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Greenstein SA, Hersh PS. Update on corneal crosslinking for keratoconus and corneal ectasia. Curr Opin Ophthalmol 2024; 35:273-277. [PMID: 38700496 DOI: 10.1097/icu.0000000000001056] [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: 05/05/2024]
Abstract
PURPOSE OF REVIEW To review corneal crosslinking for keratoconus and corneal ectasia, and recent developments in the field. This study will review the mechanism of crosslinking, clinical approaches, current results, and potential future innovations. RECENT FINDINGS Corneal crosslinking for keratoconus was first approved by U.S. FDA in 2016. Recent studies have confirmed the general long-term efficacy of the procedure in decreasing progression of keratoconus and corneal ectasia. New types of crosslinking protocols, such as transepithelial treatments, are under investigation. In addition, adjunctive procedures have been developed to improve corneal contour and visual function in these patients. SUMMARY Crosslinking has been found to be well tolerated and effective with the goal of decreasing progression of ectatic corneal diseases, keratoconus and corneal ectasia after refractive surgery. Studies have shown its long-term efficacy. New techniques of crosslinking and adjunctive procedures may further improve treatments and results.
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Affiliation(s)
- Steven A Greenstein
- Cornea and Laser Eye Institute, CLEI Center for Keratoconus, Teaneck, and the Department of Ophthalmology, Rutgers - New Jersey Medical School, Newark, New Jersey, USA
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Chauhan P, Kamalakannan P, Upadhyay AD, Sinha R, Titiyal JS, Sharma N. Comparative Evaluation of Topographic Parameters Using Three Different Topographers in Keratoconic and Cross-linked Keratoconic Corneas. J Refract Surg 2024; 40:e260-e269. [PMID: 38593263 DOI: 10.3928/1081597x-20240311-07] [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: 04/11/2024]
Abstract
PURPOSE To compare the parameters of three different topographic devices (Pentacam HR, Oculus Optikgeräte GmbH; Sirius, Costruzione Strumenti Oftalmici; and Cassini, i-Optics) in grading the severity of keratoconus in cross-linked and non-cross-linked eyes. METHODS This was a prospective comparative interventional study done in a tertiary eye care center, wherein 114 eyes of 68 patients with keratoconus were divided into two groups: 62 eyes that were observed and 52 eyes that were cross-linked. All eyes were evaluated on all three topographers at baseline, 3-month follow-up, and 6-month follow-up. RESULTS The Sirius showed significantly lower values of mean flat keratometry in comparison to the Pentacam HR (limits of agreement [LoA]: 1.75 to 3.51%) and Cassini (LoA: 1.75 to 3.51%). The mean steep keratometry values were higher for the Cassini in comparison to the Pentacam HR (LoA: 4.39 to 7.02%) and Sirius (LoA: 3.51 to 6.14%). The mean steep keratometry values of the Sirius were significantly lower than those of the Pentacam HR and in both the cross-linked and observation groups (LoA: 3.51 to 6.14%). The mean keratometry values were significantly higher in the Cassini compared to the Pentacam HR (LoA: 3.51 to 8.77%) and significantly lower in the Sirius in comparison to the Pentacam HR (LoA: 3.51 to 6.14%). The mean difference in astigmatism was also statistically significant between the three tomographers in both groups, with the Cassini showing higher values (LoA: 3.51 to 5.26%) and the Sirius lower values than the Pentacam HR (LoA: 5.26 to 6.14%). CONCLUSIONS The authors conclude the three devices cannot be used interchangeably. The Cassini showed better agreement and correlation with the Pentacam HR in the staging of keratoconus, whereas the Sirius tended to underdiagnose and under-stage the disease. [J Refract Surg. 2024;40(4):e260-e269.].
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Hagem AM, Thorsrud A, Sæthre M, Sandvik G, Kristianslund O, Drolsum L. Dramatic Reduction in Corneal Transplants for Keratoconus 15 Years After the Introduction of Corneal Collagen Crosslinking. Cornea 2024; 43:437-442. [PMID: 37851565 DOI: 10.1097/ico.0000000000003401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/28/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The aim of this study was to investigate the effect of the implementation of corneal collagen crosslinking (CXL) on the frequency of corneal transplants among patients with keratoconus (KC) in the same region. METHODS Before the introduction of CXL in 2007, 55 primary corneal transplants had been conducted in patients with KC (2005 and 2006) at the Department of Ophthalmology, Oslo University Hospital, Norway. We collected data from our corneal transplant registry for 2021 and 2022. The primary outcome was the number of corneal transplants performed in patients with KC. Age, sex, visual acuity (logarithm of the minimal angle of resolution), KC stage according to the Amsler-Krumeich classification system, and steepest keratometry reading (maximum keratometry, Pentacam, HR) were recorded. Furthermore, we registered the annual number of CXL treatments conducted from 2007 to 2022. RESULTS A total of 352 corneal transplants were performed in 2021 and 2022. Among them, 11 (3.1%) were transplants for patients with KC. All included patients were male; further, 90.1% and 9.1% of the patients were graded stages 4 and 3, respectively. The mean maximum keratometry was 79.0 diopter (range 61.0-109). The mean best-corrected visual acuity (logarithm of the minimal angle of resolution) was 1.3 (range 0.2-3.0). In 2021 to 2022, 431 CXL treatments were performed. CONCLUSIONS There was a significant decrease in the number of corneal transplants performed in patients with KC 15 years after the introduction of CXL. This indicates that the availability of CXL treatment over many years may considerably reduce the need for keratoplasties in this group of patients.
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Affiliation(s)
- Anne Marie Hagem
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Thorsrud
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Marit Sæthre
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Gunhild Sandvik
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Amaral DC, Menezes AHG, Vilaça Lima LC, Faneli AC, Neto PFS, Canedo ALC, Mora-Paez DJ, Guedes JAF, Louzada RN, Fontes BM. Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis. Clin Ophthalmol 2024; 18:865-879. [PMID: 38525385 PMCID: PMC10960511 DOI: 10.2147/opth.s451232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Corneal ectasia leads to progressive irregular corneal curvature and reduced visual acuity. Objective To assess the safety and effectiveness of corneal collagen cross-linking (CXL) for managing corneal ectasia resulting from refractive laser surgery (RSL). Methods A systematic review and meta-analysis were realized according to PRISMA guidelines. We searched PubMed, EMBASE, Cochrane, and Web of Science databases for studies on CXL in patients with ectasia after RLS. The outcomes of interest included visual acuity, refractive outcomes, topographic parameters (Kmax, index surface variance (ISV), index of Vertical Asymmetry (IVA), keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD) and Rmin (minimum sagittal curvature)), central corneal thickness, endothelial cell count, and possible adverse events. Statistical analysis was performed using the R software (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria). Results 15 studies encompassing 421 patients (512 eyes) were included. The mean age was 32.03 ± 4.4 years. The pooled results showed a stable uncorrected visual acuity post-CXL, with a significant improvement in corrected distance visual acuity (SMD = 0.09; 95% CI: -0.07 to 0.26). The spherical equivalent decreased significantly (SMD = -0.09; 95% CI: -0.35, -0.02). The topographic parameter Kmax decreased significantly (SMD = 0.15; 95% CI:0.01 to 0.28); however, the other parameters, ISV, IVA, KI, CKI, IHA, IHD, and Rmin, did not change significantly. Central corneal thickness decreased significantly (SMD = 0.24; 95% CI:0.07 to 0.41), and the endothelial cell count remained stable The complications were rare. Conclusion CXL is a safe and effective technique for managing corneal ectasia after RLS.
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Affiliation(s)
- Dillan Cunha Amaral
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Kaya Ergen S, Subaşı S, Yılmaz Tuğan B, Yüksel N, Altıntaş Ö. The effect of transepithelial corneal collagen cross-linking treatment on optical quality of the cornea in keratoconus: 12-month clinical results. Int Ophthalmol 2024; 44:146. [PMID: 38499839 DOI: 10.1007/s10792-024-03089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE To evaluate the effect of transepithelial corneal collagen crosslinking (CXL) treatment on the optical performance of the cornea at 12-month follow-up after CXL in patients with progressive keratoconus. METHODS One hundred and ten eyes of 67 patients were included. The following corneal optical aberrations over the 4-mm-diameter pupil were recorded via Sirius dual-scanning corneal tomography: total, anterior and posterior amount of corneal higher order aberrations [HOAs], vertical coma, horizontal coma, vertical trefoil, oblique trefoil, and spherical aberration, and Strehl ratio of point spread function (PSF). RESULTS There were significant improvements in mean root mean square error values for corneal total HOA, total coma, anterior HOA, anterior coma, and vertical coma following CXL (P > 0.05, for all). No significant changes were found in the posterior aberometric parameters. PSF value did not change after CXL (P > 0.05). The corneal topographic measurements not revealed a change in the mean simulated keratometry-1, simulated keratometry-2, and maximum keratometry compared with the baseline measurements (P > 0.05, for all). At 12 months, there was a significant improvement in the uncorrected (UCVA) and best corrected (BCVA) visual acuity (P < 0.001, both). Most corneal aberrations correlated significantly with postoperative BCVA, but changes in HOAs were not statistically associated with improvements in visual acuity. CONCLUSIONS Transepithelial CXL was effective in stabilizing the keratometric indices and improving the most corneal aberrations in keratoconic eyes 1 year after the procedure. While the healing effect on aberrations after CXL was in total and anterior parameters, no significant changes were observed in the posterior surface. In addition, it was observed that transepithelial CXL treatment did not cause a significant change in PSF distribution data.
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Affiliation(s)
- Sebnem Kaya Ergen
- Department of Ophthalmology, Kocaeli State Hospital, Kocaeli, Turkey.
| | - Sevgi Subaşı
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Büşra Yılmaz Tuğan
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Nurşen Yüksel
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Özgül Altıntaş
- Department of Ophthalmology, Acibadem Maslak Hospital, Istanbul, Turkey
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Yaffe JA, Matlov Kormas R, Malyugin BE, Boyko M, Tuuminen R, Knyazer B. Ethnicity, Progressive Keratoconus, and Outcomes after Corneal Cross-Linking in Southern Israel. Life (Basel) 2023; 13:2294. [PMID: 38137894 PMCID: PMC10744447 DOI: 10.3390/life13122294] [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: 09/28/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To assess clinical outcomes of corneal cross-linking (CXL) intervention in a population diagnosed with progressive keratoconus. METHODS This single-center retrospective cohort study included consecutive patients who underwent standard CXL or accelerated CXL for progressive keratoconus at a major teaching hospital in southern Israel between January 2015 and December 2019. Patients' medical files were reviewed, and pre-operative and post-operative data regarding demographics and clinical and tomographic characteristics were extracted and analyzed. RESULTS This study included 166 patients (representing 198 eyes), out of which 98 patients (123 eyes) were ethnically Bedouin, and 68 patients (75 eyes) were ethnically Jewish. Overall, 126 patients (144 eyes) had a follow-up of at least 12 months (16.84 ± 5.76). The mean patient age was 20.62 ± 7.1 years old. There were significant baseline differences between the two ethnic groups in best-corrected visual acuity (BCVA; p < 0.001), uncorrected visual acuity (UCVA; p < 0.001), mean keratometry (p = 0.028), and corneal thickness (p < 0.001). Significant changes in BCVA, UCVA, and pachymetry parameters within each group were found after 12 months. Negative binomial regression analysis showed a maximal keratometry below 55D (RR = 1.247, p < 0.001), and a standard CXL procedure (RR = 1.147, p = 0.041) are significantly related to the stability of KC after 12 months. However, the effect size of the origin of patients is negligible (RR = 1.047, p = 0.47). CONCLUSIONS In this study, the Bedouin population suffered from more progressive keratoconus when compared to the Jewish population. CXL was significantly effective in improving BCVA and UCVA in both groups after 12 months of follow-up. The effect size of the origin of patients on the stability of KC was found to be negligible.
