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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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Bradford S, Luo S, Brown D, Juhasz T, Jester J. A review of the epithelial and stromal effects of corneal collagen crosslinking. Ocul Surf 2023; 30:150-159. [PMID: 37683969 PMCID: PMC10993773 DOI: 10.1016/j.jtos.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
Induced corneal collagen crosslinking and mechanical stiffening via ultraviolet-A photoactivation of riboflavin (UVA CXL) is now a common treatment for corneal ectasia and Keratoconus. Some effects of the procedure such as induced mechanical stiffening, corneal flattening, and cellular toxicity are well-known, but others remain more controversial. Authors report a variety of contradictory effects, and provide evidence based on individual results and observations. A full understanding of the effects of and mechanisms behind this procedure are essential to predicting its outcome. A growing interest in modifications to the standard UVA CXL protocol, such as transepithelial or accelerated UVA CXL, makes analyzing the literature as a whole more urgent. This review presents an analysis of both the agreed-upon and contradictory results reported and the various methods used to obtain them.
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Affiliation(s)
- Samantha Bradford
- Department of Ophthalmology and Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
| | - Shangbang Luo
- Department of Ophthalmology and Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Donald Brown
- Department of Ophthalmology and Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Tibor Juhasz
- Department of Ophthalmology and Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - James Jester
- Department of Ophthalmology and Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
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3
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Hafezi F, Torres-Netto EA, Kollros L, Lu NJ, Hafezi N, Mazzotta C, Aydemir ME, Hillen M. Rates of infectious keratitis and other ocular surface adverse events in corneal cross-linking for keratoconus and corneal ectasias performed in an office-based setting: a retrospective cohort study. EYE AND VISION (LONDON, ENGLAND) 2023; 10:36. [PMID: 37653457 PMCID: PMC10472555 DOI: 10.1186/s40662-023-00354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/16/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND This study aimed to compare the complication rates of epithelium-off corneal cross-linking (epi-off CXL) performed in an office-based setting with those of epi-off CXL performed in an operating room. METHODS A retrospective cohort study, comprising 501 consecutive epi-off CXL procedures, performed in a non-sterile procedure room without laminar flow ventilation at the ELZA Institute in Zurich, Switzerland, between November 2015 and October 2021, was conducted. RESULTS No cases of postoperative infectious keratitis were observed, while sterile infiltrates occurred in 10 out of 501 (2.00%) patients, all of whom responded well to topical steroid therapy. Delayed epithelialization (> 7 days) occurred in 14 out of 501 (2.79%) patients. No other adverse events were noted. CONCLUSIONS Office-based epi-off CXL does not appear to be associated with an increased risk of complications when compared to operating room settings.
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Affiliation(s)
- Farhad Hafezi
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland.
- ELZA Institute, Dietikon, Switzerland.
- USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Dept. of Ophthalmology, University of Wenzhou, Wenzhou, China.
| | | | | | - Nan-Ji Lu
- ELZA Institute, Dietikon, Switzerland
| | | | - Cosimo Mazzotta
- Departmental Ophthalmology Unit, Alta Val d'Elsa Hospital, AUSL Tuscany South-East, Siena, Italy
- Postgraduate Ophthalmology School, University of Siena, Siena, Italy
- Siena Crosslinking Center, Monteriggioni, Siena, Italy
| | - M Enes Aydemir
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
- ELZA Institute, Dietikon, Switzerland
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Farrokhpour H, Soleimani M, Cheraqpour K, Masoumi A, Tabatabaei SA, Shahriari M, Hobaby S, Baharnoori SM, Chaudhry A, Djalilian AR. A Case Series of Infectious Keratitis After Corneal Cross-linking. J Refract Surg 2023; 39:564-572. [PMID: 37578174 DOI: 10.3928/1081597x-20230717-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
PURPOSE To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL). METHODS This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study. RESULTS Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious keratitis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and Staphylococcus aureus were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventually required cases to undergo keratoplasty. CONCLUSIONS This study supports the need for proper patient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient education and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings. [J Refract Surg. 2023;39(8):564-572.].
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Peng F, Xie Q, Chen J, Fang Y, Xu W, Jiang D, Chen W. Effect of Corneal Collagen Cross-Linking on Subsequent Corneal Fungal Infection in Rats. Transl Vis Sci Technol 2023; 12:12. [PMID: 37163284 PMCID: PMC10179700 DOI: 10.1167/tvst.12.5.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Purpose The purpose of this study was to determine whether corneal collagen cross-linking (CXL) alters fungal susceptibility and increases the severity of keratitis through macrophage activation in rats. Methods Four weeks following CXL pretreatment, the corneal epithelium of adult rats was removed and inoculated with Candida albicans (C. albicans; CXL + inoculation group). The non-CXL-pretreated corneas were also inoculated with C. albicans (inoculation group). Clinical scoring and histopathological examination were performed to determine the severity of fungal keratitis. Immunofluorescence and confocal microscopy imaging were applied to determine the effects of CXL treatment on corneal local macrophage content. Real-time polymerase chain reaction (RT-PCR) and Western blots were used to evaluate mRNA and protein expression. Flow cytometry assays were performed to detect M1- and M2-type macrophages. Results CXL pretreatment (CXL + inoculation) resulted in higher infection success rate and more severe fungal keratitis than inoculation alone (inoculation group). On days 1, 3, and 7 following fungal infection, the increase in macrophage infiltration and IL-1β, MMP-9, and VEGFA expression was greater in the CXL + inoculation group than in the inoculation group. Number of M1- and M2-type macrophages, M1 to M2 ratio, M1-type macrophage genes, inducible nitric oxide synthase (iNOS), and tumor necrosis factor (TNFα) expression were higher in the CXL + inoculation group compared with the inoculation group. Conclusions Our data demonstrate that CXL may increase the colonization of macrophages and activate more M1-type macrophages to increase fungal susceptibility and severity of keratitis. Translational Relevance This study may aid long-term risk assessment and treatment of the complications of CXL.
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Affiliation(s)
- Fangli Peng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- The First Affiliated Hospital of Soochow University, Dongxiaoqiao Longyu Shizi Street Intersection, 100 Meters West, Suzhou, Jiangsu, P. R. China
| | - Qi Xie
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiaqi Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiting Fang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dan Jiang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Yang Q, Wang S, He Y, Zhang Y. The research progress on the molecular mechanism of corneal cross-linking in keratoconus treatment. Cont Lens Anterior Eye 2023; 46:101795. [PMID: 36549953 DOI: 10.1016/j.clae.2022.101795] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Keratoconus (KC) is a corneal anomaly that is manifested in a limited cone-like bulge with corneal thinning. Many molecules in the cornea change during the development of KC, including various components of the extracellular matrix, cytokines, cell connection, and cell adhesion-related proteins. Several treatment options are available, with corneal cross-linking (CXL) being the treatment of choice for early KC. However, postoperative complications have been reported in some CXL patients, mainly caused by corneal epithelial resection. Despite the fact that some novel approaches have helped to reduce some of the initial post-operative issues, their effectiveness seems to be inferior to that of the original CXL. To keep effectiveness while avoiding these negative effects, it is necessary to study the mechanism of CXL in KC treatment at the molecular level. This article provides a review of the molecular mechanism of CXL in the treatment of KC from four aspects: enzyme activity, signal transduction pathway, corneal-related proteins, and other KC-related molecules, further confirming the feasibility of CXL treatment of KC, providing new ideas for improving CXL.
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Affiliation(s)
- Qingyu Yang
- Department of Ophthalmology, 2nd Hospital of Jilin University, Changchun 130041, China.
| | - Shurong Wang
- Department of Ophthalmology, 2nd Hospital of Jilin University, Changchun 130041, China.
| | - Yuxi He
- Department of Ophthalmology, 2nd Hospital of Jilin University, Changchun 130041, China
| | - Yan Zhang
- Department of Ophthalmology, 2nd Hospital of Jilin University, Changchun 130041, China.
