1
|
Singh M, Sinha BP, Mishra D, Deokar K, Bhatia G, Upreti G. Role of corneal collagen cross-linking in bullous keratopathy: A systematic review. Indian J Ophthalmol 2023; 71:1706-1717. [PMID: 37203022 PMCID: PMC10391445 DOI: 10.4103/ijo.ijo_1942_22] [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: 05/20/2023] Open
Abstract
Corneal cross-linking (CXL), a corneal strengthening procedure, is known to alter anterior stroma swelling behavior and is one of the treatment modalities of bullous keratopathy (BK). There are multiple studies published on the role of CXL in the treatment of BK. These articles had heterogeneous study population, different protocols used, and variable conclusions. This systematic review aimed to determine the role of CXL in the treatment of BK. The primary outcomes considered were changes in central corneal thickness (CCT) after 1, 3, and 6 months of CXL. The secondary outcome measures were changes in visual acuity, corneal clarity, subjective symptoms, and complications after CXL. We included randomized control trials (RCTs), observational and interventional studies, and case series with reports of more than 10 cases in this review. In RCTs, the mean pre-CXL CCT (794.0 ± 178.5 μm) in the intervention group (n = 37), decreased at 1 month (750.9 ± 154.3 μm) followed by a subsequent increase, but this difference was not significant during the 6-month follow-up (P- value 0.28, 0.82, and 0.82 at 1, 3, and 6 months, respectively). In noncomparative clinical studies (n = 188), the mean pre-CXL CCT (794.0 ± 178.5 μm) decreased at 1 month (710.9 ± 127.2 μm, P < 0.0001). Seven of the 11 articles included in the review reported no significant improvement in vision with CXL. The initial improvement in corneal clarity and clinical symptoms was not sustained. Current evidence suggests that CXL has short-term efficacy in the treatment of BK. More RCTs with high-quality evidence are needed.
Collapse
Affiliation(s)
- Mamta Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | | | - Deepak Mishra
- Department of Ophthalmology, RIO, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Gayatri Bhatia
- Department of Psychiatry, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Garima Upreti
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| |
Collapse
|
2
|
Karam M, Alsaif A, Aldubaikhi A, Aljebreen M, Alazaz R, Alkhowaiter N, Almudhaiyan T, Aljassar F. Accelerated Corneal Collagen Cross-Linking Protocols for Progressive Keratoconus: Systematic Review and Meta-analysis. Cornea 2023; 42:252-260. [PMID: 36156043 DOI: 10.1097/ico.0000000000003124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/11/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of this study was to compare the outcomes of 18 mW/cm 2 (5 minutes) versus 9 mW/cm 2 (10 minutes) accelerated corneal collagen cross-linking protocols in patients with progressive keratoconus. METHODS A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and electronic information was searched to identify studies comparing the outcomes of 5- versus 10-minute protocols in patients with progressive keratoconus. Mean changes in uncorrected visual acuity, best-corrected visual acuity, cylinder (diopters), thinnest corneal thickness, corneal keratometry values (K1 and K2), corneal high-order aberration (HOA), spherical aberration, coma, and trefoil were the primary outcome measures. Secondary outcome measures included the mean change in central corneal thickness and postoperative complications. Random effects modeling was used for the analysis. RESULTS Four studies that enrolled 329 eyes were included. The 10-minute protocol had significantly improved outcomes compared with the 5-minute protocol for the mean changes in K1 and K2 ( P < 0.00001), corneal total HOA ( P = 0.0002), and corneal coma ( P = 0.00001). However, no statistically significant differences were found between the 2 protocols in uncorrected visual acuity, best-corrected visual acuity, cylinder, thinnest corneal thickness, spherical aberration, or trefoil. The 5-minute protocol was associated with a significantly lower mean change in the central corneal thickness for secondary outcomes. In addition, no significant differences were found between the 2 protocols for postoperative complications. CONCLUSIONS The 10-minute protocol had better K1, K2, and HOA outcomes than the 5-minute protocol, but no statistically significant differences in the other outcomes.