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Affiliation(s)
- Jacob A. Yaffe
- Department of Ophthalmology, Soroka University Medical Center, Beer Sheva 8457108, Israel; (R.M.K.); (B.K.)
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
| | - Ran Matlov Kormas
- Department of Ophthalmology, Soroka University Medical Center, Beer Sheva 8457108, Israel; (R.M.K.); (B.K.)
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
| | - Boris E. Malyugin
- S. Fyodorov Eye Microsurgery Federal Institution, Moscow 127486, Russia
- Department of Ophthalmology, A. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow 127473, Russia
| | - Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8457108, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Eye Centre, Kymenlaakso Central Hospital, 48210 Kotka, Finland
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Beer Sheva 8457108, Israel; (R.M.K.); (B.K.)
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
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Vinciguerra R, Bordignon N, Ferraro V, Mazzotta C, Rosetta P, Vinciguerra P. Corneal Collagen Cross-Linking for Progressive Keratoconus in Pediatric Patients: Up to 14 Years of Follow-up. Am J Ophthalmol 2023; 255:170-177. [PMID: 37478962 DOI: 10.1016/j.ajo.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To assess the long-term outcomes of corneal collagen cross-linking according to the Dresden protocol (S-CXL) in progressive pediatric keratoconus (KC). DESIGN Retrospective, single-center noncomparative interventional study. METHODS Patients aged <18 years who underwent S-CXL from June 2007 to January 2011 in Humanitas Clinical and Research Center, Rozzano, Milan, Italy, and completed at least 10 years of follow-up were included. Corrected distance visual acuity (CDVA), refraction, and tomography were evaluated at baseline and ≥10 years after S-CXL. Meeting 2 of the following 3 criteria indicated reprogression: progression above 95% CI for post-CXL population of A or B values or a decrease in minimal thickness C evaluated with the ABCD display. RESULTS Thirty-eight eyes of 24 patients fulfilled inclusion criteria. At a mean of 11.6 years postoperation (maximum 14 years), the CDVA improved significantly (from 0.703 ± 0.33 decimal fraction to 0.887 ± 0.2, P < .001). Similarly, the A value significantly improved from 2.550 ± 1.7 to 1.627 ± 1.68 (P = .019). Thirteen eyes (34%) showed significant postoperative progression in 2 of the 3 parameters A, B, and C. Of these, only 3 eyes (7.9%) of 3 patients showed a statistically significant change in the A value. CONCLUSIONS S-CXL proved to be a safe treatment for progressive KC in pediatric patients with an anterior curvature progression rate of up to 7.9% at ≥10 years of follow-up.
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Affiliation(s)
| | - Niccolò Bordignon
- Department of Biomedical Sciences, Humanitas University (N.B., V.F., P.V.), Milan
| | - Vanessa Ferraro
- Department of Biomedical Sciences, Humanitas University (N.B., V.F., P.V.), Milan
| | - Cosimo Mazzotta
- Departmental Ophthalmology Unit, USL Toscana Sud-Est, Campostaggia (C.M.); SienaSiena Crosslinking Center, Monteriggioni (C.M.), Siena
| | | | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University (N.B., V.F., P.V.), Milan; Humanitas Clinical and Research Center, IRCCS (P.V.), Rozzano, Milan, Italy
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Prakash G, Mammen A, Jhanji V. Rate of fractional change in corneal tomography parameters in keratoconus using a combination of predictive parameters. EYE AND VISION (LONDON, ENGLAND) 2023; 10:40. [PMID: 37777798 PMCID: PMC10544119 DOI: 10.1186/s40662-023-00357-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND To compare the rate of fractional change for multiple corneal tomographic factors in progressive keratoconus (KC). METHODS In this retrospective case series, 40 eyes (40 patients) with progressive KC (increase in central keratometry of 1.00 D or maximum keratometry of 1.50 D on two visits at least six months apart) were included. Cases with previous history of ocular surgery, poor scans, corneal scars, severe dry eyes, post-excimer ectasia, pellucid marginal degeneration were excluded. Medical records, corneal tomography and anterior corneal wavefront (8 mm) (Scheimpflug tomography, Pentacam, Oculus, Germany) were analyzed. Rate of fractional change (Rx = (x1 - x0)/(|x0|tm)); where, x1 = value at follow-up, x0 = value at initial visit and tm = time in months, was measured. RESULTS The mean age of the patients was 30.0 ± 8.4 years. The mean follow-up duration was 8.9 ± 4.2 months. Coma (0.076 ± 1.4) had the largest rate of fractional change (P = 1.7 × 10-14, Kruskal-Wallis test). The rate of fractional change was higher for aberrometric parameters (anterior corneal higher-order aberrations root mean square and anterior coma) compared to pachymetric and keratometric parameters (P values ranging from 1.4 × 10-4 to 7.4 × 10-10, Mann-Whitney test, effect size ranging from 0.4-0.7). The rate of fractional change was comparable between pachymetric and keratometric factors (P > 0.05 for all comparisons, Mann-Whitney test). CONCLUSIONS Anterior corneal wavefront, especially anterior coma, were noted to have higher rate of fractional change compared to single point keratometric and pachymetric indices in progressive KC. This information can be used for decision-making when monitoring patients with KC.
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Affiliation(s)
- Gaurav Prakash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Mammen
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- University of Pittsburgh Medical Center, 203 Lothrop St, Suite 800, Pittsburgh, PA, 15213, USA.
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Xanthopoulou K, Milioti G, Daas L, Munteanu C, Seitz B, Flockerzi E. Accelerated Corneal Crosslinking for Treatment of Keratoconus in Children and Adolescents under 18 Years of Age. Klin Monbl Augenheilkd 2023; 240:1131-1142. [PMID: 36436508 DOI: 10.1055/a-1933-3084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of accelerated (9 mW/cm2, 10 min) epithelium-off (epi-off) corneal crosslinking (A-CXL) in keratoconus (KC) patients < 18 years of age. PATIENTS AND METHODS Our retrospective study included 41 eyes (25 male and 5 female patients, mean age 15.3 ± 1.2 years) who underwent A-CXL (9 mW/cm2, 10 min) because of progressive KC or critical KC at first presentation or asymmetrical finding in the partner eye. Outcome measures were best-corrected visual acuity (BCVA) and tomography readings (Pentacam HR, Oculus, Wetzlar, Germany), evaluated 2 years, 1 year, 6 months preoperatively, prior to surgery (pre-CXL) and 6 weeks, 6 months, 1 year, 2 years, > 2 years postoperatively (post-CXL). The demarcation line was assessed by anterior segment optical coherence tomography (SS-1000 and CASIA 2, Tomey, Nagoya, Japan). RESULTS Total deviation value increased statistically significantly 6 months pre-CXL to pre-CXL. Anterior steep, flat, and mean keratometry values showed a statistically significant increase 6 weeks post-CXL (p < 0.05), followed by a significant decrease until 2 years post-CXL for steep and mean keratometry. Kmax increased 6 weeks post-CXL without statistical significance and decreased significantly even > 2 years post-CXL (p < 0.0001). Posterior keratometry as well as anterior and posterior astigmatism did not show any significant changes post-CXL. Thinnest and apical pachymetry decreased significantly until 6 months post-CXL (p < 0.05) and remained stable > 2 years post-CXL (p > 0.05). BCVA decreased 6 weeks post-CXL but improved significantly > 2 years post-CXL (p = 0.003). The demarcation line reached an average depth of 52.1%. CONCLUSIONS Epi-off A-CXL stabilizes KC progression in patients < 18 years even > 2 years postoperatively and leads to a deep demarcation line. A "pseudoprogression" is observed up to the 6-week follow-up, which is not indicative of the long-term results.
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Affiliation(s)
- Kassandra Xanthopoulou
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Georgia Milioti
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Cristian Munteanu
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
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Stein R, Ong Tone S, Lebovic G, Singal N, Hatch W. Subjective and objective evaluation of corneal haze after accelerated corneal crosslinking for corneal ectasias. Acta Ophthalmol 2023. [PMID: 36707973 DOI: 10.1111/aos.15639] [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: 04/20/2022] [Revised: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the relationship between subjective (slit lamp examination [SLE]) and objective (densitometry) measurements of corneal haze after accelerated corneal crosslinking (aCXL), assess the relationship between densitometry and corrected distance visual acuity (CDVA), and determine the effect of baseline characteristics on densitometry after aCXL in eyes with progressive keratoconus and other ectasias. SETTING Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada. DESIGN Retrospective analysis of a prospective interventional cohort study. METHODS Scheimpflug-derived corneal densitometry, CDVA, maximum keratometry (Kmax ), and central corneal thickness were measured preoperatively and up to 1 year after aCXL, and post-operative haze was estimated with SLE (n = 483 eyes). A random effect model was used to examine the relationship between post-operative subjective haze with SLE and densitometry. Linear mixed models were used to examine the relationship between densitometry, pre-operative baseline characteristics, and CDVA. RESULTS There was a significant association between subjective haze with SLE and densitometry (p < 0.001). There was a significant relationship between CDVA and densitometry: for every 10 GSUs of increased densitometry in the 0-2 mm zone, CDVA worsened by approximately half a Snellen line (p < 0.001). Age and pre-operative Kmax were significant predictors of densitometry. For every 10 years of age, densitometry increased by 0.68 GSUs (95% CI [0.27 to 1.07], p < 0.001). For every 10 D of increased preoperative Kmax , densitometry increased by 0.69 GSUs (95% CI [0.41 to 0.98], p < 0.001). CONCLUSIONS Subjective haze after aCXL estimated with SLE, is significantly associated with densitometry. Increased densitometry after aCXL is associated with a reduction in CDVA.
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Affiliation(s)
- Rebecca Stein
- Kensington Eye Institute, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Stephan Ong Tone
- Kensington Eye Institute, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Crosslinking Working Group, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Neera Singal
- Kensington Eye Institute, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Crosslinking Working Group, Toronto, Ontario, Canada
| | - Wendy Hatch
- Kensington Eye Institute, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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Herber R, Lenk J, Pillunat LE, Raiskup F. Comparison of corneal tomography using a novel swept-source optical coherence tomographer and rotating Scheimpflug system in normal and keratoconus eyes: repeatability and agreement analysis. EYE AND VISION 2022; 9:19. [PMID: 35606839 PMCID: PMC9128256 DOI: 10.1186/s40662-022-00290-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
To determine the repeatability and agreement using corneal tomography of a swept-source optical coherence tomographer (SS-OCT) compared to a rotating Scheimpflug camera (RSC) in normal eyes and keratoconus (KC) eyes.