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Fungal Keratitis and Corneal Perforation as a Rare Complication of Corneal Collagen Cross-Linking Treatment. Cornea 2023:00003226-990000000-00254. [PMID: 36881003 DOI: 10.1097/ico.0000000000003270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE The aim of this study was to report a case of fungal keratitis with subsequent corneal perforation after corneal collagen cross-linking (CXL) treatment performed for keratoconus. CASE REPORT A 20-year-old woman presented with redness and discharge in the left eye. She had a history of bilateral CXL procedure performed for keratoconus elsewhere 4 days earlier. The visual acuity was hand motion in the left eye. Slit-lamp examination revealed extended corneal melting with surrounding infiltrates. The patient was hospitalized, and corneal epithelial scraping samples were sent for microbiological assessment. In the meantime, empirical antibiotic therapy (fortified topical antibiotics: vancomycin 50 mg/mL, ceftazidime 50 mg/mL, and fluconazole 2 mg/mL q1 hour) was initiated. In direct microscopy of the corneal scraping, septate hyaline fungal hyphae were detected and topical fluconazole was switched to topical voriconazole (10 mg/mL). Three days after hospitalization, corneal melting progressed to perforation and corneal suturing with 10-0 monofilament was performed to reform the anterior chamber. Complete resolution of keratitis with residual scarring was noticed in 2 weeks. Three months later, penetrating keratoplasty was performed to obtain better visual acuity. CONCLUSIONS CXL with riboflavin has become a common procedure to prevent keratoconus progression by strengthening the biomechanical specialties of the cornea. Although the treatment itself has been used in the management of microbial keratitis and related corneal melting, fungal keratitis and corneal perforation after a CXL procedure for keratoconus might also be detected. Clinicians should be aware of this rare but devastating complication of CXL treatment and start prompt treatment when suspected.
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Sun Z, Li Z, Chung JT, Lau LCM, Jhanji V, Chau Y. Low-intensity low-frequency ultrasound mediates riboflavin delivery during corneal crosslinking. Bioeng Transl Med 2023; 8:e10442. [PMID: 36925678 PMCID: PMC10013762 DOI: 10.1002/btm2.10442] [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: 04/28/2022] [Revised: 08/24/2022] [Accepted: 10/20/2022] [Indexed: 11/28/2022] Open
Abstract
We employed the mechanical effect from 40 kHz ultrasound (US) to improve the delivery of riboflavin into corneal stroma for collagen crosslinking, which can benefit the treatment of keratoconus and other corneal ectasias. Experiments were conducted, first with porcine corneas ex vivo and then with New Zealand white rabbits in vivo, at varying mechanical index (MI) and sonication time. Results showed that 15 min of US applied on the cornea at MI = 0.8 in the presence of 0.5% of riboflavin solution enabled its delivery to deeper corneal stroma. Excessive heat was removed by a cooling setup to negate the thermal effect. The corneal absorption amount and penetration of riboflavin through cornea as detected by fluorotron, as well as the enhancement of corneal stiffness as measured by Young's modulus, were comparable to the conventional approach that requires complete corneal epithelium debridement. Histological analysis revealed minor exfoliation of superficial cell layers of corneal epithelium and loss of ZO-1 tight junctions immediately after US. Full recovery of the corneal epithelium and restoration of tight junctions occurred in 3-4 days. The study shows that low-intensity low-frequency ultrasound (LILF US) is a less invasive alternative to the conventional epithelium-off method for delivering riboflavin into the corneal stroma.
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Affiliation(s)
- Zhe Sun
- Department of Chemical and Biological EngineeringThe Hong Kong University of Science and TechnologyHong Kong SARChina
| | - Zhiming Li
- Department of Chemical and Biological EngineeringThe Hong Kong University of Science and TechnologyHong Kong SARChina
| | - Jin Teng Chung
- Department of Chemical and Biological EngineeringThe Hong Kong University of Science and TechnologyHong Kong SARChina
| | - Laurence Chi Ming Lau
- Department of Chemical and Biological EngineeringThe Hong Kong University of Science and TechnologyHong Kong SARChina
| | - Vishal Jhanji
- Department of OphthalmologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Ying Chau
- Department of Chemical and Biological EngineeringThe Hong Kong University of Science and TechnologyHong Kong SARChina
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Ang MJ, Darbinian JA, Hoskins EN, Holsclaw DS, Sudesh S, Chandra NS. The Safety Profile of FDA-Approved Epithelium-Off Corneal Cross-Linking in a US Community-Based Healthcare System. Clin Ophthalmol 2022; 16:1117-1125. [PMID: 35431539 PMCID: PMC9012302 DOI: 10.2147/opth.s359224] [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: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the occurrence of early post-operative complications following FDA-approved epithelium-off corneal cross-linking in the United States. Materials and Methods This multicenter, retrospective cohort study identified patients who underwent epithelium-off (epi-off) corneal cross-linking (CXL) for keratoconus and post-refractive keratectasia within the Kaiser Permanente Northern California healthcare system between 2016 and 2018. Post-operative complications including delayed epithelial healing, infection, and loss of visual acuity were recorded. Results The study included 878 eyes of 654 patients. The mean age was 27±9.4 years (range 7–71). Five hundred ninety-nine patients (91.6%) had keratoconus while 55 had post-refractive corneal ectasia (8.4%). Forty-seven eyes had prolonged follow-up because of the occurrence of complications in the early post-operative period. The respective rates of delayed epithelial healing, and keratitis were 3.9% (95% CI 2.7–5.3%), and 1.5% (95% CI 0.8–2.5%). Four approaches for management of delayed epithelial healing were compared; epithelium healing duration was the longest in the repeat bandage contact lens (BCL) group (23.8 days) and the shortest in the antibiotic ointment group (14.3 days), with statistically significant differences (p < 0.05) in the healing time between these 2 groups. Conclusion The concern for early clinical complications after epi-off CXL often leads to delayed CXL intervention and further keratoconus progression with increased economic burdens. A large retrospective review of 878 eyes found that FDA-approved epi-off CXL protocol appears to be safe with low occurrence rates of early post-operative complications. The recommended management for delayed epithelial healing is using antibiotic ophthalmic ointment.
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Affiliation(s)
- Michael J Ang
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Jeanne A Darbinian
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Eliza N Hoskins
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Douglas S Holsclaw
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Sudha Sudesh
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Naveen S Chandra
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
- Correspondence: Naveen S Chandra, The Permanente Medical Group, 320 Lennon Lane, Walnut Creek, CA, 94598, 94598, Tel +1 925-906-2550, Fax +1 925-906-2332, Email
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de Paiva ADCM, Ferreira MDC, da Fonseca ADS. Photodynamic therapy for treatment of bacterial keratitis. Photodiagnosis Photodyn Ther 2022; 37:102717. [PMID: 35021106 DOI: 10.1016/j.pdpdt.2022.102717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 12/22/2022]
Abstract
Microbial keratitis is the main cause of corneal opacification and the fourth leading cause of blindness worldwide, with bacteria the major infectious agent. Recently, bacterial keratitis has become a serious threat due to routine use of antibiotics leading to selection of resistant and multidrug-resistant bacteria strains. New approaches for treatment of bacterial keratitis are necessary to outcome the increasing antibiotic resistance. Antimicrobial photodynamic therapy is based on three agents: photosensitizer, oxygen, and light radiation. This therapy has been successful for treatment of infections in different tissues and organs as well as against different type of infectious agents and no resistance development. Also, new photosensitizers are being developed that has increased the spectrum of therapeutic protocols for treatment of a number of infectious diseases. Thus, antimicrobial photodynamic therapy has an extraordinary potential for treatment of those bacterial keratitis cases that actually are not solved by traditional antibiotic therapy.
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Affiliation(s)
- Alexandre de Carvalho Mendes de Paiva
- Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros, 775, Maracanã, Rio de Janeiro 20270002, Brazil
| | - Michelle da Costa Ferreira
- Faculdade de Odontologia, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 157, Vila Isabel, Rio de Janeiro 20551030, Brazil
| | - Adenilson de Souza da Fonseca
- Departamento de Ciências Fisiológicas, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rua Frei Caneca, 94, Rio de Janeiro 20211040, Brazil; Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 87 fundos, 4º andar, Vila Isabel, Rio de Janeiro 20551030, Brazil; Centro de Ciências da Saúde, Centro Universitário Serra dos Órgãos, Avenida Alberto Torres, 111, Teresópolis, Rio de Janeiro 25964004, Brazil.