Collapse
Affiliation(s)
- Mohammad Karam
- Cornea Unit, AlBahar Ophthalmology Center, Ibn Sina Hospital, Ministry of Health, State of Kuwait
| | - Abdulmalik Alsaif
- Department of Surgery, Walsall Healthcare NHS Trust, West Midlands, UK
| | - Ahmed Aldubaikhi
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | | | - Rand Alazaz
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nahlaa Alkhowaiter
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tariq Almudhaiyan
- Division of Ophthalmology, Department of Surgery, National Guard Hospital, Riyadh, Saudi Arabia; and
- Department of Ophthalmology, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Aljassar
- Cornea Unit, AlBahar Ophthalmology Center, Ibn Sina Hospital, Ministry of Health, State of Kuwait
| |
Collapse
|
3
|
Debono C, Smadja D, Saunier V, Touboul D. Sequential intracorneal ring segment implantation followed by transepithelial phototherapeutic keratectomy and corneal cross-linking. J Fr Ophtalmol 2022; 45:1117-1125. [DOI: 10.1016/j.jfo.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/05/2022]
|
4
|
Screening of Keratoconus Using Autokeratometer and Keratometer Keratoconus Index. Diagnostics (Basel) 2021; 11:diagnostics11112120. [PMID: 34829466 PMCID: PMC8619968 DOI: 10.3390/diagnostics11112120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
The keratometer keratoconus index (KKI) is a diagnostic index for the risk of keratoconus calculated from autokeratometer test values. We partially modified the KKI equation and assessed it without limiting the target age and severity of keratoconus. This retrospective study included 179 eyes of 99 patients with keratoconus and 468 eyes from 235 normal controls. In the modified KKI, oblique astigmatism or against-the-rule astigmatism was defined as ≥1D astigmatism. KKI diagnostic power was analyzed in subgroups of <50 and ≥50-year-old patients, and at different keratoconus stages. Although the sensitivity of modified KKI was comparable with that of original KKI (92.7% vs. 95.5%), modified KKI specificity was significantly higher (79.7% vs. 68.6%) (p = 0.0001). Using the modified KKI, sensitivity reached 100% (4/4) and specificity, 63.5% (33/52), in ≥50-year-old patients, while overall sensitivity in keratoconus ≥stage 2 was 100% (30/30). In conclusion, the modified KKI proved to be effective in keratoconus screening at all stages. However, it should be noted that false-positive frequency is higher in ≥50-year-old patients.
Collapse
|
5
|
D'Oria F, Palazón A, Alio JL. Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis. EYE AND VISION (LONDON, ENGLAND) 2021; 8:34. [PMID: 34565473 PMCID: PMC8465763 DOI: 10.1186/s40662-021-00256-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 08/08/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking (CXL) techniques compared with standard epi-off CXL. METHODS We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) and we evaluated the selected papers according to the Cochrane risk of bias tool. We considered, as primary outcomes, average Kmax flattening, changes in uncorrected and corrected distance visual acuity (UDVA and CDVA); as secondary outcomes, we considered changes in pachymetry values and endothelial cell density (ECD). We also investigated adverse events related to the treatments and treatment failure. Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference (MD) with 95% confidence interval (CI) as the effect size. RESULTS A total of 15 studies were included and among these 15 trials, 9 were RCTs and 6 were NRSIs, but only 4 studies showed no high risk of bias and were included in this meta-analysis. Our analysis revealed significant postoperative differences in CDVA (MD = 0.07; 95% CI 0.04 to 0.10; P < 0.001), and no significative differences in UDVA, Kmax, central corneal thickness (CCT) and ECD (P > 0.05). Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing (P = 0.035) and persistent stromal haze (P = 0.026). CONCLUSION Epi-on CXL is as effective as epi-off CXL. Except for a higher significant improvement in CDVA with current epi-on protocols, our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual, topographic, pachymetric, and endothelial parameters. Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.