Methods
This prospective repeatability analysis was performed at the Department of Ophthalmology of University Hospital Carl Gustav Carus, Dresden, Germany. Forty-three normal and 57 KC eyes were enrolled in the study. Three consecutive measurements were performed by the same operator on each device. Corneal parameters of anterior and posterior corneal surface, such as simulated keratometry (SimK), as well as central and thinnest corneal thickness were evaluated. Repeatability and agreement were assessed by using the coefficient of repeatability and Bland-Altman analysis.
Results
The repeatability of anterior corneal parameters was comparable between RSC and SS-OCT in normal eyes (repeatability < 0.5 D). Repeatability was increased in mild and moderate KC for all parameters using both devices. In moderate KC, repeatability of Kmax was 1.33 D and 0.78 D for RSC and SS-OCT, respectively. Repeatability of posterior corneal parameters was consistently better for SS-OCT. Significant offsets and wide ranges of limits of agreement were found between the devices for SimK and corneal thickness values.
Conclusions
SS-OCT showed highly repeatable measurements of anterior and posterior corneal parameters in normal and KC eyes. Compared to RSC, the SS-OCT had a better repeatability of anterior corneal parameters in mild and moderate KC as well as posterior corneal parameters in all groups. Both devices should not be used interchangeably in the diagnostic process of patients.
Trial registration NCT04251143 at Clinicaltrials.gov, registered on 12 March 2018, https://clinicaltrials.gov/ct2/show/NCT04251143?cond=Keratoconus&cntry=DE&city=Dresden&draw=2&rank=1
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12
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EpiSmart® Crosslinking for Keratoconus: A Phase 2 Study. Cornea 2022:00003226-990000000-00116. [PMID: 36173242 DOI: 10.1097/ico.0000000000003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to assess changes in visual acuity after epithelium-on ("epi-on") corneal crosslinking after a diagnosis of keratoconus. METHODS Subjects with corneal ectatic diseases were enrolled in a prospective, randomized, controlled, open-label, multicenter trial. Subjects were randomized to 1 of 3 treatment groups and treated with an epi-on crosslinking system including riboflavin/sodium iodide and pulsed UVA exposure (EpiSmart® , CXL Ophthalmics, Encinitas, CA). The UVA treatment groups were 2.4 J/cm2 over 20 minutes, 3.6 J/cm2 over 20 minutes, and 3.6 J/cm2 over 30 minutes. The primary end point was logarithm of the minimum angle of resolution corrected distance visual acuity (CDVA). Secondary end points were logarithm of the minimum angle of resolution uncorrected distance visual acuity (UCVA), maximum corneal curvature (Kmax), and minimum corneal thickness. Data were assessed 6 and 12 months post-operatively, using t-tests for differences from baseline. RESULTS Two thousand two hundred twenty-eight subjects were treated with epi-on crosslinking. One thousand nine hundred twenty-two subjects had a diagnosis of keratoconus; other treated eyes had postsurgical and other ectasias. At 6 and 12 months, the subjects with keratoconus demonstrated significant improvements in CDVA, UCVA, and Kmax; minimum corneal thickness was unchanged. One hundred ninety-five subjects (8.7%) reported at least 1 adverse event (AE). A mild corneal epithelial defect was reported in 31 cases (1.4%) and was the only AE reported in >1% of subjects. There were no serious AEs related to the treatment. CONCLUSIONS EpiSmart® epi-on crosslinking resulted in mean improvements in CDVA, UCVA, and Kmax at both 6 and 12 months and an excellent safety and efficacy profile in subjects with keratoconus, with few significant side effects. Differences between UVA treatment groups were not significant.
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Joshi MR, Voison KJ, Piano M, Farnon N, Bex PJ. A novel tool for quantitative measurement of distortion in keratoconus. Eye (Lond) 2022:10.1038/s41433-022-02240-x. [PMID: 36104521 PMCID: PMC9472732 DOI: 10.1038/s41433-022-02240-x] [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: 12/15/2021] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Keratoconus is associated with thinning and anterior protrusion of the cornea resulting in the symptoms of blurry and distorted vision. The commonly used clinical vision tests such as visual acuity and contrast sensitivity may not reflect the symptoms experienced in keratoconus and there are no quantitative tools to measure visual distortion. In this study, we used a quantitative test based on vernier alignment and field matching techniques to quantify visual distortion in keratoconus and assess its relation to corneal structural changes. Methods A total of 50 participants (25 keratoconus and 25 visually normal) completed the experiment where they aligned supra-threshold white target circles in opposite field in reference to guidelines and circles to complete a square structure monocularly. The task was repeated five times and the global distortion index (GDI) and global uncertainty index (GUI) were calculated as the mean and standard deviation respectively of local perceived misalignment of target circles over five trials. Results Both GDI and GUI were higher in participants with keratoconus compared to controls (p < 0.01). Both parameters correlated with the best corrected visual acuity, maximum corneal curvature (Kmax), topographical keratoconus classification (TKC) and central corneal thickness (CCT). Conclusion Our findings show that the quantitative measure of distortion could be a useful tool for behavioural assessment of progressive keratoconus.
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14
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Anitha V, Ravindran M. Commentary: Bunsen-Roscoe reciprocity - Is it still valid? Indian J Ophthalmol 2022; 70:2936-2937. [PMID: 35918947 PMCID: PMC9672781 DOI: 10.4103/ijo.ijo_294_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Venugopal Anitha
- Cornea, Ocular surface, Trauma and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Paediatrics and Strabismology Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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15
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Chan TCY, Tsui RWY, Chow VWS, Lam JKM, Wong VWY, Wan KH. Accelerated corneal collagen cross-linking in progressive keratoconus: Five-year results and predictors of visual and topographic outcomes. Indian J Ophthalmol 2022; 70:2930-2935. [PMID: 35918946 PMCID: PMC9672700 DOI: 10.4103/ijo.ijo_2778_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To analyze the 5-year results of accelerated corneal collagen crosslinking (CXL) for progressive keratoconus and identify preoperative characteristics predictive of visual and topographic outcomes. Methods: A prospective interventional case series. Nineteen eyes of 19 patients receiving accelerated CXL with settings of 18 mW/cm2 for 5 min were included. Clinical and topographic parameters were assessed. Linear regression and logistic regression were used to compare the R2 and odds ratio (OR), respectively, between baseline characteristics and postoperative outcomes. Results: Corrected distance visual acuity (CDVA) remained stable from 0.28 ± 0.21 to 0.25 ± 0.18 logMAR (P = 0.486). The mean cylindrical refraction was stable (P = 0.119). The maximal keratometry (Kmax) decreased from 61.99 ± 10.37 to 59.25 ± 7.75 D (P < 0.001), flattening in the flattest and steepest meridians and mean keratometry were also observed (P ≤ 0.040). The mean anterior elevation at the apex reduced from 21.42 ± 16.69 to 18.53 ± 12.74 mm (P = 0.013) and changes in posterior elevation were non-significant (P = 0.629). Preoperative Kmax best predicted the postoperative change in Kmax (R2 = 0.55, P < 0.001) compared to the other baseline characteristics (P ≤ 0.028), whereas preoperative CDVA was the only significant predictor of postoperative change in CDVA (R2 = 0.41, P = 0.003). Accelerated CXL is less likely to fail in eyes with a steeper preoperative Kmax (OR = 0.74, P = 0.040) or greater posterior elevation at the apex (OR = 0.91, P = 0.042). Conclusion: Kmax significantly decreased following accelerated CXL. Eyes with worse preoperative CDVA and higher Kmax were more likely to have an improvement in visual acuity and corneal flattening.
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Affiliation(s)
- Tommy C Y Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Rachel W Y Tsui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Hong Kong Eye Hospital, Hong Kong
| | - Vanissa W S Chow
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Hong Kong Eye Hospital, Hong Kong
| | - Jasmine K M Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Hong Kong Eye Hospital, Hong Kong
| | - Victoria W Y Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Hong Kong Eye Hospital; LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kelvin H Wan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Hong Kong Eye Hospital, Hong Kong
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16
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Yang K, Xu L, Wang S, Zhu M, Fan Q, Gu Y, Wang Y, Wang Q, Zhao D, Pang C, Ren S. A Bibliometric Analysis of 100 Most-Cited Articles on Corneal Cross-Linking. Front Med (Lausanne) 2022; 9:904077. [PMID: 35721090 PMCID: PMC9199002 DOI: 10.3389/fmed.2022.904077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Highly cited papers are expected to have high-quality data that significantly contribute to the body of knowledge. The study aimed to evaluate the characters of the 100 most-cited articles on corneal cross-linking (CXL) through a bibliometric analysis. Materials and Methods The Web of Science database was searched to identify papers published from 1950 to 2020. A bibliometric analysis of the top 100-cited articles was conducted in the current study. The citation differences between basic research, clinical research, and reviews were compared by Kruskal-Wallis test. The association between citations and publication year was evaluated by Spearman correlation analysis. The VOSviewer software was used to create networks of co-authorship and keywords map. Results The median values of the number of citations, citations/year since publication, and citations since 2013 were 101, 9.5, and 11.92, respectively. A total of 61% of articles were clinical research. The citations since 2013 of clinical research were lower than basic research and the reviews (all p < 0.001). The publication year was positively correlated with the number of publications (r = 0.665, p = 0.013), and the total number of citations decreased for basic research (r = -0.447, p = 0.017), and clinical research (r = -0.433, p < 0.001). The J REFRACT SURG publishes the highest number of articles. The corresponding authors were predominantly from the Italy (N = 17), Germany (N = 16), and United States (N = 15). Spoerl Eberhard has the highest number of citations and total link strength with 15 articles. Extensive collaboration existed among the main core nodes containing "cross-linking (N = 45)," "riboflavin (N = 44)," and "ultraviolet A (UVA) (N = 42)." Conclusion The present study focused on the comprehensive analysis of the top 100-cited articles on the CXL research, providing insight into research developments over the past decades.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaopei Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Zhu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yawen Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongqing Zhao
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
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Wang L, Wang J, Sun H, Pang Z, Mu G. Corneal Collagen Cross-Linking Inhibits Corneal Blood and Lymphatic Vessels Temporarily in Alkali-Burned Rabbits. Curr Eye Res 2022; 47:1266-1271. [PMID: 35634710 DOI: 10.1080/02713683.2022.2079143] [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: 11/03/2022]
Abstract
PURPOSE This study aimed to explore whether corneal cross-linking (CXL) could regress corneal blood vessels (CBV) and corneal lymphatic vessels (CLV) in alkali-burned rabbits. METHODS A total of 80 rabbits 2-3 months old weighing 1.5-2.0 kg were randomly divided into four groups: CXL7 group; CTL7 group; CXL14 group; and CTL14 group. Then, 3% sodium pentobarbital 1 ml/kg and tetracaine eye drop 5 g/L were administered before surgery. NaOH 2 mol/L was topically applied to the central cornea to establish the alkali burning model. Then CXL was administered within 2 h in groups CXL7 and CXL14. Corneal opacity and edema, CBV and CLV volume, cluster differentiation 31 (CD31), and lymphatic vessel endothelial receptor 1 (LYVE-1) expression levels were analyzed on days 7 and 14. RESULTS CXL reduced cornea opacity, CNV, and CLV volumes on day 7 in alkali-burned rabbits. However, CNV and CLV volumes were increased on day 14. CXL also showed down- and upregulation of CD31 and LYVE-1 expression levels on days 7 and 14, respectively. CONCLUSIONS CXL effectively regulated CBV and CLV in alkali-burned rabbits. The transient angioregression and lymphangioregression induced by CXL may be potentially helpful in vascularized high-risk eyes.