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11
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Lu Y, Yin Y, Hu T, Du K, Fu Y, Xiang A, Fu Q, Wu X, Li Y, Wen D. Polymicrobial keratitis after accelerated corneal collagen cross-linking in keratoconus: Case reports and literature review. Eur J Ophthalmol 2021; 32:1375-1385. [PMID: 34821524 DOI: 10.1177/11206721211051922] [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: 11/16/2022]
Abstract
PURPOSE To report two cases of polymicrobial keratitis following corneal collagen cross-linking for keratoconus and to review the literature. METHODS Retrospective case note and literature review. RESULTS The first case involved a 27-year-old male who presented with amebic corneal ulcers 3 days after the collagen cross-linking procedure. Some gram-negative (gram-ve) cocci were found upon staining, and cysts were observed by confocal microscopy at 7 days after surgery. Acanthamoeba infection mixed with gram-ve organisms was diagnosed. In the second case, a 14-year male developed Staphylococcus aureus corneal infection with anterior chamber empyema 3 days after the collagen cross-linking procedure for keratoconus. Occasional gram-positive (gram + ve) cocci and gram-ve bacilli were observed under a microscope. The mixed keratitis in the two patients resolved after systemic and topical antibiotic therapy, but the infection ultimately resulted in corneal scarring. Follow-up keratoplasty was needed to improve vision acuity in both patients. CONCLUSION Although ultraviolet irradiation and the reactive oxygen released by riboflavin during collagen cross-linking have bactericidal effects, a lack of a corneal epithelial barrier, bandage contact lens usage, perioperative hygiene, and an abnormal immune state are risk factors for infectious keratitis after collagen cross-linking. Perioperative management of collagen cross-linking is important to prevent infection.
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Affiliation(s)
- Ying Lu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yewei Yin
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Tu Hu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Kaixuan Du
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yanyan Fu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Aiqun Xiang
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Qiuman Fu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Xiaoying Wu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yuanjun Li
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Dan Wen
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
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12
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Singh RB, Das S, Chodosh J, Sharma N, Zegans ME, Kowalski RP, Jhanji V. Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis. Prog Retin Eye Res 2021; 88:101028. [PMID: 34813978 DOI: 10.1016/j.preteyeres.2021.101028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the "anti-biotic era". Although, we are expeditiously developing our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins. In this review article, we have provided an overview of the established classical diagnostic techniques and therapeutics for keratitis caused by various bacteria. We have extensively reported our recent in-roads through novel tools for accurate diagnosis of mono- and poly-bacterial corneal infections. Furthermore, we outlined the recent progress by our group and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discussed in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Leiden University Medical Center, 2333, ZA Leiden, the Netherlands
| | - Sujata Das
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneshwar, India
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Michael E Zegans
- Department of Ophthalmology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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13
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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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14
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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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15
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Ung L, Chodosh J. Foundational concepts in the biology of bacterial keratitis. Exp Eye Res 2021; 209:108647. [PMID: 34097906 PMCID: PMC8595513 DOI: 10.1016/j.exer.2021.108647] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/28/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
Bacterial infections of the cornea, or bacterial keratitis (BK), are notorious for causing rapidly fulminant disease and permanent vision loss, even among treated patients. In the last sixty years, dramatic upward trajectories in the frequency of BK have been observed internationally, driven in large part by the commercialization of hydrogel contact lenses in the late 1960s. Despite this worsening burden of disease, current evidence-based therapies for BK - including broad-spectrum topical antibiotics and, if indicated, topical corticosteroids - fail to salvage vision in a substantial proportion of affected patients. Amid growing concerns of rapidly diminishing antibiotic utility, there has been renewed interest in urgently needed novel treatments that may improve clinical outcomes on an individual and public health level. Bridging the translational gap in the care of BK requires the identification of new therapeutic targets and rational treatment design, but neither of these aims can be achieved without understanding the complex biological processes that determine how bacterial corneal infections arise, progress, and resolve. In this chapter, we synthesize the current wealth of human and animal experimental data that now inform our understanding of basic BK pathophysiology, in context with modern concepts in ocular immunology and microbiology. By identifying the key molecular determinants of clinical disease, we explore how novel treatments can be developed and translated into routine patient care.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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16
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Lang SJ, Maier P, Reinhard T. Crosslinking und Keratokonus. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1205-7737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungEin Keratokonus führt zu einer progressiven Vorwölbung und Verdünnung der
Hornhaut. Um dies aufzuhalten, kann ein Crosslinking durchgeführt werden. Dabei
ist eine Behandlung nach dem „Dresdener Protokoll“ eine effektive und sichere
Behandlungsmöglichkeit, aber auch zahlreiche neue Anwendungsprotokolle
(akzeleriertes Crosslinking, transepitheliales Crosslinking) und sogar weitere
Indikationen (refraktive Eingriffe, infektiöse Keratitis) wurden in den letzten
Jahren veröffentlicht.
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17
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Lang SJ, Maier P, Reinhard T. [Crosslinking and Keratoconus]. Klin Monbl Augenheilkd 2021; 238:733-747. [PMID: 33873207 DOI: 10.1055/a-1472-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Keratoconus leads to a progressive protrusion and thinning of the cornea. In order to stop this, corneal crosslinking can be performed if the progression of the disease is proven. Crosslinking according to the "Dresden protocol" includes abrasion of the corneal epithelium, application of riboflavin eye drops and irradiation with UV-A light of an intensity of 3 mW/cm² for 30 minutes. The efficacy has been shown in several prospective randomized studies. One of the more recent developments is accelerated crosslinking, which allows a shorter irradiation time. On the other hand, the possibility of transepithelial crosslinking was presented, which does not require an abrasion of the cornea. This should reduce the occurrence of postoperative pain. The range of indications has also been expanded. Corneal crosslinking is used for post-LASIK keratectasia as well. It is also being considered for use in infectious keratitis. Topographically controlled crosslinking can likewise be used to try to positively influence the refractive power of the cornea. The risks of crosslinking include the occurrence of pain, haze or scarring, endothelial cell damage and, rarely, the occurrence of keratitis.
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18
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Khoo P, Cabrera-Aguas M, Watson SL. Microbial Keratitis After Corneal Collagen Cross-Linking for Corneal Ectasia. Asia Pac J Ophthalmol (Phila) 2021; 10:355-359. [PMID: 33534235 DOI: 10.1097/apo.0000000000000379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to report the clinical profile and microbiological of patients with microbial keratitis post accelerated corneal collagen cross-linking (CXL). METHODS A retrospective case series of all patients diagnosed with microbial keratitis post-CXL who attended the Sydney Eye Hospital, Australia from January 1, 2012 to December 31, 2019 were included. Patients were identified from hospital coding and pathology data. Data were extracted from patients' medical records. RESULTS Eleven eyes from 10 patients with a mean age of 29 ± 11 years (range 16-48) were included. The median time of infection after CXL surgery was 4 days [interquartile range (IQR) 3-83]. Median initial and final Visual acuity at presentation were 1.3 logMAR (IQR 1-2.0) and 0.8 logMAR (IQR 0.6-1.2), respectively. The culture positivity rate was 92%, identifying 13 isolates, predominately made up of coagulase-negative Staphylococcus (n = 6, 50%) and Staphylococcus aureus (n = 3, 25%). The median epithelial healing time was 30 days (IQR 15-53). CONCLUSIONS Post-CXL microbial keratitis was predominately associated with gram-positive bacteria and in some cases delayed epithelialization. Microbial keratitis post-CXL may lead to moderate to poor patient outcomes.
