal crosslinking (CXL) with 18-mW/cm 2 irradiance and 5.4-J/cm 2 radiant exposure-early postoperative safety. Graefes Arch Clin Exp Ophthalmol 2018; 256:1521-1525. [PMID: 29666915 DOI: 10.1007/s00417-018-3978-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To investigate safety of accelerated corneal crosslinking during the first postoperative month. METHODS In this retrospective study, 76 eyes of 60 patients with verified progressive keratectasia were enrolled in this study and followed for 1 month after accelerated CXL (18 mW/cm2 for 5 min, radiant exposure 5.4 J/cm2) (A-CXL(5*18)). Preoperatively, objective refraction, slit lamp inspection, and corneal tomography were performed. Early postoperative slit lamp examinations were performed on days 1 and 4. At 1 month, objective refraction, slit lamp inspection, and corneal tomography were performed. RESULTS Gender distribution was m:f = 55:21, OD:OS was 40:36, and the average age was 26.5 ± 8.6 years at surgery. Only 71 of the 76 eyes completed the 1-month follow-up, indicating a dropout rate of 6.6%. In 7.0% (n = 5), sterile infiltrates were observed; 5.6% of eyes (n = 4) showed delayed epithelial healing (> 4 days) in 2.8% (n = 2); an infection occurred and in 1 eye (1.4%), a stromal scar was detected; no other complications, neither a loss of two or more Snellen lines at 1 month postoperatively, were observed. As a risk factor for sterile infiltrates, thin preoperative pachymetry could be identified (p = 0.027). CONCLUSIONS This study revealed no difference in early postoperative safety between CXL using 18 mW/cm2 and standard corneal CXL. Thinner preoperative pachymetry could be identified predicting a higher rate of postoperative sterile infiltrates.
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Affiliation(s)
- Isaak Fischinger
- The Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 21, 81675, Munich, Germany. .,The Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Switzerland. .,The Inselspital Bern, Universitätsspital Bern, Bern, Switzerland.
| | - Theo G Seiler
- The Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 21, 81675, Munich, Germany.,The Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Switzerland.,The Inselspital Bern, Universitätsspital Bern, Bern, Switzerland
| | - Karthiga Santhirasegaram
- The Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 21, 81675, Munich, Germany
| | - Moritz Pettenkofer
- The Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 21, 81675, Munich, Germany
| | - Chris P Lohmann
- The Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 21, 81675, Munich, Germany
| | - Daniel Zapp
- The Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 21, 81675, Munich, Germany
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Böhm M, Shajari M, Remy M, Kohnen T. Corneal densitometry after accelerated corneal collagen cross-linking in progressive keratoconus. Int Ophthalmol 2018; 39:765-775. [PMID: 29582259 DOI: 10.1007/s10792-018-0876-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/21/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze changes in corneal densitometry 3 months after accelerated corneal collagen cross-linking (CXL) measured with Scheimpflug tomography. METHODS In this study we reviewed charts and anterior segment data of patients who had undergone accelerated pulsed epithelium-off CXL (30 mW/cm2 for 4 min, 8 min total radiation time) for treatment of progressive keratoconus in the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Visual, topographic, pachymetric and densitometric data were extracted before surgery and at the 3-month follow-up. Corneal densitometry measurements from different corneal layers and zones obtained using Scheimpflug tomography (Pentacam HR, Oculus). RESULTS The study investigated 12 eyes of 12 patients. The anterior (120 μm) stromal layer within the 0.0 to 2.0 mm and 2.0 to 6.0 mm concentric zones showed a significant elevation of mean densitometry 3 months post-surgery (P = 0.045; P = 0.015) compared to baseline. A mean stromal demarcation line was apparent at a depth of 203.00 μm ± 13.53 (SD). After accelerated CXL, no change in mean corrected distance visual acuity (LogMAR) was observed but a thinning of the cornea measured by a significant reduction in central pachymetry (μm). CONCLUSION Accelerated CXL results in an increase in corneal densitometry, particularly in the anterior stromal layer within the two central concentric zones (0.0 to 2.0 mm and 2.0 to 6.0 mm) of the cornea at 3 months postoperatively. The changes in corneal densitometry of the anterior stromal layer did not correlate with postoperative visual acuity or central pachymetry.