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Affiliation(s)
- Lijun Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.,Department of Ophthalmology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Jia Wang
- Department of Ophthalmology, Aier Eye Hospital Group (J.W.), LiaochengAier Eye Hospital, Liaocheng, Shandong, China
| | - Hongkun Sun
- Department of Hematopathology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Zuoxiang Pang
- Department of Ophthalmology, Weifang Eye Hospital, Weifang, Shandong, China
| | - Guoying Mu
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Xanthopoulou K, Milioti G, Daas L, Munteanu C, Seitz B, Flockerzi E. Accelerated corneal crosslinking causes pseudoprogression in keratoconus within the first 6 weeks without affecting posterior corneal curvature. Eur J Ophthalmol 2022; 32:2565-2576. [PMID: 35535408 DOI: 10.1177/11206721221099257] [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: 11/15/2022]
Abstract
PURPOSE To evaluate the effectiveness of epithelium-off (epi-off) accelerated corneal crosslinking (A-CXL, 9 mW/cm2, 10 min) in adult keratoconus (KC) patients. METHODS The study included 151 KC corneas (124 patients) after A-CXL. The parameters best corrected visual acuity (BCVA) and the tomographic readings (Pentacam HR, Oculus, Germany) were analysed at 24, 12 and 6 months preoperatively, prior to surgery; and 6 weeks, 6 months, 1, 2 and >2 years postoperatively. The demarcation line was assessed by anterior segment optical coherence tomography (Tomey SS-1000, CASIA 2 (Tomey, Nagoya, Japan)). RESULTS Comparing pre- to postoperative findings 6 weeks after A-CXL with paired t-test, the anterior steep (46.8 ± 4.0|47.1 ± 4.1), flat (50.2 ± 4.3|50.6 ± 4.6) and maximal keratometry (57.6 ± 6.8|58.3 ± 6.8) increased (p < 0.05), while the thinnest pachymetry decreased significantly (459 ± 39|444 ± 42, p < 0.05). Lateron, however, there was a decreasing anterior flat (1, 2 and >2 years; p < 0.0001), mean (1 year; p = 0.01 and 2 years; p = 0.03) and maximal keratometry (1, 2 and >2 years; p < 0.0001). The posterior corneal keratometry readings did not change significantly until >2 years after A-CXL (MANOVA; steep, p = 0.008; flat, p = 0.027; mean, p = 0.007). The mean depth of the demarcation line was 242 ± 62 µm (53.6%). The preoperative logMAR BCVA (0.35 ± 0.02) decreased 6 weeks after A-CXL (0.39 ± 0.03) followed by a continuous improvement until the latest follow-up (0.18 ± 0.04). CONCLUSION A-CXL constitutes a successful method for KC stabilization. Signs of KC progression occur within the first 6 weeks postoperatively ("pseudoprogression"), but this is not indicative of the long-term effect.
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Affiliation(s)
| | - Georgia Milioti
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| | - Loay Daas
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| | - Cristian Munteanu
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
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OZALP ONUR, ATALAY ERAY. Belin ABCD Progression Display Identifies Keratoconus Progression Earlier Than Conventional Metrics. Am J Ophthalmol 2022; 236:45-52. [PMID: 34653352 DOI: 10.1016/j.ajo.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare the progression rate and time to progression determined using the Belin ABCD Progression Display (BAPD) with conventional metrics in patients with keratoconus (KC). DESIGN Retrospective comparison of progression assessment. METHODS Patients 18 years and older and 35 years and younger with at least 1 year of follow-up and 3 Pentacam (Oculus, Inc) visits were included in the study. Progression was evaluated by selecting either the first visit or the first 2 visits individually as the baseline on the BAPD, and the red gate was used to determine progression (variability in any A, B, and C parameters ≥95% CI or any 2 parameters ≥80% CI). An increase of ≥1 diopter in corneal astigmatism and curvature parameters and a ≥2% reduction in thickness parameters constituted progressive disease. RESULTS Two hundred seventy-seven eyes of 155 patients were included. The 2 baseline visit criteria identified the highest progression (n = 186 [67.2%]), followed by the single baseline visit (n = 158 [57%]), minimum corneal thickness (n = 114 [41.2%]), central corneal thickness (n = 111 [40.1%]), maximum keratometry (n = 76 [27.4%]), corneal astigmatism (n = 55 [19.9%]), back mean keratometry (n = 50 [18.1%]), and front mean keratometry (n = 31 [11.2%]) criteria. The median time to progression was shortest using the single baseline visit criterion (11 months), followed by the 2 baseline visits (11.6 months), minimum corneal thickness (12.1 months), maximum keratometry (12.3 months), corneal astigmatism (14.8 months), central corneal thickness (16.6 months), back mean keratometry (18.4 months), and front mean keratometry (24.4 months) criteria. In a subgroup analysis, progression could be identified 4 to 7 months earlier with the BAPD in eyes that were also progressive for maximum keratometry and central corneal thickness. CONCLUSIONS BAPD detects progression at a higher rate and earlier than conventional parameters.
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Eslami M, Ghaseminejad F, Dubord PJ, Yeung SN, Iovieno A. Delayed Topographical and Refractive Changes Following Corneal Cross-Linking for Keratoconus. J Clin Med 2022; 11:jcm11071950. [PMID: 35407560 PMCID: PMC8999946 DOI: 10.3390/jcm11071950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 12/22/2022] Open
Abstract
Background: The aim of this study was to analyze the long-term topographic and refractive outcomes of corneal cross-linking (CXL) in keratoconus. Methods: We used a retrospective observational study of patients with keratoconus who underwent CXL with a minimum follow-up of 5 years. Patients’ refractive and topography data (corrected distance visual acuity, sphere, cylinder, average and maximum keratometry, and corneal aberrations) were collected. Results: A total of 112 patients/150 eyes (mean age: 33.2 ± 10.7 years; range: 13−61) were included. The mean follow-up was 5.87 ± 1.35 years (range: 5−10). At the last follow-up visit, an improvement in CDVA, spherical and cylindrical refraction, average and steepest keratometry, and corneal aberrations were observed (p < 0.05), with the exception of trefoil. At the last visit, 49 (34.8%) and 31 (22.0%) eyes had an improvement beyond 1D in their spherical and cylindrical power, respectively, and 43 (28.7%) eyes had a flattening of their steepest keratometry. Progressive improvement over time was observed for spherical refraction; max and mean-K; as well as corneal RMS, total, high, coma, and spherical aberrations (p < 0.05). More severe disease at the baseline correlated with an improvement in corneal aberrations over time. Conclusions: In addition to a progressive improvement in refractive and keratometric indices, corneal aberrations also demonstrate a steady decline with long-term follow-up after CXL, which was more pronounced in more severe patients.
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21
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Correlation between Placido's Disk and Rotating Scheimpflug Keratometric Findings in Children with Keratoconus before and after Corneal Cross-Linking. J Cataract Refract Surg 2022; 48:1183-1189. [PMID: 35333826 DOI: 10.1097/j.jcrs.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Evaluate correlation between Placido's disk and rotating Scheimpflug keratometric findings in children with progressive keratoconus (KC) before and after corneal cross-linking (CXL) and investigate whether these limits of agreement varied according to disease severity. SETTING Department of Ophthalmology of São Paulo Hospital, São Paulo, Brazil. DESIGN Prospective nonrandomized open study. METHODS Data obtained using rotating Scheimpflug-based tomography and Placido-based topography devices were collected from preoperative and last follow-up postoperative children with KC operated on using standard CXL protocol. Correlation and agreement analyses were performed between the two devices before and after CXL to obtain keratometric findings. RESULTS Forty-four eyes from 44 patients 8 to 16 years of age were analyzed at all time points. All parameters were found to be strongly correlated before (r = 0.84-0.99, p < 0.001) and after (r = 0.93-0.99, p < 0.001) CXL. Mean Scheimpflug measurements of flat K, steep K, Kmax, mean K, and corneal astigmatism were higher than Placido measurements in preoperative period. This mean difference decreased in postoperative, but, with exception of Kmax and corneal astigmatism, Scheimpflug measurements remained higher. Mean parameter measurements from both devices decreased after CXL. 95% limits of agreement between instruments were wide for all parameters, and decreased in postoperative and in mild KC. CONCLUSION Keratometry measurements obtained using rotating Scheimpflug and Placido disk technology were found to be closely correlated but not interchangeable before and after CXL in pediatric patients. Agreement between devices was better after CXL and in mild KC than in advanced KC.
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22
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Tian M, Jian W, Zhang X, Sun L, Shen Y, Zhou X. Predictive factors of the accelerated transepithelial corneal cross-linking outcomes in keratoconus. BMC Ophthalmol 2022; 22:7. [PMID: 34980018 PMCID: PMC8725418 DOI: 10.1186/s12886-021-02235-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background This study aimed to evaluate the clinical outcomes and assess preoperative characteristics that may predict outcomes in keratoconus 1 year after accelerated transepithelial corneal cross-linking (ATE-CXL). Methods This prospective study included 93 eyes of 84 consecutive keratoconus patients with 1-year follow-up after ATE-CXL. Preoperative characteristics included corneal astigmatism, anterior chamber depth, anterior chamber volume, radius of curvature, posterior elevation, central corneal thickness (CCT), thinnest corneal thickness, steepest meridian keratometry, flattest meridian keratometry, and the maximum keratometry (Kmax). Data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. The patient eyes were grouped into 3 subgroups according to CCT and Kmax values to observe the changes of keratoconus progression. Results All patients were successfully operated without complications at any follow-up time point. Mean changes of Kmax from baseline at 6 and 12 months were − 0.60 ± 2.21 D (P = 0.011) and − 0.36 ± 1.58 D (P = 0.030), respectively. Eyes with a thinner CCT and higher Kmax values exhibited a tendency for topographic flattening of ≥1.0 D (P = 0.003; P = 0.003). In the subgroup comparison, the Kmax values decreased significantly at 6 and 12 months after ATE-CXL in the group with CCT ≤ 450 μm (P = 0.018 and P = 0.045); the Kmax values of the group with Kmax > 65.0 D decreased significantly at 6 months postoperatively (P = 0.025). Conclusion ATE-CXL is a safe and effective treatment for keratoconus patients. Patients with thinner CCT and higher Kmax values are more likely to benefit from ATE-CXL.