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Affiliation(s)
- Pauline Khoo
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Maria Cabrera-Aguas
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
- Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
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AlQahtani BS, Alshahrani S, Khayyat WW, Abdalla-Elsayed MEA, Altalhi AA, Saifaldein AA, Taha MA. Outcomes of Corneal Topography among Progressive Keratoconus Patients 12 months following Corneal Collagen Cross-Linking. Clin Ophthalmol 2021; 15:49-55. [PMID: 33442228 PMCID: PMC7800689 DOI: 10.2147/opth.s284981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/04/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to assess the overall and specific topographic changes among patients who underwent corneal collagen cross-linking (CXL) due to progressive keratoconus. Methods This retrospective case series study was conducted at a single-arm hospital in King Abdulaziz Medical City, Riyadh. All progressive keratoconus patients who underwent CXL between January 2017 and December 2018 were included consecutively. The epi-off crosslinking technique (Dresden protocol) was applied in all patients. The topographic values were measured preoperatively and 12 months postoperatively. Patients with a history of a previous corneal procedure, corneal trauma, or any corneal scarring were excluded. Results Among our population (29 eyes of 24 patients), 58.6% of eyes were for male patients, and the mean age of the population was 27.76 ± 4.21 years. Based on the topography results, the mean values of corneal thickness at central 3 mm decreased from 473.45 ± 38 µm to 465.72 ± 41.78 µm following CXL (Z = −1.93, 95% confidence interval [CI] = 0.048–0.057, p= 0.053). Clinically significant astigmatism measurements were present in 28 (96.6%) eyes before CXL compared to 26 (89.7%) eyes after CXL. The mean values of astigmatism among the patients were 3.37 ± 2.25 diopters before and 3.67 ± 2.61 diopters after CXL (Z = −1696, 95% confidence interval [CI] = 0.085–0.096, p = 0.09). After CXL, the mean values of the front elevation at the apex changed from 33.90 ± 20.13 µm to 36.10 ± 21.09 µm (Z = −2.792, 95% [CI] = 0.003–0.006, p = 0.005). The mean values of the back elevation at the apex changed from 68.4 ± 35.66 µm to 69.90 ± 35.89 µm (Z = −0.934, 95% CI = 0.343–0.366, p = 0.35). Conclusion The topographic corneal parameters improved significantly in the patients with corneal ectasia after CXL. These results revealed the safety and efficacy of CXL in stabilizing keratoconus progression among Saudi patients at 1 year of follow-up.
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Affiliation(s)
- Bader S AlQahtani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Saeed Alshahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Waleed W Khayyat
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Abdullah A Altalhi
- Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amjad A Saifaldein
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Taha
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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20
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Complications of accelerated corneal collagen cross-linking: review of 2025 eyes. Int Ophthalmol 2020; 40:3269-3277. [PMID: 32715365 DOI: 10.1007/s10792-020-01512-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the early- and late-stage complications of accelerated cross-linking (A-CXL) in a large case series and investigate the relationship of A-CXL complications with ocular and systemic conditions accompanying keratoconus. METHODS Retrospectively, records of 2025 eyes of 1184 patients diagnosed with keratoconus between March 2013 and 2020 who underwent A-CXL (18 mW/cm2 for 5 min) treatment were reviewed. Comorbid ocular and systemic diseases other than keratoconus were recorded. In the postoperative follow-up, early and late complications and their association with accompanying diseases were examined. RESULTS The mean age of patients was 26.16 ± 6.05 (range 18-42), and the mean follow-up time was 3.40 ± 1.63 years (range 1-8 years). Vernal keratoconjunctivitis (3.7%) was the most common disease accompanying keratoconus. Less frequently, systemic allergic diseases (2.9%) and Down syndrome (2.3%) were observed. The most common complication in the early postoperative period was haze formation (9.1%), while failure of the treatment (4.2%) occurred in the late period. Other common complications were loss of two or more Snellen lines (2.4%) and delayed epithelial healing (1.8%). There was a significant relationship between vernal keratoconjunctivitis and delayed epithelial healing (p = 0.011). Statistically significant relationships were found between Down syndrome and haze formation (p < 0.001) and sterile infiltrate formation (p = 0.041). CONCLUSION Although A-CXL complication rates are low, vernal keratoconjunctivitis following A-CXL might increase the risk of delayed epithelial healing, and similarly corneal haze and sterile infiltrates might be observed more frequently in patients with Down syndrome.
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21
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Alternaria keratitis after corneal crosslinking. Am J Ophthalmol Case Rep 2020; 17:100616. [PMID: 32083224 PMCID: PMC7021532 DOI: 10.1016/j.ajoc.2020.100616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a case of fungal keratitis after corneal collagen crosslinking (CXL) surgery. Observations We report a case of fungal keratitis after CXL for post-refractive surgery ectasia. The patient presented 12 days after surgery with a corneal ulcer that was culture positive for Alternaria species of fungus. She subsequently developed a bacterial superinfection. The keratitis resolved with medical therapy, although the patient required a penetrating keratoplasty (PKP) due to central corneal scarring. Conclusions and Importance To our knowledge, this is the first case of fungal keratitis as a complication after CXL in the United States and the first case of Alternaria infection after CXL using the Dresden protocol. Infectious keratitis is a rare but serious complication of CXL, and we suggest continued innovation of operative techniques that may reduce the risk of infectious keratitis.
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22
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Moghadam RS, Akbari M, Alizadeh Y, Medghalchi A, Dalvandi R. The Outcome of Corneal Collagen Cross-Linking in Patients with Advanced Progressive Keratoconus: A 2-Year Follow-up Study. Middle East Afr J Ophthalmol 2019; 26:11-16. [PMID: 31114118 PMCID: PMC6507378 DOI: 10.4103/meajo.meajo_101_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE: The aim of this study was to evaluate the safety and efficacy of collagen cross-linking (CXL) in advanced progressive keratoconus with a maximum keratometry (Kmax) value of more than 58 diopters (D). METHODS: This prospective interventional case series involved patients with advanced progressive keratoconus with a Kmax of more than 58 D. The best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), Kmax, mean keratometry (Kmean) value, corneal astigmatism, and thinnest corneal thickness before surgery and 24 months after CXL were determined for 30 eyes of 27 patients. A Pentacam was used to measure the paraclinical parameters. RESULTS: The mean age of the patients was 24.47 ± 3.33 years. The mean logarithm of the minimum angle of resolution (logMAR) of the uncorrected visual acuity UCVA decreased from 0.73 ± 0.36 D at baseline to 0.48 ± 0.30 D (P = 0.01), while the mean thinnest point thickness of the cornea decreased from 438.65 ± 40.11 μm to 431.43 ± 61.92 μm (P = 0.005) after 24 months. The decreases in the mean logMAR of the BCVA, Kmax and Kmean values, and corneal astigmatism were not statistically significant (P > 0.05) at the 24-month follow-up. Progression was halted in 29 eyes (96.6%); only 1 eye (3.3%) showed an increase in the Kmax value of more than 2.0 D, which was indicative of treatment failure. In contrast, most other eyes showed a decrease in the Kmax value although it was not statistically significant. There were no major complications in any of the patients during the study period. CONCLUSION: Standard CXL treatment was safe and stabilized both the visual acuity and tomographic parameters at the 2-year follow-up in eyes with advanced progressive keratoconus.
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Affiliation(s)
| | - Mitra Akbari
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Yousef Alizadeh
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Reza Dalvandi
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Faramarzi A, Hassanpour K, Roshandel D, Fatourechi A. Recurrent Peripheral Stromal Keratitis Following Corneal Collagen Cross-linking: A Case Report. J Ophthalmic Vis Res 2019; 14:211-214. [PMID: 31114658 PMCID: PMC6504722 DOI: 10.4103/jovr.jovr_100_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Corneal collagen cross-linking (CXL) has become the standard initial intervention in eyes with progressive keratoconus (KC) that have not undergone keratoplasty. The prolonged exposure of the de-epithelialized cornea predisposes it to adverse complications, such as microbial keratitis and melting. Herein, we report a case of bilateral recurrent peripheral stromal keratitis following CXL. Case Report We present a 29-year-old woman who complained of ocular redness and discomfort in both eyes for 4 months, and had undergone bilateral CXL 10 months before. The best spectacle corrected visual acuity (BSCVA) was 60/200 in the right and 80/200 in the left eye. Both eyes showed moderate conjunctival hyperemia, dilation, and engorgement of the perilimbal episcleral vessels. There was a peripheral corneal stromal infiltration with thinning, and an overlying epithelial defect in the right eye with a lucid interval from the limbus. She was treated with lubricating eye drops and ointments and topical corticosteroids every 4 hours for 2 weeks then slowly tapered off. Afterwards, she experienced multiple recurrences in both eyes, which were successfully managed with topical corticosteroids and lubricants. After 2 years, her BSCVA was 20/30 with -3.00-5.50 * 90 in the right eye and 20/40 with -4.00-4.50 * 90 in the left. Conclusion Although CXL is a safe method, studies with longer follow-ups are needed to investigate the risk of rare complications.