Collapse
Affiliation(s)
- Francesco D'Oria
- Vissum Innovation, c/ Cabañal, 1, 03016, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Antonio Palazón
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - Jorge L Alio
- Vissum Innovation, c/ Cabañal, 1, 03016, Alicante, Spain.
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
| |
Collapse
|
6
|
Takahashi A, Yamaguchi T, Tomida D, Nishisako S, Sasaki C, Shimazaki J. Trends in surgical procedures and indications for corneal transplantation over 27 years in a tertiary hospital in Japan. Jpn J Ophthalmol 2021; 65:608-615. [PMID: 34216283 DOI: 10.1007/s10384-021-00849-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To characterize trends in procedures, and indications for corneal transplantation over 27 years in a single referral center in Japan. STUDY DESIGN Retrospective study. METHODS Data from a consecutive series of corneal transplant surgery cases performed from 1991 to 2017at Ichikawa General Hospital were collected. The surgical procedures, indications, and causes of corneal endothelial dysfunction were evaluated. RESULTS Among 6,025 transplantations, a total of 3,991 cases underwent penetrating keratoplasty (PKP), 1009 underwent (deep) anterior lamellar keratoplasty, 746 underwent endothelial keratoplasty, and 309 underwent epithelial transplantation. Over that period the frequency of PKP decreased, whereas the frequency of lamellar keratoplasty increased. The four major surgical indications were bullous keratoplasty (BK 30.0%), regraft (24.2%), post-keratitis scars (17.1%), and keratoconus (11.4%). After dividing the study period into four time periods, we found that BK and regraft increased (from 20.3% to 34.5% and 18.2% to 31.1%, respectively), whereas post-keratitis scars and keratoconus decreased (from 26.0% to 9.5% and 14.1% to 7.2%, respectively) between the first and last period. Pseudophakic or aphakic BK were the major causes of corneal endothelial dysfunction until 2010. Cases of laser-iridotomy-induced BK peaked in 35 eyes (34.3% of BK) in 2000 and declined after 2013. Cases of Fuchs endothelial corneal dystrophy increased from 0 in 1991, to 15 eyes (18.5% of BK) in 2017. CONCLUSION Lamellar keratoplasty has replaced PKP in our hospital. BK and regraft have increased, whereas post-keratitis scars and keratoconus have decreased. Laser-iridotomy-induced BK has decreased during the past decade, whereas Fuchs endothelial corneal dystrophy has increased.
Collapse
Affiliation(s)
- Aya Takahashi
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Daisuke Tomida
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Sota Nishisako
- Cornea Center, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Chiaki Sasaki
- Cornea Center, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.,Cornea Center, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| |
Collapse
|
7
|
Özülken K, Aksoy Aydemir G, Aydemir E, Kızıltoprak H, Yüksel E. Comparison of Two Different Accelerated Corneal Cross-linking Procedure Outcomes in Patients with Keratoconus. Balkan Med J 2020; 37:131-137. [PMID: 31909581 PMCID: PMC7161613 DOI: 10.4274/balkanmedj.galenos.2020.2019.8.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Corneal cross-linking treatment is the unique treatment method that can cease the progression of keratoconus disease. Because of the long duration of conventional treatment, accelerated cross-linking treatment methods are being developed. Aims To compare two different accelerated corneal cross-linking protocols in terms of postoperative visual acuity and topographic findings (higher-order aberrations and keratometry values). Study Design Retrospective comparative study. Methods Sixty-five eyes of 43 patients (30 men and 13 women) who underwent two different accelerated corneal cross-linking protocols (10 min, 9 mW/cm2 and 5 min, 18 mW/cm2) for progressive keratoconus were retrospectively analyzed. Patients were divided into two groups according to the accelerated corneal cross-linking treatment protocol: group 1 (10 min, 9 mW/cm2, 32 eyes of 21 patients) and group 2 (5 min, 18 mW/cm2, 33 eyes of 22 patients). Uncorrected visual acuity and best-corrected visual acuity values and topographic findings (central corneal thickness and flat and steep keratometry values) were recorded preoperatively and 6 months after corneal cross-linking treatment. High-order aberration values measured with Pentacam preoperatively and 6 months after corneal cross-linking were also recorded. Results In both groups, a significant improvement was detected in the uncorrected visual acuity and best-corrected visual acuity levels preoperatively and 6 months postoperatively (group 1: p=0.001, p=0.001 and group 2: p=0.001, p=0.001, respectively). In addition, central corneal thickness values decreased significantly in both groups (p=0.006 and 0.001). Trefoil values showed no significant difference preoperatively and 6 months postoperatively in group 1 (p=0.160 and 0.620, respectively). In groups 1 and 2, coma values were found to decrease significantly in the 6th postoperative month compared with preoperative values (p=0.001 and 0.020, respectively). There was no significant difference between preoperative and 6th month postoperative horizontal and vertical trefoil values in both groups (p=0.850 and 0.140, respectively). There was no significant difference between the two groups in terms of preoperative and 6th month postoperative higher-order aberrations, refractive errors, keratometry values, and uncorrected visual acuity and best-corrected visual acuity levels. Conclusion Both accelerated corneal cross-linking procedures provide similar improvement in topographic findings, coma values and visual acuity.