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Affiliation(s)
- Mi Tian
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Weijun Jian
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoyu Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ling Sun
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yang Shen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Barequet D, Gutfreund S, Goldstein M, Loewenstein A, Gamzu R, Varssano D. Evaluation of a Telemedicine Model for Following Keratoconus Patients in the Era of COVID-19 Pandemic. Telemed J E Health 2021; 28:1023-1027. [PMID: 34788576 DOI: 10.1089/tmj.2021.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the diagnostic accuracy and reliability of a telemedicine approach for detecting keratoconus patients' progression in the era of coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: A retrospective study, comparing the office and telemedicine evaluations in determining whether keratoconus patients were at risk of progression and indicated for further treatment of corneal crosslinking, was conducted. The clinic examination included best spectacle corrected visual acuity measurement and manifest refraction, full ophthalmic examination, and corneal topography, which provided with the gold-standard diagnosis. The remote assessment included two decisions of keratoconus progression or stability: the first evaluation after revealing patient demographics and topography images, and the second with the manifest refraction and clinical findings as documented in the outpatient clinic visit. Results: Two-hundred and four eyes of 102 keratoconus patients were included. There was an agreement of assessment between the in-person and the remote diagnostic decisions in 192 (94%) of the eyes. Among the remaining 12 eyes, a false-positive diagnosis was made in 8 (3.9%) eyes, whereas a false-negative diagnosis was made in 4 (1.9%) eyes. The remote assessment showed a sensitivity and specificity of 69% and 96%, respectively. In no case was remote diagnostic decision 2 different from remote decision 1. Conclusions: The telemedicine model yielded high specificity, but low sensitivity values, therefore, not suitable as an alternative for keratoconus patient follow-up (Clinical trial number TLV-0363-20).
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Affiliation(s)
- Dana Barequet
- Division of Ophthalmology and Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Gutfreund
- Division of Ophthalmology and Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michaella Goldstein
- Division of Ophthalmology and Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Division of Ophthalmology and Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronni Gamzu
- Managment, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Varssano
- Division of Ophthalmology and Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Transepithelial Diluted Alcohol and Iontophoresis-Assisted Corneal Crosslinking for Progressive Keratoconus in Adults: 4-Year Clinical Results. Cornea 2021; 41:462-469. [PMID: 34743098 DOI: 10.1097/ico.0000000000002821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to compare the 4-year clinical outcomes of transepithelial diluted alcohol and iontophoresis-assisted corneal crosslinking (DAI-CXL) and standard corneal crosslinking (S-CXL) in adults with progressive keratoconus. METHODS This retrospective study included 36 eyes of 36 keratoconic patients who underwent DAI-CXL (n = 18) or S-CXL (n = 18). Best spectacle-corrected visual acuity (BSCVA) and corneal topography parameters were analyzed at baseline and at 1, 2, 3, and 4 years of follow-up. Corneal demarcation line depth (DLD) at 1 month was measured, and the relation of DLD with corneal thickness (DL%) was assessed. RESULTS BSCVA improved significantly only in S-CXL (P = 0.01). A significant decrease in maximum keratometry and mean keratometry occurred at 4 years in both groups (all P < 0.05), and these changes were similar in both groups (all P > 0.05). There was a significant reduction in the thinnest corneal thickness in S-CXL (P = 0.01); however, the mean thinnest corneal thickness in DAI-CXL remained stable (P = 0.094). Higher-order aberrations and coma aberration decreased significantly in both groups at 4 years (all P < 0.05), with a higher decrease in S-CXL (all P < 0.05). Spherical aberration showed a significant reduction only in S-CXL (P = 0.005). In contrast to the similar mean DLD in both groups, DL% in DAI-CXL was significantly greater than that in S-CXL (P = 0.032). There were no correlations between the improvement in BSCVA, maximum keratometry, mean keratometry, higher-order aberrations, and the mean DLD and DL% (all P > 0.05). CONCLUSIONS DAI-CXL was as effective as S-CXL in arresting the progression of keratoconus and showed similar clinical results to S-CXL at the 4-year follow-up.
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Veselý P, Veselý Ľ, Combová V, Žukovič M. SPECIFIC CORNEAL PARAMETERS AND VISUAL ACUITY CHANGES AFTER CORNEAL CROSSLINKING TREATMENT FOR PROGRESSIVE KERATOCONUS. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2021; 77:184-189. [PMID: 34507494 DOI: 10.31348/2021/21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the effect of crosslinking (CXL) therapy on the change in the quality of visual acuity and the change in the topographic properties of the cornea - curvature, pachymetry, and change of astigmatism, coma abberation and CLMIaa (Cone Localisation and Magnitude Index). METHODS A retrospective analytical study included 29 eyes of 24 patients who had progressed in the last 12 months and were suitable candidates for CXL surgery. The monitored parameters were the steepest, flatest and mean anterior instantaneous curvature (AICS, AICF, AICM) and the steepest, flatest and mean posterior instantaneous curvature (PICS, PICF, PICM) of the cornea, corneal thickness in the centre of the cornea (PACHC) and in the thinnest point of the cornea (PACHT), corneal astigmatism (ASTIG). coma (COMA), Cone Localization and Magnitude Index (CLMIaa) and uncorrected distance visual acuity (UDVA) with corrected distance visual acuity (CDVA). Data were analysed before surgery and 12 months after surgery. The AIC, COMA, CLMIaa and ASTIG parameters were analysed by paired t test. As the parameters of UDVA, CDVA, PIC and PACH did not meet the conditions of normal distribution, the Wilcoxon test was used to investigate the change in these parameters after CXL. RESULTS Twelve months after the procedure, we recorded an improvement in UDVA (p = 0.371) and CDVA (p = 0.825), an increase in PICS, PICF and PICM (p = 0.902; p = 0.87 and p = 0.555), a decrease in PACHCC (p = 0.294) and a decrease in CLMIaa (p = 0.113) that did not reach statistical significance. The decrease in PACHT (p = 0.027), decrease in COMA (p = 0.037) and decrease in anterior corneal curvature of AICS, AICF and AICM were statistically significant (p = 0.019; p = 0.010 and p = 0.005). The decrease in the value of astigmatism did not show statistical significance, as p = 0.297. CONCLUSION CXL corneal therapy has been shown to be an effective method to stabilize the cornea in progressive keratoconus, and to improve the higher order of coma. This contributes to the possible improvement of UDVA and CDVA.
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Vinciguerra R, Pagano L, Borgia A, Montericcio A, Legrottaglie EF, Piscopo R, Rosetta P, Vinciguerra P. Corneal Cross-linking for Progressive Keratoconus: Up to 13 Years of Follow-up. J Refract Surg 2021; 36:838-843. [PMID: 33295997 DOI: 10.3928/1081597x-20201021-01] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 10/08/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the long-term efficacy and safety of epithelium-off corneal cross-linking according to the Dresden protocol (S-CXL) in progressive keratoconus. METHODS Patients treated with S-CXL from April 2006 to January 2010 at Humanitas Clinical and Research Center, Rozzano, Italy, who completed at least 10 years of follow-up were included. Corrected distance visual acuity (CDVA), refraction, and corneal topography and tomography with Pentacam (OCULUS Optikgeräte GmbH) were evaluated at baseline and 10+ years after the procedure. The definition of progression after S-CXL was two of the following three criteria: increase of "A" value, increase of "B" value, or decrease of minimum thickness evaluated with the ABCD progression display above 95% CI for the post-CXL population. RESULTS Twenty-seven eyes of 22 patients were included. At a mean of 11 years of follow-up (maximum 13 years), S-CXL was able to maintain CDVA and induce significant regularization of the corneal surface as demonstrated by a significant decrease of the central keratoconus index (P = .035) and a decrease of anterior curvature ("A" value) starting from 2.54 ± 2.46, which reduced to 1.14 ± 1.60 (P = .005) at 10+ years of follow-up. Two of 27 eyes included showed significant progression after S-CXL (7.4%). CONCLUSIONS S-CXL was confirmed to be a safe and effective treatment for progressive keratoconus with a failure rate of 7.4% at up to 13 years of follow-up. The authors suggest the use of a combined progression system that evaluates anterior and posterior curvature and with thickness map together with the knowledge of the noise level of the testing system. [J Refract Surg. 2020;36(12):838-843.].
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Topography/wavefront-guided photorefractive keratectomy combined with crosslinking for the treatment of keratoconus: preliminary results. J Cataract Refract Surg 2021; 47:11-17. [PMID: 32902932 DOI: 10.1097/j.jcrs.0000000000000359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of topography/wavefront-guided (TWFG) photorefractive keratectomy (PRK) using a new high-definition aberrometer combined with epithelium-off crosslinking (CXL-Plus). SETTING Centro Oculistico Bresciano, Brescia, Italy. DESIGN Prospective case series study. METHODS Patients with grade I or II keratoconus, according to the Amsler-Krumeich classification, were included in this prospective case series. All cases underwent TWFG PRK using the VISX STAR S4 IR excimer laser and the new iDesign 2.0 system, followed by accelerated epithelium-off CXL. Visual, refractive, ocular aberrometric, and safety outcomes were evaluated during a 6-month follow-up. RESULTS Thirty-five eyes of 19 patients were included. A significant improvement was observed in the uncorrected and corrected distance visual acuities (P < .001). Manifest sphere and cylinder were reduced significantly (P ≤ .001), with a total of 20 eyes (57%) and 30 eyes (86%) having a postoperative spherical equivalent within ±0.50 and ±1.00 diopter, respectively. Most corneal irregularity indexes and the level of ocular higher-order aberrations, primary coma, and trefoil (P < .05) were significantly reduced postoperatively. No significant corneal haze or safety issues were observed. CONCLUSIONS TWFG PRK, using the iD2 system with simultaneous CXL, regularized the cornea by correcting the spherocylindrical error and minimizing the amount of higher-order aberrations in mild-to-moderate keratoconus.
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Comparison of pulsed and continuous accelerated corneal crosslinking for keratoconus: 1-year results at a single center. J Cataract Refract Surg 2021; 47:641-648. [PMID: 33196569 DOI: 10.1097/j.jcrs.0000000000000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the clinical outcomes between pulsed and continuous accelerated crosslinking (CXL) for keratoconus. SETTING Hospital. DESIGN Retrospective comparison study. METHODS Korean patients who were treated for keratoconus between September 2015 and January 2018 at Seoul St. Mary's Hospital were included. Eyes were subjected to pulsed accelerated crosslinking (30 mW/cm2 for 8 minutes, 1 second on/1 second off) or continuous accelerated crosslinking (30 mW/cm2 for 4 minutes; delivering 7.2 J/cm2). Outcomes were evaluated after 1 year. RESULTS At 1 year, the 2 groups did not exhibit changes in their corrected and uncorrected distance visual acuity values. The pulsed group (25 eyes in 25 patients) exhibited significantly improved values for sphere (P = .009) and spherical equivalent (P = .033), although no statistically significant difference was observed in the continuous group (20 eyes in 20 patients). All keratometry (k)values (SimKf, SimKs, SimKmean, and Kmax) improved in both groups (all P < .05), although the pulsed group had significantly greater changes in the SimKmean value (P = .036) and the Kmax value (P = .03). Both groups had significantly decreased central and thinnest corneal thicknesses (all P < .001), although the pulsed group had a substantially lower thinnest corneal thickness (P = .017). Corneal densitometry measured using the Pentacam device increased in both groups (all P < .001), with a higher densitometry value in the pulsed group (P = .013). Furthermore, the depth of the demarcation line was deeper in the pulsed group (P = .015). CONCLUSIONS Pulsed accelerated crosslinking might provide better postcrosslinking effects than continuous accelerated crosslinking.