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Affiliation(s)
- Amir Faramarzi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Danial Roshandel
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Fatourechi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Corneal crosslinking without epithelial removal. J Cataract Refract Surg 2018; 44:1363-1370. [PMID: 30228014 DOI: 10.1016/j.jcrs.2018.07.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 07/08/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate the effect of riboflavin-ultraviolet (UV)-A corneal crosslinking (CXL) without epithelial removal on ectatic corneal disease. SETTING Woolfson Eye Institute, Atlanta, Georgia, USA. DESIGN Prospective observational study. METHODS Patients were treated with a new riboflavin formulation without epithelial removal, then exposed to UV light (365 nm) at 4 mW/cm2 with on-off cycling for 30 minutes. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, maximum corneal curvature (maximum keratometry [Kmax]), total higher-order aberrations (HOAs), and coma were measured at 3, 6, 12, and 24 months postoperatively. Progression was defined as an increase of more than 1 diopter (D) in Kmax and loss of more than 1 line of CDVA. RESULTS Five hundred twelve eyes of 308 patients with keratoconus or forme fruste keratoconus and 80 eyes of 55 patients with ectasia after laser in situ keratomileusis (LASIK) were treated with the new riboflavin formulation without epithelial removal; 229 patients received bilateral treatments, 95 of which were simultaneous. The mean UDVA and CDVA improved by 1 to 1.5 Snellen lines at 1 and 2 years postoperatively (P < .0001). Mean Kmax decreased by 0.48 D at 2 years postoperatively (P = .0002). Mean total HOAs and coma decreased by 36% (P < .0001) and 37% (P = .0002), respectively, at 2 years postoperatively. Kmax decreased more than 1 D in three times as many eyes as it increased more than 1 D (P < .0001). No eyes progressed, and there was no loss of effect between 1 and 2 years postoperatively. No vision-threatening events were observed. Pain typically resolved within 24 hours, and visual acuity returned to preoperative levels in 1 to 2 days. CONCLUSION Epithelium-on CXL using this new protocol halted the progression of keratoconus and ectasia after LASIK. It was safer and provided more rapid visual recovery than CXL with epithelial removal, allowing routine bilateral, simultaneous treatment.
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25
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Evaluation of the Effectiveness of Cross-Linking Combined With Photorefractive Keratectomy for Treatment of Keratoconus. Cornea 2018; 37:1143-1150. [PMID: 29952798 PMCID: PMC6092093 DOI: 10.1097/ico.0000000000001663] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of combined epithelium-off cross-linking (CXL) with photorefractive keratectomy (CXL Plus) for correction of the myopic and astigmatic components of keratoconus. METHODS Seventy-nine eyes of 46 patients who underwent CXL Plus were enrolled in this retrospective, multicenter, noncomparative clinical study. Uncorrected distance visual acuity, corrected distance visual acuity, refraction, keratometry, and pachymetry measurements were recorded preoperatively and at 3, 6, 12, and 18 months during follow-up. RESULTS The mean (±SD) preoperative uncorrected distance visual acuity and corrected distance visual acuity were 1.00 ± 0.22 logarithm of the minimum angle of resolution (logMAR) and 0.62 ± 0.38 logMAR, respectively, and improved to 0.71 ± 0.36 logMAR and 0.32 ± 0.18 logMAR postoperatively. The mean k value, mean corneal thickness at the thinnest location, and mean myopic and astigmatic components decreased from 46.58 ± 0.97 D, 473 ± 29 μm, 3.65 ± 1.72 D, and 1.83 ± 0.69 D preoperatively to 43.79 ± 1.17 D, 431 ± 38 μm, 1.02 ± 0.78 D, and 1.15 ± 0.26 D, respectively, during follow-up. Eleven eyes had delayed epithelial healing, 2 had stromal opacities, 1 had primary herpes simplex keratitis, and 5 showed progression of keratoconus. CONCLUSIONS CXL Plus improved the refractive status of keratoconus during 18 months of follow-up, despite its potential early postoperative complications of delayed epithelial healing and corneal haze. CXL Plus reduced the myopic component more than the astigmatic component of keratoconus. However, the safety and stability of the procedure were offset by longer-term postoperative complications and a high rate of postoperative progression of keratoconus.
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Sharif R, Fowler B, Karamichos D. Collagen cross-linking impact on keratoconus extracellular matrix. PLoS One 2018; 13:e0200704. [PMID: 30020979 PMCID: PMC6051648 DOI: 10.1371/journal.pone.0200704] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/19/2018] [Indexed: 01/16/2023] Open
Abstract
Background Keratoconus (KC) is a common multifactorial ectatic corneal disease with unknown onset. KC most commonly appears in adolescence and affects approximately 1:400 people worldwide. Treatment options, for advanced KC cases, are collagen cross-linking (CXL) and corneal transplants. CXL is a new KC treatment that helps arrest the disease. Unfortunately, only a fraction of KC patients will qualify for CXL treatment. Our goal, in this study, was to begin to understand how CXL affects the corneal microenvironment and pave the way towards a more patient-driven CXL treatment. Methods Primary human corneal fibroblasts from healthy and KC donors were plated on transwell polycarbonate membranes and stimulated by a stable vitamin C. At 4 weeks, riboflavin was added followed by UVA irradiation. Transmission Electron Microscopy (TEM) and western blots were used to assess the effect of CXL on the extracellular matrix (ECM) and the resident cells, pre- and post CXL. Results Data shows CXL improved lamellar organization showing more organized collagen fibrils decorated with proteoglycans (PGs). The distribution of the collagen fibrils and interfibrillar spacing was also visibly improved, post-CXL. Lumican, mimecan, and decorin were the dominant PGs and were significantly upregulated in post-CXL cultures. ECM degradation proteins, matrix metalloproteinases (MMPs), MMP-1, -3, and -9, but not MMP-2, were significantly downregulated post-CXL. TIMP-1 and -2 were not modulated by CXL. Conclusion The unknown effects of CXL on the human corneal microenvironment have hampered our ability to make CXL available to all KC patients. Our current study provides a deeper understanding on CXL activity, using our unique 3D in vitro model.
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Affiliation(s)
- Rabab Sharif
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Ben Fowler
- Oklahoma Medical Research Foundation (OMRF), Imaging Core Facility, Oklahoma City, OK, United States of America
| | - Dimitrios Karamichos
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
- * E-mail:
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Mirzaei M, Bagheri M, Taheri A. Influence of standard corneal cross-linking in keratoconus patients on macular profile. J Curr Ophthalmol 2018; 30:330-336. [PMID: 30555966 PMCID: PMC6277222 DOI: 10.1016/j.joco.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To determine the effect of corneal cross-linking (CXL) on retinal structure and function. Methods The current study was conducted on 42 eyes of 21 patients with keratoconus (KCN) who were candidates for CXL due to disease progression. The Optovue optical coherence tomography (OCT) (Optovue Inc., Fremont, USA) from macula and multifocal electroretinography (mERG) were performed on all patients prior to surgery and at 1- and 6- month follow-up. Structural and functional parameters of macula including retinal thickness in OCT, and amplitude and latency of electroretinogram were compared between eyes that underwent surgery and control fellow eyes during the study period. Results A statistically significant increase in central foveal, foveal, parafoveal, and perifoveal thickness was observed at 1-month follow-up. The changes were non-significant at 6 months. Although a statistically significant reduction in amplitude and increase in latency in both rings 2 and 3 were observed at 1 month in mERG, only amplitude changes in ring 2 remained significant at 6 months. Conclusion Transient anatomical and functional alterations following CXL were observed in the current study.