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Affiliation(s)
- Myriam Böhm
- Department of Ophthalmology, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Mehdi Shajari
- Department of Ophthalmology, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Matthias Remy
- Department of Ophthalmology, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Salomão M, Lopes B, Ambrósio R, Faria-Correia F, Silva-Lopes Í, Azevedo-Wagner A, Tanos FW. Paradigms, Paradoxes, and Controversies on Keratoconus and Corneal Ectatic Diseases. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10025-1158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Price MO, Fairchild K, Feng MT, Price FW. Prospective Randomized Trial of Corneal Cross-linking Riboflavin Dosing Frequencies for Treatment of Keratoconus and Corneal Ectasia. Ophthalmology 2017; 125:505-511. [PMID: 29203068 DOI: 10.1016/j.ophtha.2017.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate whether the riboflavin dosing frequency affects corneal cross-linking efficacy or safety, given that isotonic riboflavin solution is viscous and each installation coats the corneal surface with a film that absorbs some of the incident ultraviolet A light. DESIGN Prospective, randomized, single-center equivalence trial. PARTICIPANTS Patients with progressive keratoconus or ectasia after refractive surgery (n = 510). METHODS One eye per patient was prospectively randomized to 2-minute or 5-minute riboflavin dosing intervals with standard corneal cross-linking (epithelial removal and 30-minute irradiation with 3 mW/cm2 ultraviolet A light). Block randomization resulted in comparable representation of keratoconus and ectasia after refractive surgery in the 2 treatment arms. Treatment equivalence was assessed using the 2 one-sided test. Fellow eyes (n = 207) were treated with 5-minute dosing and considered in the safety analysis. MAIN OUTCOME MEASURES The primary hypothesis was equivalent change in the topography-derived maximum keratometry value from baseline to 6 months with 2-minute vs. 5-minute dosing. A ±0.75-diopter margin of equivalence for the treatment difference between dosing regimens was considered clinically relevant. Adverse events and changes from baseline to 6 months in corrected distance visual acuity (CDVA), uncorrected distance visual acuity, and minimum corneal thickness were assessed. RESULTS The mean reduction in maximum keratometry from baseline was equivalent with 2-minute and 5-minute riboflavin dosing intervals at 6 months (0.97 and 0.76 diopters, respectively; 90% confidence interval for treatment difference, -0.23 to 0.66; per-protocol population). With both dosing intervals, the mean improvement in CDVA was 0.07 logarithm of the minimum angle of resolution or 3.5 letters at 6 months. Of the 635 study and fellow eyes examined at 6 months, 134 (21%) gained and 32 (5%) lost 2 or more lines of CDVA. Three eyes (0.4%) developed sterile infiltrates, 1 (0.1%) had delayed epithelial healing with dendrites, and 3 (0.4%) had recurrent epithelial defects. Three eyes (0.4%) were re-treated. CONCLUSIONS The 2 riboflavin dosing regimens produced equivalent reduction in the maximum keratometry value, with a favorable safety profile.
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Affiliation(s)
| | - Kelly Fairchild
- Cornea Research Foundation of America, Indianapolis, Indiana
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Soeters N, Bennen E, Wisse RPL. Performing corneal crosslinking under local anaesthesia in patients with Down syndrome. Int Ophthalmol 2017; 38:917-922. [PMID: 28424993 PMCID: PMC5988782 DOI: 10.1007/s10792-017-0535-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/10/2017] [Indexed: 01/11/2023]
Abstract
Purpose To report on the ability to perform corneal crosslinking (CXL) under local anaesthesia for the treatment of keratoconus in patients with Down syndrome. Methods Nine eyes of seven patients with both keratoconus and Down syndrome were scheduled for an epithelium-off CXL procedure under local anaesthesia. Exclusion criteria were a corneal thickness under 400 µm and the presence of corneal scars. A standardized clinical decision tool was used to estimate patient cooperation and the likelihood for a successful procedure under local rather than general anaesthesia. Results In seven eyes, the CXL was completed successfully. The treatment was aborted in two eyes due to insufficient corneal thickness (<400 µm) prior to ultraviolet-A irradiation, even after employing hypoosmolar riboflavin. No adverse events occurred post-operatively, except for one case of delayed epithelial healing (23 days). Conclusions With a proper patient selection, CXL under local anaesthesia can be achieved in patients with Down syndrome.
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Affiliation(s)
- Nienke Soeters
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, HP E03.136, Heidelberglaan 100, 3508 GX, Utrecht, The Netherlands.
| | - Esmée Bennen
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, HP E03.136, Heidelberglaan 100, 3508 GX, Utrecht, The Netherlands
| | - Robert P L Wisse
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, HP E03.136, Heidelberglaan 100, 3508 GX, Utrecht, The Netherlands
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Jiang LZ, Qiu SY, Li ZW, Zhang X, Tao XC, Mu GY. Therapeutic and inducing effect of corneal crosslinking on infectious keratitis. Int J Ophthalmol 2016; 9:1820-1823. [PMID: 28003986 DOI: 10.18240/ijo.2016.12.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/09/2016] [Indexed: 11/23/2022] Open
Abstract
The corneal crosslinking (CXL) with riboflavin and ultraviolet-A (UVA) is a new therapy method to successfully treat infectious keratitis in clinical practice. However, there are rare reports on the complications of CXL such as the secondary keratitis. The diverse clinical outcomes on keratitis have highlighted the necessity to further evaluate the efficacy and complications of CXL. We reviewed the positive and negative reports on UVA/riboflavin related with keratitis and provided our opinion on the therapeutic and side effect of UVA/riboflavin crosslinking on keratitis.