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Evaluating keratoconus progression prior to crosslinking: maximum keratometry vs the ABCD grading system. J Cataract Refract Surg 2021; 47:33-39. [PMID: 33181627 DOI: 10.1097/j.jcrs.0000000000000475] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/18/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the correlation between changes in maximum keratometry (Kmax) and ABC values from the ABCD Progression Display (Pentacam) in progressive keratoconus (KC) and to evaluate whether the ABC changes were able to detect progression earlier than Kmax. SETTING Humanitas Clinical and Research Center, Rozzano, Milan, Italy. DESIGN Retrospective study. METHODS Kmax, ABC values, and thinnest point (ThCT) were recorded at the day of corneal crosslinking (CXL) (T0) and previous follow-up (T-1). In patients without earlier progression in Kmax, follow-up examination (T-2) was used to determine whether any of the ABC parameters reached statistical significance for progression. RESULTS Seventy-six eyes of 63 patients scheduled for CXL with documented progression (Kmax increase of >1.00 diopter) were included. There was a significant, albeit moderate, correlation between the change in Kmax between T0 and T-1 and the change in both A (ρ = 0.391) and B values (ρ = 0.339). There was no significant correlation between the change in Kmax between T0 and T-1 and the change in either C or ThCT. In patients with T-2 examinations, 16 (51.6%) of 31 patients showed a statistically significant change on the ABCD progression display that was not detected with Kmax. CONCLUSIONS This study showed a significant, but moderate, correlation between the change in Kmax and the change in A and B values in progressive KC. Moreover, more than half of the cases showed documented progression earlier with the ABCD progression display than that detected by standard Kmax changes. This study suggests possible changes in progression criteria to allow for earlier intervention.
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Abstract
Corneal crosslinking has been well-described for the treatment of progressive corneal ectasias. Although the goal of treatment in these conditions is the decrease in the risk of progressive steepening of the cornea, studies have shown that flattening of the cornea is achieved in many cases. This finding has led to the postulation that corneal crosslinking may have a potential role in the primary treatment of myopia, and that targeted approaches with more specialized patterns of treatment may be used as primary treatments for astigmatism and hyperopia. In this review, we provide a summary of the clinical and laboratory-based studies evaluating corneal crosslinking as a primary, solitary, refractive treatment for myopia, hyperopia, and astigmatism. Clinical studies thus far are small case series. The primary benefit of refractive corneal crosslinking seems to be the correction of small myopic or hyperopic refractive errors without the need for corneal incisions or tissue removal.
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Affiliation(s)
- Viral V Juthani
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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Pagano L, Gadhvi KA, Borroni D, Iselin KC, Vinciguerra R, Tzamalis A, Kaye SB, Romano V. Bilateral Keratoconus Progression: Immediate Versus Delayed Sequential Bilateral Corneal Cross-linking. J Refract Surg 2021; 36:552-556. [PMID: 32785729 DOI: 10.3928/1081597x-20200629-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/12/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare immediate sequential bilateral corneal cross-linking (CXL), wherein both eyes are treated on the same day, to delayed sequential bilateral CXL, where each eye is treated on different days for bilateral progressive keratoconus. METHODS This was a retrospective case note review of all patients who underwent sequential CXL or delayed CXL for keratoconus at Royal Liverpool University Hospital, United Kingdom. Parameters assessed were the change in maximum keratometry and minimum central corneal thickness on corneal tomography scan, corrected distance visual acuity, and cost estimates of treatment. RESULTS A total of 38 patients (31 men and 7 women) with keratoconus with a mean age of 25.3 ± 7.0 years were included. Twenty patients received sequential CXL and 18 received delayed CXL treatment. In both the sequential CXL and delayed CXL groups, the treated eye(s) showed no evidence of progression after the corneal CXL treatment at last follow-up visit after 358 ± 158 days for sequential CXL and 451 ± 205 days for delayed CXL. There were no complications from the treatment in either group. In the delayed CXL group, the mean time interval between the two CXL procedures was 146 ± 129 days. Five of 18 patients (27%) showed progression of keratoconus in their second eye during the waiting time. Economical evaluation showed that four visits were saved for each sequential CXL treatment compared to delayed CXL. CONCLUSIONS Delayed CXL carries a risk of progression in the second eye and is associated with a higher economic burden. [J Refract Surg. 2020;36(8):552-556.].
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Vinciguerra R, Fossati G, Sorrentino T, Legrottaglie EF, Piscopo R, Rosetta P, Vinciguerra P. Corneal Cross-linking for Progressive Keratoconus in Patients Older Than 40 Years: Long-term Follow-up. J Refract Surg 2021; 37:338-342. [PMID: 34044691 DOI: 10.3928/1081597x-20210210-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the long-term efficacy and safety of epithelium-off corneal cross-linking according to the standard (Dresden) protocol (S-CXL) in patients with progressive keratoconus older than 40 years. METHODS Seventy-six eyes of 64 patients with a mean age of 46.4 ± 5.2 years were included. At baseline and after 6, 12, 24, 36, 48, 60, 72, 84, and more than 96 months (when available) after S-CXL, all patients were assessed with distance-corrected visual acuity (DCVA) and corneal topography and tomography with Pentacam HR (OCULUS Optikgeräte GmbH). A generalized linear model was used to compare the groups. Outcome measures were maximum keratometry, thinnest point, coma, spherical, and higher order aberrations, and ABC values. Fixed and random factors were age, gender, atopy, laterality, and group. RESULTS The mean follow-up time was 62.1 ± 40.1 months (range: 12 to 144 months). The main outcome of the study was the evidence that S-CXL was able to safely stop the progression of keratoconus in all patients with none requiring repeat CXL. The generalized linear model analysis showed no significant change in DCVA over time (P = 1.000), but atopy was negatively associated with DCVA (P = .030, B = -0.69). The generalized linear model also showed that CXL was able to induce a significant flattening demonstrated as reduction of maximum keratometry (P = .001, B = -0.35) and A value (P =.001, B = -0.015) of the ABC display. Similarly, coma aberration was reduced over time (P = .006, B = -0.005). CONCLUSIONS S-CXL was confirmed to be a safe and effective treatment for progressive keratoconus even after the age of 40 years, inducing a significant flattening of the cone. [J Refract Surg. 2021;37(5):338-342.].
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Sot M, Gan G, François J, Chaussard D, Da Costa M, Luc MS, Goetz C, Dinot V, Lhuillier L, Perone JM. Risk factors for keratoconus progression after treatment by accelerated cross-linking (A-CXL): A prospective 24-month study. J Fr Ophtalmol 2021; 44:863-872. [PMID: 34059330 DOI: 10.1016/j.jfo.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/15/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Identification of potential predictive factors for keratoconus progression after treatment by accelerated Cross-linking (A-CXL) SECONDARY OBJECTIVES: Evaluation of clinical and topographic outcomes for two years following accelerated cross-linking treatment for progressive keratoconus including: best spectacle corrected visual acuity (BSCVA), thinnest pachymetry, maximum keratometry (Kmax), cylinder. STUDY Prospective, interventional, monocentric study. SITE: Metz-Thionville Regional Medical Center, Lorraine University, Mercy Hospital, Metz, France. PATIENTS AND METHODS We included 82 eyes of 60 patients between March 2014 and June 2016 who underwent accelerated corneal cross-linking (A-CXL) with epithelial debridement for progressive keratoconus, with a minimum follow-up of 2 years. A complete clinical evaluation and corneal topography were performed before cross-linking, and subsequently at 6, 12 and 24 months post-procedure. The following parameters were monitored during follow-up: best spectacle corrected visual acuity (BSCVA), minimal pachymetry, maximum keratometry (Kmax), mean anterior and posterior curvatures, maximum posterior curvature, presence of optical aberrations, subdivided into spherical aberration, coma, astigmatism, higher order optical aberrations and residual optical aberrations. After a 2-year follow-up, two groups, defined as "responders" and "non-responders" to treatment, were separated for analysis, and their initial characteristics were compared. RESULTS Data for 82 eyes of 60 patients with progressive keratoconus with a mean age of 24±7 years were studied. Fourteen eyes (17.1%) showed signs of progression after treatment by A-CXL (non-responders), and 68 eyes (82.9%) showed stabilization of the disease (responders). Characteristics of non-responding eyes after A-CXL included a younger mean age (20±5 vs. 25±7 years) (P=0.04) and a lower initial mean BCVA for non-responders of 0.44±0.16 logMAR vs. 0.29±0.19 logMAR (P=0.03). Non-responders also had a higher mean maximal posterior curvature (AKB) of -10.84±1.72D vs. -9.46± 1.12D (P=0.03). They also showed more higher order optical aberrations (3.84±1.72D vs. 2.4±1.02D; P=0.01), including coma (3.85±1.81D vs. 2.1±1.01D; P=0.03) and more residual aberrations than responders (1.05±0.44D vs. 0.45±0.6D; P=0.005). No significant differences were found between responders and non-responders for the other parameters in our study. CONCLUSION Eyes with progressive keratoconus who did not respond to A-CXL treatment were the most aggressive cases in the youngest patients, with highest maximum corneal curvatures and most pronounced optical aberrations. These patients should be informed in advance of the high risk of non-response to A-CXL treatment, and of the potential need for additional treatment in the future.
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Affiliation(s)
- M Sot
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - G Gan
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - J François
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - D Chaussard
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - M Da Costa
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - M S Luc
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - C Goetz
- Clinical Research Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - V Dinot
- Clinical Research Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - L Lhuillier
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - J M Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
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Omar HA, El-Agha MSH, Hassaballah MA, Khalil NM. Safety and Efficacy of Epithelial Island Crosslinking in Keratoconus with Thinnest Pachymetry less than 400µ. Middle East Afr J Ophthalmol 2021; 28:11-17. [PMID: 34321817 PMCID: PMC8270024 DOI: 10.4103/meajo.meajo_186_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/08/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE: To evaluate the efficacy and safety of epithelial-island crosslinking (EI-CXL) in keratoconus with corneas thinner than 400 µm. METHODS: Twenty-six patients (30 eyes) underwent EI-CXL (preserving the epithelium over the thinnest area), using standard protocol (3 mW/cm2 for 30 min). Uncorrected and best spectacle-corrected distance visual acuity (UCDVA, BCDVA), manifest refractive spherical equivalent (SEQ), mean simulated keratometry (Kmean), maximum keratometry (Kmax), and thinnest corneal thickness (TCT) were determined preoperatively and at 1, 3, 6, and 12 months following CXL. Endothelial cell count (ECC) was determined preoperatively and at 6 months. Anterior segment optical coherence tomography (AS-OCT) was done at 1 month to determine the depth of the corneal stromal demarcation line (DL). RESULTS: After 1 year, mean UCDVA improved from 1.29 preoperatively to 1.17 (P = 0.001) and BCDVA from 0.62 to 0.57 (P = 0.011). Mean manifest SEQ decreased from -7.63 to-7.32D (P = 0.001). Mean Kmean decreased from 54.92 to 54.81D (P = 0.045), and Kmax from 67.60 to 67.42D (P = 0.072), and mean TCT changed minimally from 377.17 to 375.30 µ (P = 0.11). The mean ECC decreased from 2329 to 2268 cells/mm2 (2.6% decrease, P < 0.001). AS-OCT showed a DL in 29 out of 30 eyes at an average depth of 215.9 µ under the spared epithelium, and 299.9 µ in the de-epithelialized cornea. CONCLUSION: EI-CXL halted keratoconus progression over a 1-year period. This was associated with statistically significant endothelial loss, but less than seen with conventional epi-off CXL in thinner corneas.