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Affiliation(s)
- Mohammad Mirzaei
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Bagheri
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Taheri
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Aounzou S, Chraibi F, El Bahloul M, El Abdellaoui M, Benatiya Andaloussi I, Tahri H. [Infectious keratitis after crosslinking for keratoconus in a patient with systemic lupus]. J Fr Ophtalmol 2018; 41:e215-e218. [PMID: 29853413 DOI: 10.1016/j.jfo.2017.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | - H Tahri
- CHU Hassan II-fès, Fès, Maroc.
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Bregman J, Jeng BH. Microbial Keratitis Secondary to Therapeutic Contact Lens Wear. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0177-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maharana PK, Sahay P, Sujeeth M, Singhal D, Rathi A, Titiyal JS, Sharma N. Microbial Keratitis After Accelerated Corneal Collagen Cross-Linking in Keratoconus. Cornea 2018; 37:162-167. [PMID: 29111996 DOI: 10.1097/ico.0000000000001439] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the pattern of microbial keratitis after accelerated corneal collagen cross-linkage (aCXL) in patients with keratoconus. METHOD The medical records of cases of keratoconus that underwent aCXL from June 2014 to May 2017 were reviewed. Cases that developed microbial keratitis after aCXL were included in the study. The clinical, microbiological profile and the treatment outcomes were evaluated. RESULTS Of 532 eyes that underwent aCXL, 7 cases developed microbial keratitis during the study period. Median age at presentation was 11 years (range 8-17). Association with vernal keratoconjunctivitis was noted in 57.1% of cases (n = 4/7). The median time at the onset of infection was 3 days after aCXL (range 1-4). Microbiological reports revealed mixed infection in 3 cases [coagulase-negative Staphylococcus (CoNS) + Aspergillus fumigatus, Staphylococcus aureus and Mucor spp., Staph. aureus and Acanthamoeba], Staph. aureus in 2 cases, and CoNS and Alternaria spp. in 1 case each. Resistance to fourth-generation fluoroquinolones was noted in 83.3% of cases of bacterial keratitis (n = 5/6). All cases were initially managed with empirical antibiotic treatment that was later tailored based on microbiological reports. One case eventually required therapeutic penetrating keratoplasty for corneal perforation. At 6 months, the corrected distance visual acuity was >6/60 in 3 cases while 4 cases had corrected distance visual acuity <6/60. CONCLUSIONS Microbial keratitis after aCXL is rare; however, the infection tends to be severe with high preponderance of mixed infection and resistance to fourth-generation fluoroquinolones.
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Affiliation(s)
- Prafulla K Maharana
- Cornea, Cataract, and Refractice Services, the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kasparova EA, Sobkova OI, Yang B. [Corneal collagen cross-linking in the treatment of infectious keratitis and corneal ulcers]. Vestn Oftalmol 2018; 133:113-119. [PMID: 29319677 DOI: 10.17116/oftalma20171336113-118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent years, collagen cross-linking (CXL) of the cornea has acquired a new usage - in the treatment of infectious keratitis and corneal ulcers. This review was aimed at compiling the previously published data and assessing the effectiveness of the method.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - O I Sobkova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - Biao Yang
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
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Subasinghe SK, Ogbuehi KC, Dias GJ. Current perspectives on corneal collagen crosslinking (CXL). Graefes Arch Clin Exp Ophthalmol 2018; 256:1363-1384. [PMID: 29623463 DOI: 10.1007/s00417-018-3966-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 12/13/2022] Open
Abstract
Corneal collagen crosslinking has revolutionized the treatment of keratoconus and post-refractive corneal ectasia in the past decade. Corneal crosslinking with riboflavin and ultraviolet A is proposed to halt the progression of keratectasia. In the original "Conventional Dresden Protocol" (C-CXL), the epithelium is removed prior to the crosslinking process to facilitate better absorption of riboflavin into the corneal stroma. Studies analyzing its short- and long-term outcomes revealed that although there are inconsistencies as to the effectiveness of this technique, the advantages prevail over the disadvantages. Therefore, corneal crosslinking (CXL) is widely used in current practice to treat keratoconus. In an attempt to improve the visual and topographical outcomes of C-CXL and to minimize time-related discomfort and endothelial-related side effects, various modifications such as accelerated crosslinking and transepithelial crosslinking methods have been introduced. The comparison of outcomes of these modified techniques with C-CXL has also returned contradictory results. Hence, it is difficult to clearly identify an optimal procedure that can overcome issues associated with the CXL. This review provides an up-to-date analysis on clinical and laboratory findings of these popular crosslinking protocols used in the treatment of keratoconus. It is evident from this review that in general, these modified techniques have succeeded in minimizing the immediate complications of the C-CXL technique. However, there were contradictory viewpoints regarding their effectiveness when compared with the conventional technique. Therefore, these modified techniques need to be further investigated to arrive at an optimal treatment option for keratoconus.
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Affiliation(s)
- Sandeepani K Subasinghe
- Department of Anatomy, University of Otago, P.O. Box 913, 270 Great King Street, Dunedin, 9054, New Zealand.
| | - Kelechi C Ogbuehi
- Ophthalmology Section, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - George J Dias
- Department of Anatomy, University of Otago, P.O. Box 913, 270 Great King Street, Dunedin, 9054, New Zealand
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Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes. J Curr Ophthalmol 2017; 29:235-247. [PMID: 29270469 PMCID: PMC5735256 DOI: 10.1016/j.joco.2017.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose To review the historical background and basic principles of collagen cross-linking, to bring together the data regarding the outcomes and complications of collagen cross-linking and finally to explore the efficacy and safety of new variations of this technique. Methods A literature review was performed using PubMed and Scopus. The following keywords were used for literature search: cross linking, crosslinking, cross-linking, keratoconus, keratectasia. Results In contrast to traditional treatment modalities for keratoconus (KCN), this new technique addresses the progression of the disease. Several clinical studies have been conducted to assess the efficacy of corneal collagen cross-linking (CXL) in the last decade. The results were promising as collagen cross-linking showed significant improvement in visual acuity and keratometric values. Moreover, initial results show that it is a safe procedure with few reported complications. Conclusion CXL is an emerging treatment method in ophthalmology that offers the possibility to effectively treat progressive KCN.
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Oakey Z, Thai K, Garg S. Bilateral corneal perforation due to MRSA keratitis in a crosslinking patient. GMS OPHTHALMOLOGY CASES 2017; 7:Doc21. [PMID: 28875112 PMCID: PMC5574252 DOI: 10.3205/oc000072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: The cornea may become infected and perforated after epithelium-on collagen crosslinking. Case presentation: A healthy 33-year-old male who underwent corneal collagen crosslinking in both eyes developed a purulent keratitis and bilateral corneal perforations, requiring bilateral penetrating keratoplasties. He was exposed to methicillin resistant staphylococcus aureus (MRSA) by a family member with a tracheostomy and was treated with MRSA-directed antibiotics. After prolonged recovery and treatment of his infection, he had acceptable but limited uncorrected visual acuity, with excellent corrected visual acuity. Conclusion: While epithelium-on crosslinking is commonly thought to be associated with a lower risk of postoperative infection, this case illustrates that even epithelium-on treatment may present the patient with a risk of infection. Patients in higher risk groups who are exposed to infectious disease may be more predisposed.