Collapse
Affiliation(s)
- Kemal Özülken
- Department of Ophthalmology, TOBB ETU School of Medicine, Ankara, Turkey
| | - Gözde Aksoy Aydemir
- Clinic of Ophthalmology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Emre Aydemir
- Clinic of Ophthalmology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Hasan Kızıltoprak
- Clinic of Ophthalmology, Bingöl Maternity and Child Diseases Hospital, Bingöl, Turkey
| | - Erdem Yüksel
- Department of Ophthalmology, Kastamonu University School of Medicine, Kastamanonu, Turkey
| |
Collapse
|
8
|
Kasai K, Kato N, Den S, Konomi K, Shinzawa M, Shimazaki J. A prospective, randomized clinical study comparing accelerated corneal collagen crosslinking with 5% NaCl hypertonic saline for bullous keratopathy in Asian eyes. Medicine (Baltimore) 2019; 98:e18256. [PMID: 31860972 PMCID: PMC6940161 DOI: 10.1097/md.0000000000018256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We compared the clinical outcomes of accelerated corneal collagen crosslinking (CXL) and 5% NaCl hypertonic saline (HS) for the treatment of symptomatic bullous keratopathy (BK). METHODS A randomized controlled trial was held at Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan. Twenty-three eyes of 23 consecutive patients with symptomatic BK were enrolled. The etiology of BK included pseudophakic BK, previous keratoplasty, previous endotheliitis, previous glaucoma surgery, trauma, herpes infection, as well as unknown causes. Eleven eyes received epi-off accelerated CXL (with epithelial abrasion and 18 mW/cm ultraviolet A irradiation for 5 minutes) and 12 eyes received HS instillation. In addition to the usual ophthalmic examination, the best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were determined. The CCT was measured using anterior segment optical coherence tomography before and up to 6 months after treatments. Subjective symptoms of pain, blurred vision, photophobia, and irritation were also recorded. RESULTS The follow-up was completed for all patients in the CXL group. However, 6 patients in the HS group requested CXL treatments after 3 months. The BCVA was not significantly changed during the study periods in both groups. The CCT was significantly thinner in the CXL group compared to the HS group at 1 and 6 months (P = .015 and 0.144, respectively). Among the subjective symptoms recorded, irritation was significantly lower in the CXL group at 1 month (P = .013). CONCLUSIONS Accelerated CXL may produce transient improvement in pain and corneal edema in patients with BK.
Collapse
Affiliation(s)
- Kozue Kasai
- Departments of Ophthalmology, Jikei University School of Medicine, Tokyo,
- Departments of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Naoko Kato
- Departments of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Seika Den
- Departments of Ophthalmology, Jikei University School of Medicine, Tokyo,
- Departments of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Kenji Konomi
- Departments of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Megumi Shinzawa
- Departments of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Jun Shimazaki
- Departments of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| |
Collapse
|