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Affiliation(s)
- Hisham A Omar
- Department of Ophthalmology, Kasr Al Ainy School of Medicine, Cairo University, Giza, Egypt
| | | | - Mohamed A Hassaballah
- Department of Ophthalmology, Kasr Al Ainy School of Medicine, Cairo University, Giza, Egypt
| | - Noha M Khalil
- Department of Ophthalmology, Kasr Al Ainy School of Medicine, Cairo University, Giza, Egypt
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Derakhshan A, Heravian J, Abdolahian M, Bamdad S. Long-term Outcomes of Collagen Crosslinking for Early Keratoconus. J Ophthalmic Vis Res 2021; 16:151-157. [PMID: 34055251 PMCID: PMC8126731 DOI: 10.18502/jovr.v16i2.9077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the long-term outcomes of collagen crosslinking in early keratoconus. Methods Thirty eyes of twenty patients with early keratoconus were enrolled. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), objective refraction, subjective refraction, corneal topography and pachymetry were assessed before and 3, 6, 12 months and 9 years after performing collagen crosslinking surgery. Results The patients' mean age was 31.2 ± 5.59 years at nine-year follow-up (range, 25–44 years). The means of preoperative UCVA and BSCVA were 0.57 ± 0.34 and 0.15 ± 0.12 logMAR, respectively, and these values remained stable at the final follow-up (P = 0.990 and P = 0.227, respectively). The mean objective spherical equivalent decreased considerably from –6.00 ± 4.05 D preoperatively to –5.22 ± 3.71 D at the final follow-up (P< 0.05). The mean subjective spherical equivalent was –4.25 ± 2.87 D preoperatively and this value was stable at the last follow-up (P = 0.92). No considerable difference was found between the post- and preoperative mean objective cylinder values (P = 0.34). The mean subjective cylinder value changed significantly from –4.05 ± 1.85 D preoperatively to –3.1 ± 1.42 D at the final follow-up (P< 0.05). The mean central corneal thickness was 496.97 ± 45.95 µm preoperatively and this value was stable at nine-year follow-up (P = 0.183). No significant difference was found between the pre- and postoperative mean maximum and mean minimum corneal curvature values (P = 0.429 and P = 0.248, respectively). There were no significant postoperative complications. Conclusion Corneal crosslinking in early keratoconus seems to be a safe procedure that can effectively stabilize UCVA, BSCVA, subjective SE and CCT, while improving objective spherical equivalent.
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Affiliation(s)
- Akbar Derakhshan
- Cornea Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Khatam-Al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Heravian
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Optometry, School of Paramedical Science, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Milad Abdolahian
- Department of Optometry, School of Paramedical Science, Mashhad University of Medical Sciences, Mashhad, Iran.,Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Bamdad
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gilevska F, Biscevic A, Popovic Suic S, Bohac M, Patel S. Are changes in visual acuity and astigmatism after corneal cross-linking (CXL) in keratoconus predictable? Graefes Arch Clin Exp Ophthalmol 2021; 259:2259-2268. [PMID: 33885984 DOI: 10.1007/s00417-021-05173-5] [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: 09/10/2020] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate changes in corrected distance visual acuity (CDVA), ratio of anterior and posterior corneal radii over the thinnest region of the cornea (ARC/PRC), and astigmatism after cross-linking (CXL) in keratoconus. METHODS Subjective refraction and ARC/PRC (using Pentacam™) were monitored over 1 year in (I) keratoconus treated with routine CXL (n = 53), (II) relatively stable keratoconus (n = 23), and (III) age/gender matched controls (n = 24). RESULTS CDVA (median, mode, interquartile range) improved significantly in group I, compared with groups II and III (p < 0.05), from 0.45 (0.60, 0.20-0.63) to 0.80 (0.95, 0.60-0.95); change in CDVA was associated with preop CDVA (p < 0.01 at all times postop). ARC/PRC (mean ± sd, 95% CI) changed from 1.362 (± 0.048, 1.347-1.377) to 1.425 (± 0.073, 1.401-1.449). CDVA and ARC/PRC remained stable in II and III. Significant relationships were revealed between logCDVA and ARC/PRC in I and II (at 12 months, I rs = - 0.464, II rs - 0.449) and logCDVA at postop(y), log CDVA at preop(x1), and ARC/PRC at preop(x2) in I (at 12 months, y = 0.356x1 - 1.312x2 + 1.806, r21 = 0.494, r22 = 0.203). Astigmatic power (mean ± sd, 95% CI) improved from - 3.10DC (± 1.52, - 3.55 to - 2.66) to - 2.53DC (± 1.24, - 2.90 to - 2.17) in I, and worsened from - 1.27DC (± 1.32, - 1.81 to - 0.73) to - 1.61DC (± 1.28, - 2.13 to - 1.09) in II. Vector analysis revealed in group I (a) the power of the surgically induced astigmatism (SIA) was linked to astigmatic power at preop and (b) the difference between the axis of astigmatism at preop(ø) and the axis of the SIA was linked to ø. CONCLUSION CXL improved CDVA, increased the ARC/PRC ratio, and modified the association between CDVA and ARC/PRC. The change in CDVA was linked to preop CDVA and ARC/PRC values. The association between SIA and preop astigmatism implies there is not a simple cause and effect relationship with CXL.
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Affiliation(s)
- Fanka Gilevska
- Eye Clinic Sistina Oftalmologija, Skupi 5A, Skopje, Republic of North Macedonia.
| | | | | | - Maja Bohac
- Specialty Eye Hospital "Svjetlost", Zagreb, Croatia.,School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sudi Patel
- Specialty Eye Hospital "Svjetlost", Zagreb, Croatia
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Asgari S, Hashemi H, Mohamadi A, Jafarzadehpur E, Miraftab M, Shahhoseini S, Mehravaran S, Fotouhi A. Scotopic contrast sensitivity and glare after accelerated corneal cross‐linking. Clin Exp Optom 2021; 101:52-56. [DOI: 10.1111/cxo.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/26/2017] [Accepted: 03/31/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Soheila Asgari
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran,
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran,
| | - Alireza Mohamadi
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran,
| | | | - Mohammad Miraftab
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran,
| | - Saied Shahhoseini
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran,
| | - Shiva Mehravaran
- Stein Eye Institute, University of California, Los Angeles, California, USA,
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
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38
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Severinsky B, Wajnsztajn D, Frucht‐pery J. Silicone hydrogel mini‐scleral contact lenses in early stage after corneal collagen cross‐linking for keratoconus: a retrospective case series. Clin Exp Optom 2021; 96:542-6. [DOI: 10.1111/cxo.12034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Boris Severinsky
- Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel,
| | - Denise Wajnsztajn
- Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel,
| | - Joseph Frucht‐pery
- Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel,
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Chan E, Snibson GR. Current status of corneal collagen cross‐linking for keratoconus: a review. Clin Exp Optom 2021; 96:155-64. [DOI: 10.1111/cxo.12020] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/24/2012] [Accepted: 10/03/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elsie Chan
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia,
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Yang K, Xu L, Fan Q, Gu Y, Zhang B, Meng F, Zhao D, Pang C, Ren S. A hospital-based study on clinical data, demographic data and visual function of keratoconus patients in Central China. Sci Rep 2021; 11:7559. [PMID: 33824422 PMCID: PMC8024332 DOI: 10.1038/s41598-021-87291-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
China is a populous country but lacks epidemiological data on keratoconus (KC). The present study aimed to investigate the clinical data, demographic data, and visual function (VF) data of KC patients in Central China. A total of 524 KC eyes in 307 KC patients (217 bilateral and 90 unilateral) from Henan Eye Hospital were included in the current study. Demographic and VF data were assessed with questionnaires administered by well-trained staff during face-to-face interviews. Visual acuity value was examined by a qualified optometrist, and the clinical data were measured by professional clinicians. The distributions of sex, residence and education level of KC patients were compared by Chi-square tests, and the ratios of people wearing glasses and rigid gas permeable (RGP) lenses were compared by McNemar tests. General linear models/Chi-squared tests were used to compare the clinical and demographic data according to KC severity. Spearman’s correlation analysis was used to test the associations between the data and KC severity. The mean age at diagnosis was 20.98 ± 6.06 years, and males had a higher ratio of KC than females (P < 0.001). Patients in rural areas had a higher rate of KC than those in urban areas (P = 0.039), and the proportion of KC patients with a higher education level (above high school) was high (P < 0.001). A total of 68.40% of the patients reported eye rubbing and 3.52% had a positive family history. The percentage of people wearing glasses was higher than that of patients wearing RGP lenses (P < 0.001). The total VF score of KC patients was 69.35 ± 15.25. The thinnest corneal thickness (TCT) and stiffness parameter at the first applanation (SP-A1) values were inversely correlated with KC severity (P < 0.05). The mean, steep, and max keratometry (Km, Ks and Kmax) values, the RGP lens use and keratoplasty were positively correlated with KC severity (all P < 0.05). The total VF score of the eye with better VA decreased as the severity increased (r = − 0.21, P = 0.002). The present study comprehensively describes various associated features of KC patients from a tertiary hospital in Central China, providing a reference for understanding the characteristics of KC patients in China.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Bo Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Feiying Meng
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Dongqing Zhao
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China.