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Affiliation(s)
- Zackery Oakey
- Gavin Herbert Eye Institute, University of California, Irvine, USA
| | - Kevin Thai
- Touro University California, Vallejo, USA
| | - Sumit Garg
- Gavin Herbert Eye Institute, University of California, Irvine, USA
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Koc M, Bostanci B, Demirel OO, Genc F, Tekin K, Koban Y, Dincel AS, Sen M, Yilmazbas P. The Effect of Ascorbic Acid (Vitamin C) on Transepithelial Corneal Cross-Linking in Rabbits. J Ocul Pharmacol Ther 2017; 33:525-529. [PMID: 28590790 DOI: 10.1089/jop.2017.0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mustafa Koc
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Basak Bostanci
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Ozlem Ozbas Demirel
- Department of Biochemistry, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Feyza Genc
- Department of Chemistry, Hacettepe University, Ankara, Turkey
| | - Kemal Tekin
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Yaran Koban
- Department of Ophthalmology, FEBO, Kafkas University, Kars, Turkey
| | | | - Murat Sen
- Department of Chemistry, Hacettepe University, Ankara, Turkey
| | - Pelin Yilmazbas
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Sterile corneal infiltrates after simultaneous photorefractive keratectomy and corneal crosslinking. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jcro.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Acharya Y, Acharya B, Karki P. Fungal keratitis: study of increasing trend and common determinants. Nepal J Epidemiol 2017; 7:685-693. [PMID: 29181230 PMCID: PMC5673246 DOI: 10.3126/nje.v7i2.17975] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 05/20/2017] [Accepted: 05/30/2017] [Indexed: 12/13/2022] Open
Abstract
Fungal keratitis is one of the leading cause of ocular morbidity. Fungal keratitis possesses a clinical challenge due to its slow pathologic process, overlapping features, diagnostic difficulty, and potential complications. Its increasing trend can be attributed to the use of contact lens, non-judiciary corticosteroid, and vegetative trauma. Early diagnosis and treatment is the cornerstone for its effective control. Knowledge of pathological course and clinical characteristics of fungal keratitis will definitely add in early diagnosis and treatment, with reduction in ocular morbidity. This review article explores the risk factor of fungal keratitis, its clinical course and management strategy.
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Affiliation(s)
- Yogesh Acharya
- Assistant professor, Avalon University School of Medicine, Willemstad Curacao, Netherland Antilles
| | - Bhawana Acharya
- Registered nurse, VHA home health care, Toronto Ontario, Canada
| | - Priyanka Karki
- Medical officer, Nobel Medical College and Hospital, Biratnagar Morang, Nepal
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Tsekoura EK, Helling AL, Wall JG, Bayon Y, Zeugolis DI. Battling bacterial infection with hexamethylene diisocyanate cross-linked and Cefaclor-loaded collagen scaffolds. Biomed Mater 2017. [DOI: 10.1088/1748-605x/aa6de0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Heikal MA, Soliman TT, Fayed A, Hamed AM. Efficacy of transepithelial corneal collagen crosslinking for keratoconus: 12-month follow-up. Clin Ophthalmol 2017; 11:767-771. [PMID: 28461739 PMCID: PMC5408943 DOI: 10.2147/opth.s129037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the efficacy of transepithelial corneal collagen crosslinking (TE-CXL) in patients with progressive keratoconus. Patients and methods This is a prospective interventional consecutive study carried out on 30 eyes of 18 patients with progressive keratoconus who underwent TE-CLX using both ParaCel™ (riboflavin 0.25%, hydroxy propyl methyl cellulose, NaCl, ethylenediaminetetraacetic acid [EDTA], Tris, and benzalkonium chloride) and vibeX-Xtra (riboflavin 0.22%, phosphate-buffered saline solution). The procedure was carried out at Ebsar Eye Center in Egypt in the period from 2012 to 2014. The follow-up visits were scheduled on days 1, 3, 6, and 12 months after treatment. Results There were statistically significant improvements (P<0.001) in the mean best-corrected visual acuity (0.54±0.22 preoperatively vs 0.61±0.19 at 12 months postoperatively), the mean manifest refraction spherical equivalent (MRSE; −6.16±3.90 diopters [D] preoperatively and −5.91±3.72 D at 12 months postoperatively), and the mean preoperative corneal astigmatism (−3.39±2.11 D preoperatively and −2.46±2.60 D at 12 months postoperatively). Conclusion TE-CXL could halt the progression of keratoconus in adult patients. TE-CXL resulted in a statistically significant improvement in best-corrected visual acuity, manifest refraction, refractive and corneal astigmatism and K values in keratoconus patients at the 12-month follow-up. Larger sample sizes and longer follow-ups are required in order to make meaningful conclusions.
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Affiliation(s)
| | | | - Ayser Fayed
- Department of Ophthalmology, Benha University, Benha, Egypt
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Wu MF, Deichelbohrer M, Tschernig T, Laschke MW, Szentmáry N, Hüttenberger D, Foth HJ, Seitz B, Bischoff M. Chlorin e6 mediated photodynamic inactivation for multidrug resistant Pseudomonas aeruginosa keratitis in mice in vivo. Sci Rep 2017; 7:44537. [PMID: 28295043 PMCID: PMC5353637 DOI: 10.1038/srep44537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
Following corneal epithelium scratches, mouse corneas were infected with the multidrug resistant (MDR) P. aeruginosa strain PA54. 24 hours later, 0% (for control group), 0.01%, 0.05% or 0.1% Chlorin e6 (Ce6), a second generation photosensitizer derived from chlorophyll, was combined with red light, for photodynamic inactivation (PDI). 1 hour or 2 days later, entire mouse eyes were enucleated and homogenized for counting colony forming units (CFU) of P. aeruginosa. For comparison, 0.1% Ce6 mediated PDI was started at 12 hours post infection, and 0.005% methylene blue mediated PDI 24 hours post infection. Clinical scores of corneal manifestation were recorded daily. Compared to the control, CFU 1 hour after PDI started 24 hours post infection in the 0.01% Ce6 and 0.05% Ce6 groups were significantly lower (more than one log10 reduction), the CFU 2 days post PDI higher in the 0.1% Ce6 group, clinical score lower in the 0.1% Ce6 group at 1 day post PDI. These findings suggest that PDI with Ce6 and red light has a transient efficacy in killing MDR-PA in vivo, and repetitive PDI treatments are required to fully resolve the infection. Before its clinical application, the paradoxical bacterial regrowth post PDI has to be further studied.
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Affiliation(s)
- Ming-Feng Wu
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.,Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mona Deichelbohrer
- Institute for Anatomy and Cell Biology, Saarland University, Homburg/Saar, Germany
| | - Thomas Tschernig
- Institute for Anatomy and Cell Biology, Saarland University, Homburg/Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical &Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Hans-Jochen Foth
- Department of Physics, University of Kaiserslautern, Kaiserslautern, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Markus Bischoff
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
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Çerman E, Özcan DÖ, Toker E. Sterile corneal infiltrates after corneal collagen cross-linking: evaluation of risk factors. Acta Ophthalmol 2017; 95:199-204. [PMID: 27775234 DOI: 10.1111/aos.13218] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/10/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate possible risk factors leading to sterile corneal infiltrates following corneal collagen cross-linking (CXL). METHODS A total of 588 eyes of 459 patients treated with Epi-off (n = 461) or Epi-on (n = 127) CXL were retrospectively evaluated. Risk factors, including preoperative blepharitis and vernal conjunctivitis, the postoperative use of topical non-steroidal anti-inflammatory drugs (NSAIDs), as well as Kmax and pachymetry measurements, were assessed. In vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) analyses were performed in patients with sterile infiltrates. RESULTS Sterile infiltrates developed in 19 cases (3.2%). No patients in the Epi-on group developed sterile infiltrates. The evaluation of acceleration of the CXL procedure as a risk factor revealed no specific difference in the incidence of infiltrates among four different Epi-off groups (3 mW/cm2 -30 min, 9 mW/cm2 -10 min, 18 mW/cm2 -5 min, 30 mW/cm2 -4 min procedures; p > 0.05, all). Blepharitis, vernal conjunctivitis, Kmax and pachymetry were not identified as risk factors (p > 0.05). Postoperative use of NSAIDs was a significant contributor (p = 0.007), and it increased the chance of sterile infiltrates 4.09 times (95% CI, 1.463-11.428). In vivo confocal microscopy (IVCM) showed non-specific inflammation with dendritic cells at the epithelium and at Bowman's layer. In AS-OCT, a hyper-reflective band at the level of the anterior stroma to a depth of 100-140 μm was observed. CONCLUSION The evaluation of the risk factors such as blepharitis, the use of NSAIDs, vernal conjunctivitis, the duration of CXL procedure and amount of light intensity showed that epithelial damage is possibly the common pathway in the pathogenesis, as no sterile infiltrates in Epi-on CXL occurred, and the postoperative use of NSAIDs increased the risk of developing sterile infiltrates about four times.