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Affiliation(s)
- Liang-Zhu Jiang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China; Department of Ophthalmology, the People's Hospital of Linyi, Linyi 276000, Shandong Province, China
| | - Shi-Yan Qiu
- Department of Pediatrics, the People's Hospital of Linyi, Linyi 276000, Shandong Province, China
| | - Zhi-Wei Li
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
| | - Xiao Zhang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
| | - Xiang-Chen Tao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
| | - Guo-Ying Mu
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
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Seiler TG, Fischinger I, Koller T, Zapp D, Frueh BE, Seiler T. Customized Corneal Cross-linking: One-Year Results. Am J Ophthalmol 2016; 166:14-21. [PMID: 26944278 DOI: 10.1016/j.ajo.2016.02.029] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the efficacy of customized corneal cross-linking (CXL) with standard CXL. DESIGN Prospective, nonrandomized comparative clinical study. METHODS In a prospective study at the Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland, 40 eyes of 40 patients with documented progressive primary keratoconus were treated with customized CXL (n = 20) or standard CXL (n = 20) and followed for 1 year. Customized irradiation patterns had an energy fluence of 9 mW/cm(2) and total energy levels ranging from 5.4 J/cm(2) up to 10 J/cm(2) and were centered on the maximum of the posterior float. The control group received homogenous irradiation with a fluence of 9 mW/cm(2) and a total energy of 5.4 J/cm(2). Scheimpflug tomographies, endothelium cell count, best spectacle-corrected visual acuity (BSCVA), and anterior segment optical coherence tomography (OCT) were compared preoperatively and 1 year postoperatively. RESULTS Pachymetry and ΔKmax showed significant changes 1 year postoperatively within each group. Epithelial healing time, ΔKmax, and regularization index (RI) were significantly better in the customized CXL group. Two out of 19 eyes (11%) in the standard group but 7 out of 19 eyes (37%) in the customized CXL group showed a flattening of 2 or more diopters (P = .03). The RI was 5.2 ± 2.7 D in the customized group vs 4.1 ± 3.1 D in the control group (P = .03). Statistically significant correlations between RI and preoperative Kmax, preoperative pachymetry, and preoperative posterior float were found only in the customized group. CONCLUSIONS Customized CXL seems to be as safe as standard CXL with stronger flattening in Kmax and RI, and a faster epithelial healing period.
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Galvis V, Tello A, Carreño NI, Ortiz AI, Barrera R, Rodriguez CJ, Ochoa ME. Corneal Cross-Linking (with a Partial Deepithelization) in Keratoconus with Five Years of Follow-Up. OPHTHALMOLOGY AND EYE DISEASES 2016; 8:17-21. [PMID: 27199574 PMCID: PMC4869599 DOI: 10.4137/oed.s38364] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/13/2016] [Accepted: 03/15/2016] [Indexed: 02/04/2023]
Abstract
We performed a retrospective interventional case series including 80 eyes of 48 patients with keratoconus (KC) who were treated with modified corneal cross-linking (CXL) for KC (with a partial deepithelization in a pattern of stripes). The average follow-up was 5.8 years (with a minimum of 5 years). At the last follow-up visit, compared with preoperative values, there were no significant changes in spherical equivalent, average keratometry, corneal thickness, corneal hysteresis, or corneal resistance factor. The distance-corrected visual acuity was 20/39 preoperatively and 20/36 postoperatively (P = 0.3). The endothelial cell count decreased by 4.7% (P < 0.005). These findings suggest that this modified corneal CXL technique is a safe and effective alternative to halt the progression of KC up to five years after the procedure. However, some concerns remain as to whether this technique can affect in some degree the corneal endothelial cells.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia.; Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia.; Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
| | - Néstor I Carreño
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia.; Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
| | - Alvaro I Ortiz
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia.; Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
| | - Rodrigo Barrera
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
| | | | - Miguel E Ochoa
- Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