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Affiliation(s)
- Eren Çerman
- Department of Ophthalmology; Marmara University School of Medicine; Istanbul Turkey
| | | | - Ebru Toker
- Department of Ophthalmology; Marmara University School of Medicine; Istanbul Turkey
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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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Corneal collagen crosslinking for corneal ectasias: a review. Eur J Ophthalmol 2016; 27:253-269. [PMID: 28009397 DOI: 10.5301/ejo.5000916] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To review the published literature on corneal collagen crosslinking (CXL). METHODS Importance has been placed on seminal publications, systemic reviews, meta-analyses, and randomized controlled clinical trials. Where such evidence was not available, cohort studies, case-controlled studies, and case series with follow-up greater than 12 months were examined. RESULTS Corneal collagen crosslinking with riboflavin and ultraviolet A (UVA) 370 nm radiation appears to be capable of arresting the progression of ectatic corneal disorders, with most studies reporting significant improvements in visual, keratometric, and topographic measurements. Its mode of action at the molecular level is undetermined. Follow-up is limited to 5-10 years but suggests sustained stability and enhancement in corneal shape with time. Nearly all published long-term data and comparative studies are with epithelium-off techniques. Epithelium-on investigations suggest some efficacy but less than with epithelium-off treatments and long-term data are unavailable. Accelerated techniques with higher UVA fluencies and shorter treatments times, delivering the same UVA energy dosage, are the subject of recent investigation, with some laboratory and clinical studies suggesting reduced efficacy compared to the standard 3 mW/cm2 for 30 minutes irradiation procedure. Combined methodologies of CXL with techniques such as photorefractive keratectomy and intrastromal rings show promise but long-term follow-up is indicated. Sight-threatening complications of CXL are rare. CONCLUSIONS Studies of epithelium-off CXL with irradiation at 3 mW/cm2 for 30 minutes support its efficacy. Refinement in techniques may allow for safer and more rapid procedures with less patient discomfort but require further investigation.
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One-year Outcomes of Pachymetry and Epithelium Thicknesses after Accelerated (45 mW/cm(2)) Transepithelial Corneal Collagen Cross-linking for Keratoconus Patients. Sci Rep 2016; 6:32692. [PMID: 27597655 PMCID: PMC5011692 DOI: 10.1038/srep32692] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/10/2016] [Indexed: 11/09/2022] Open
Abstract
The thickness of corneal pachymetry and the epithelium after accelerated (45 mW/cm(2)) transepithelial corneal collagen cross-linking (CXL) for keratoconus were assessed in this prospective case series study. Twenty-eight patients were treated for keratoconus. The mean Kmax was 56.18 ± 7.90. The thinnest point, as assessed by optical coherence tomography (OCT), was 443.18 ± 39.75 μm. Accelerated transepithelial CXL was performed, and corrected distance visual acuity (CDVA), corneal topography, and OCT were recorded at 1 week postoperatively as well as at 1, 3, 6, and 12 months. The surgery was uneventful in all eyes. Postoperative epithelial edema was observed and faded in 3 days. The postoperative Kmax was 54.56 ± 8.81, 55.78 ± 8.11, 56.37 ± 8.71, 55.80 ± 7.92, and 55.47 ± 8.24 at 1 week, 1 month, 3 months, 6 months, and 12 months, respectively (all, P > 0.05). The thinnest postoperative corneal point, 439.04 ± 44.99 μm, was observed at 12 months (P = 0.109). The epithelial thickness decreased during the first postoperative week then showed a gradual recovery. Postoperative pachymetry thickness showed no significant changes for up to 12 months. Postoperative epithelial thickness decreased temporarily, then stabilized at month 12. Accelerated transepithelial CXL was shown to be effective and safe for the treatment of keratoconus.
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Potential Effects of Corneal Cross-Linking upon the Limbus. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5062064. [PMID: 27689081 PMCID: PMC5027324 DOI: 10.1155/2016/5062064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/10/2016] [Indexed: 12/13/2022]
Abstract
Corneal cross-linking is nowadays the most used strategy for the treatment of keratoconus and recently it has been exploited for an increasing number of different corneal pathologies, from other ectatic disorders to keratitis. The safety of this technique has been widely assessed, but clinical complications still occur. The potential effects of cross-linking treatment upon the limbus are incompletely understood; it is important therefore to investigate the effect of UV exposure upon the limbal niche, particularly as UV is known to be mutagenic to cellular DNA and the limbus is where ocular surface tumors can develop. The risk of early induction of ocular surface cancer is undoubtedly rare and has to date not been published other than in one case after cross-linking. Nevertheless it is important to further assess, understand, and reduce where possible any potential risk. The aim of this review is to summarize all the reported cases of a pathological consequence for the limbal cells, possibly induced by cross-linking UV exposure, the studies done in vitro or ex vivo, the theoretical bases for the risks due to UV exposure, and which aspects of the clinical treatment may produce higher risk, along with what possible mechanisms could be utilized to protect the limbus and the delicate stem cells present within it.
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Polat N, Gunduz A, Gunduz A, Cumurcu T, Gunduz G. The Influence of Corneal Collagen Crosslinking on Conjunctival Flora. Curr Eye Res 2016; 42:364-367. [DOI: 10.1080/02713683.2016.1196710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nihat Polat
- Department of Ophthalmology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Abuzer Gunduz
- Department of Ophthalmology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Ayten Gunduz
- Department of Microbiology, Malatya State Hospital, Malatya, Turkey
| | - Tongabay Cumurcu
- Department of Ophthalmology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Göksel Gunduz
- Department of Ophthalmology, Medical Faculty, Inonu University, Malatya, Turkey
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Gatzioufas Z, Raiskup F, O'Brart D, Spoerl E, Panos GD, Hafezi F. Transepithelial Corneal Cross-linking Using an Enhanced Riboflavin Solution. J Refract Surg 2016; 32:372-7. [DOI: 10.3928/1081597x-20160428-02] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
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49
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Sadoughi MM, Feizi S, Delfazayebaher S, Baradaran-Rafii A, Einollahi B, Shahabi C. Corneal Changes After Collagen Crosslinking for Keratoconus Using Dual Scheimpflug Imaging. J Ophthalmic Vis Res 2016; 10:358-63. [PMID: 27051478 PMCID: PMC4795383 DOI: 10.4103/2008-322x.176894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate corneal changes after collagen crosslinking (CXL) therapy for keratoconus (KCN) using the Galilei dual Scheimpflug analyzer. Methods: This prospective, nonrandomized clinical study included 35 eyes of 32 keratoconus patients who had undergone CXL. The eyes were saturated with riboflavin solution and were subjected for 30 minutes to ultraviolet-A (UV-A) light with irradiance of 3 mW/cm2. Effectiveness of the treatment was assessed by measuring uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest cylinder/sphere, keratometry, pachymetry, posterior and anterior elevations by the Galilei dual Scheimpflug analyzer. Prior to treatment and 8 months after therapy, Scheimpflug analysis was performed using the Galilei system. The four sets of data including keratometry values, pachymetry, elevation parameters and surface indices were statistically analyzed and compared. Results: Mean patient age was 22.3 ± 3.8 years and mean postoperative follow-up was 8.1 ± 3.2 months. There was a significant increase in UCVA (0.54 ± 0.35 Log MAR preoperatively to 0.49 ± 0.34 LogMAR postoperatively, P = 0.01) and BCVA (0.21 ± 0.19 Log MAR preoperatively to 0.16 ± 0.17 LogMAR postoperatively, P = 0.01). Mean cycloplegic spherical equivalent refractive error was −4.13 ± 2.65 Diopter (D) preoperatively and − 4.67 ± 2.96 D postoperatively (P < 0.001). During the follow-up period, no significant difference was observed in pachymetric and elevation data postoperatively. Conclusion: Corneal stabilization could be achieved by collagen crosslinking therapy for keratoconus in terms of corneal thickness, keratometry values, elevation parameters and surface indices.
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Affiliation(s)
| | - Sepehr Feizi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Delfazayebaher
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Baradaran-Rafii
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Einollahi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Camelia Shahabi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Keratoconus und dessen Behandlung mit Hornhautvernetzung und Kontaktlinsen: ein Überblick. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-015-0290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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