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Cagil N, Sarac O, Cakmak HB, Can G, Can E. Mechanical epithelial removal followed by corneal collagen crosslinking in progressive keratoconus: short-term complications. J Cataract Refract Surg 2016; 41:1730-7. [PMID: 26432132 DOI: 10.1016/j.jcrs.2014.12.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/04/2014] [Accepted: 12/28/2014] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the complications occurring within the first 3 months of corneal collagen crosslinking (CXL) performed with mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal in keratoconus patients. SETTING Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey. DESIGN Nonrandomized retrospective clinical study. METHODS Eyes of consecutive progressive keratoconus patients who had PTK or mechanical epithelial removal followed by CXL were included. All patients were examined regularly until epithelial healing. Detailed ophthalmologic examinations were performed preoperatively and 1 and 3 months postoperatively. RESULTS The study comprised 499 eyes (302 patients) that had transepithelial PTK (Group 1, 153 eyes) or mechanical epithelial removal (Group 2, 256 eyes) followed by CXL. Delayed epithelial healing occurred in 15.0% of eyes in Group 1 and 3.5% of eyes in Group 2 (P = .001). Epithelial hypertrophy occurred in 24.8% of eyes and 3.5% of eyes, respectively (P = .001). Salzmann-like epithelial nodules (2.6%), epithelial herpetic keratitis (1.9%), anterior uveitis (1.9%), and elevated intraocular pressure (1.9%) occurred in Group 1 only and infective keratitis (0.8%) in Group 2 only. Marked stromal edema and peripheral sterile infiltrates occurred at similar rates in both groups (P = .567 and P = .479, respectively). Grade 1+ corneal haze was significantly high in Group 2. Grade 2+ and 3+ haze was significantly high in Group 1 (P = .001). CONCLUSIONS Ocular surface healing disorders were the most common early complications of CXL. Short-term complications were higher with the transepithelial PTK epithelial removal technique than with mechanical epithelial removal. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Nurullah Cagil
- From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Ozge Sarac
- From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
| | - Hasan Basri Cakmak
- From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Gamze Can
- From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Erol Can
- From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
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Neue Behandlungsprotokolle der Hornhautvernetzung (Corneal Crosslinking). SPEKTRUM DER AUGENHEILKUNDE 2015. [DOI: 10.1007/s00717-015-0257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abbouda A, Abicca I, Alió JL. Infectious Keratitis Following Corneal Crosslinking: A Systematic Review of Reported Cases: Management, Visual Outcome, and Treatment Proposed. Semin Ophthalmol 2014; 31:485-91. [PMID: 25392046 DOI: 10.3109/08820538.2014.962176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To describe the infectious complications and the group of pathogens involved in the infection following corneal crosslinking, the visual outcome, and the treatment proposed. METHODS A Medline (National Library of Medicine, Bethesda, MD, USA) search from October 2000 to October 2013 was performed to identify all articles describing infectious keratitis following corneal crosslinking treatment. Nineteen articles were selected. Ten articles reported infectious complications of corneal crosslinking treatment were included. Nine articles were excluded, because seven described sterile keratitis, one article was in German, and one reported general complication without describing the infection complication. RESULTS A total number of infections reported included 10 eyes. The infectious keratitis was associated with bacteria in five eyes (50%): gram-positive bacteria in three eyes (30%) (staphylococcus epidermidis, S. aureus and streptococcus salivarius plus S. oralis, respectively) and gram-negative bacteria in two eyes (20%) (E. coli; P. aeruginosa); there was herpes virus in two eyes, fungus in two eyes (Fusarium and Microsporidia) (20%), and Acanthamoeba in one eye (10%). CONCLUSIONS Only 10 cases of infectious keratitis following corneal crosslinking are published. The most virulent pathogens were Pseudomonas aeruginosa and Acanthamoeba. Less virulent organisms were Escherichia coli and S. epidermidis. Two cases of herpes keratitis were described, suggesting the possibility of systemic antiviral prophylaxis before corneal crosslinking treatment. The most common risk factor of infections identified was postoperative incorrect patient behavior.
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Affiliation(s)
- A Abbouda
- a Vissum Corporación Oftalmológica , Alicante , Spain .,b Division of Ophthalmology , University of Rome Sapienza , Rome , Italy , and
| | - I Abicca
- b Division of Ophthalmology , University of Rome Sapienza , Rome , Italy , and
| | - J L Alió
- a Vissum Corporación Oftalmológica , Alicante , Spain .,c Division of Ophthalmology , Universidad Miguel Hernández , Alicante , Spain
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Scheschy U, Scheschy H. Langzeit-Verlaufsbeobachtung des Keratoconus bei Unilateralität. SPEKTRUM DER AUGENHEILKUNDE 2014. [DOI: 10.1007/s00717-014-0216-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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MacGregor C, Tsatsos M, Hossain P. Is accelerated corneal collagen cross-linking for keratoconus the way forward? No. Eye (Lond) 2014; 28:786-7. [PMID: 24788014 DOI: 10.1038/eye.2014.98] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- C MacGregor
- Southampton Eye Unit, Southampton University Hospitals NHS Trust, Southampton, UK
| | - M Tsatsos
- 1] Southampton Eye Unit, Southampton University Hospitals NHS Trust, Southampton, UK [2] Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - P Hossain
- Southampton Eye Unit, Southampton University Hospitals NHS Trust, Southampton, UK
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