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Wan KH, Ip CKY, Kua WN, Chow VWS, Chong KKL, Young AL, Cheng GPM, Jhanji V. Transepithelial corneal collagen cross‐linking using iontophoresis versus the Dresden protocol in progressive keratoconus: A meta‐analysis. Clin Exp Ophthalmol 2021; 49:228-241. [DOI: 10.1111/ceo.13918] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Kelvin H. Wan
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Kowloon Hong Kong
- Hong Kong Eye Hospital Kowloon Hong Kong
| | - Christina K. Y. Ip
- Department of Ophthalmology and Visual Sciences Prince of Wales Hospital Shatin Hong Kong
| | - Wee Nie Kua
- Department of Ophthalmology Tuen Mun Hospital Tuen Mun Hong Kong
| | - Vanissa W. S. Chow
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Kowloon Hong Kong
- Hong Kong Eye Hospital Kowloon Hong Kong
| | - Kelvin K. L. Chong
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Kowloon Hong Kong
- Department of Ophthalmology and Visual Sciences Prince of Wales Hospital Shatin Hong Kong
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Kowloon Hong Kong
- Department of Ophthalmology and Visual Sciences Prince of Wales Hospital Shatin Hong Kong
| | - George P. M. Cheng
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Kowloon Hong Kong
- Hong Kong Laser Eye Centre Central Hong Kong
| | - Vishal Jhanji
- Department of Ophthalmology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
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Results of Corneal Collagen Cross-Linking in Adolescents with Progressive Keratoconus - A Prospective Study. J Cataract Refract Surg 2021; 47:1333-1337. [PMID: 33769766 DOI: 10.1097/j.jcrs.0000000000000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Evaluate the safety and efficacy of epi-off corneal cross-linking (CXL) in adolescents with progressive keratoconus (KC). SETTING Private clinical practice DESIGN:: Nonrandomized prospective clinical trial METHODS:: 230 adolescent patients aged 10-19 years old with progressive keratoconus (increasing maximum keratometry (Kmax) or astigmatism of ≥ 1 D associated with decreased corrected distance visual acuity (CDVA)) underwent CXL. Exclusion criteria were age at time of CXL < 10 years or > 19 years, corneas that were thinner than 400 μm or demonstrated central corneal scarring, history of herpetic eye disease, or pregnancy or nursing. Follow up examinations of uncorrected distance visual acuity (UDVA), CDVA, Kmax and minimum pachymetry occurred on 130 eyes at 1 year, 77 eyes at 2 years and 55 eyes at 3 years post-CXL. RESULTS UCVA significantly improved from preop to 1, 2 and 3 years post-CXL. CDVA significantly improved from preop to 1, 2 and 3 years post-CXL. Kmax significantly reduced (improved) from preop to 1 and 3 years post-CXL and reduced (improved) (p=0.22) from preop to two years post-CXL. Minimum pachymetry decreased significantly from preop to 1, 2 and 3 years post-CXL. CONCLUSIONS CXL in patients aged 10-19 years old is safe and efficacious, halts progression of KC and can improve UCVA, CDVA and Kmax. Minimum pachymetry decreases and stabilizes post-CXL. Ophthalmologists should encourage adolescent patients with KC to obtain prompt evaluation and possible CXL to halt progression of the disease.
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43
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Mahjoob M, Birjandi F, Ostadimoghaddam H, Yekta A. Initial power of rigid gas permeable contact lenses in patients with keratoconus. J Curr Ophthalmol 2021; 33:413-416. [PMID: 35128187 PMCID: PMC8772499 DOI: 10.4103/joco.joco_23_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 11/04/2022] Open
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Badawi A. Corneal haze and densitometry in keratoconus after collagen cross-linking by three different protocols. J Curr Ophthalmol 2021; 33:422-430. [PMID: 35128189 PMCID: PMC8772486 DOI: 10.4103/joco.joco_145_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 11/04/2022] Open
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Kankariya VP, Dube AB, Grentzelos MA, Kontadakis GA, Diakonis VF, Petrelli M, Kymionis GD. Corneal cross-linking (CXL) combined with refractive surgery for the comprehensive management of keratoconus: CXL plus. Indian J Ophthalmol 2020; 68:2757-2772. [PMID: 33229651 PMCID: PMC7856931 DOI: 10.4103/ijo.ijo_1841_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The past two decades have witnessed an unprecedented evolution in the management of keratoconus that demands a holistic approach comprising of inhibiting the ectatic progression as well as visual rehabilitation. The advent of corneal cross-linking (CXL) in the late 1990s resulted in long-term stabilization of the ectatic cornea along with limited reduction in corneal steepening and regularization of corneal curvature. However, CXL as a standalone procedure does not suffice in rehabilitating the functional vision especially in patients who are unwilling or intolerant towards contact lenses. The concept of “CXL plus” was proposed which incorporates adjunctive use of refractive procedures with CXL in order to overcome the optical inefficiency due to corneal irregularity, decrease the irregular astigmatism, correct the residual refractive error and improve functional visual outcome in keratoconus. Several refractive procedures such as conductive keratoplasty (CK), photorefractive keratectomy (PRK), transepithelial phototherapeutic keratectomy (t-PTK), intrastromal corneal ring segments (ICRS) implantation, phakic intraocular lens (PIOL) implantation and multiple other techniques have been combined with CXL to optimize and enhance the CXL outcome. This review aimed to summarize the different protocols of CXL plus, provide guidelines for selection of the optimum CXL plus technique and aid in decision-making for the comprehensive management of cases with primary keratoconus in addition to discussing the future and scope for innovations in the existing treatment protocols.
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Affiliation(s)
| | - Ankita B Dube
- Asian Eye Hospital and Laser Institute, Pune, Maharashtra, India
| | - Michael A Grentzelos
- Asian Eye Hospital and Laser Institute, Pune, Maharashtra, India; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - George A Kontadakis
- Laboratory of Vision and Optics, Medical School, University of Crete, Heraklion, Greece
| | | | - Myrsini Petrelli
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - George D Kymionis
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
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Sheludchenko VM, Voronin GV, Osipyan GA, Djalili RA. [Methods of surgical treatment of keratectasia and analysis of postsurgical quality of vision]. Vestn Oftalmol 2020; 136:308-316. [PMID: 33063982 DOI: 10.17116/oftalma2020136052308] [Citation(s) in RCA: 2] [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
Keratectasias are non-inflammatory dystrophic diseases of the cornea characterized by progressive bilateral thinning of the cornea that lead to deterioration in the quantitative and qualitative characteristics of vision reducing patient's quality of life. The changes can be asymmetrical and destructive. A number of surgeries have been proposed to reduce the negative effects of keratectasia including penetrating keratoplasty and its modifications, implantation of corneal ring segments, corneal cross-linking - alone and in combination with other methods, intrastromal keratoplasty. These methods can improve visual acuity to a certain degree and help slow the progression of keratectasia. This article studies various surgical methods used for treating keratectasia and analyses possible assessment of the quality of vision before and after the treatment.
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Affiliation(s)
| | - G V Voronin
- Research Institute of Eye Diseases, Moscow, Russia
| | - G A Osipyan
- Research Institute of Eye Diseases, Moscow, Russia
| | - R A Djalili
- Research Institute of Eye Diseases, Moscow, Russia
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47
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Legrottaglie EF, Balia L, Camesasca FI, Vallejo-Garcia JL, Fossati G, Vinciguerra R, Rosetta P, Vinciguerra P. Management of an ophthalmology department during COVID-19 pandemic in Milan, Italy. Eur J Ophthalmol 2020; 31:2259-2267. [PMID: 32962415 PMCID: PMC7511831 DOI: 10.1177/1120672120960334] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Spreading from China, COVID-19 pandemic reached Italy, the first massively involved western nation. At the beginning of March, 2020 in Northern Italy a complete lockdown of activities was imposed. Access to all healthcare providers, was halted for patients with elective problems. We present the management experience of the Humanitas Clinical and Research Center Ophthalmology Department in Rozzano, Milan, Italy, during the lockdown. METHODS Containment measures were taken to reduce viral transmission and identify infected patients. All planned visits were canceled but for those not deferrable. Social distancing was introduced reducing number of visits per hour. Minor surgery for progressive pathologies was continued. As the lockdown prolonged, we reorganized patient care. All canceled cases were evaluated by electronic medical records analysis and telephonic triage, to identify, recall, and visit patients at risk of vision loss. RESULTS From March 9, to April 30, 2020 we performed a total of 930 visits and 612 exams. Some visits (n = 698) and exams (n = 160) were deemed as necessary for continuity of care and performed as planned. Among the remaining 1283 canceled appointments, after evaluation 144 visits and 32 instrumental exams were classified as urgent and rapidly rescheduled. Performed surgical activities were limited to corneal collagen cross linking (n = 39) and intravitreal injections (n = 91), compared to 34 and 94, respectively, in the same period of 2019. CONCLUSION In-office activities deemed not deferrable were performed safely. The recall service was highly appreciated by all patients. No patient or staff member reported symptoms of COVID-19.
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Affiliation(s)
| | - Laura Balia
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | | | | | - Giovanni Fossati
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | | | | | - Paolo Vinciguerra
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Comparative Results of "Epi-Off" Conventional versus "Epi-Off" Accelerated Cross-Linking Procedure at 5-year Follow-Up. J Ophthalmol 2020; 2020:4745101. [PMID: 32774904 PMCID: PMC7396097 DOI: 10.1155/2020/4745101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The aim of our study was to compare the long-term efficacy and safety of “epi-off” conventional and “epi-off” accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. Methods “Epithelial-off” (“Epi-off”) CXL using the conventional technique (3 mW/cm2, 30 minutes) was performed in 93 eyes of 93 patients (S-CXL group) and “epi-off” accelerated method (9 mW/cm2, 10 minutes) in 76 eyes of 76 patients with progressive KCN (A-CXL group). Cases with different stages of keratoconus and topographic evidence of progression were included. Main outcomes comprised refraction, keratometry measurements, uncorrected (UCVA) and best-corrected visual acuity (BCVA), and topographical indices. Micromorphological analysis was assessed by anterior segment ocular coherence tomography (AS-OCT). The follow-up period was 5 years. Results In both groups, Kflat presented similar results: decrease at 1 year (p=0.465), at 2 years (p=0.672), at 3 years (p=0.198), at 4 years (p=0.32), and at 5 years (p=0.864). In both groups, Ksteep presented a similar decrease at 1 year (p=0.709), at 2 years (p=0.455), at 3 years (p=0.43), at 4 years (p=0.57), and at 5 years (p=0.494), with no statistically significant difference. Decrease in Kavg was similar in both groups at all analyzed time points (p=0.18 at 1 year, p=0.093 at 2 years, p=0.57 at 3 years, p=0.154 at 4 years, and p=0.247 at 5 years). Kmax had a similar decrease in both groups at 1 year (p=0.06), at 2 years (p=0.09), at 3 years (p=0.126), at 4 years (p=0.113), and at 5 years (p=0.114). There was no statistically significant difference between the cylinder decrease in both groups (p=0.349 at 1 year, p=0.6782 at 2 years, p=0.299 at 3 years, p=0.0943 at 4 years, and p=0.144 at 5 years). The BCVA values were statistically significantly higher than the preoperative values in both groups at all time points (p < 0.05). Topographical indices such as thinnest corneal point (TP), corneal volume (CV), index vertical asymmetry (IVA), index of vertical asymmetry (ISV), index of height asymmetry (IHA), index of height decentration (IHD), Belin/Ambrosio Enhanced Ectasia Display (BAD_D), and Ambrosio retinal thickness (ART Max) were significantly statistically decreased compared with baseline at all time points, in both groups. Conclusion “Epi-off” accelerated and conventional CXL have the same efficacy in terms of improvement in visual and topographic outcomes.
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De Paula TAA, Cresta FB, Alves MR. Comparative Two-Photon Fluorescence Microscopy Analysis of Riboflavin Penetration in Two Different Solutions: Dextran and Hydroxypropyl Methylcellulose. Clin Ophthalmol 2020; 14:1867-1874. [PMID: 32669833 PMCID: PMC7337433 DOI: 10.2147/opth.s258603] [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: 04/17/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study compared riboflavin penetration in porcine corneas using two different solutions: dextran and hydroxypropyl methylcellulose (HPMC). Methods Porcine corneas were de-swollen and after prepared in an artificial anterior chamber with balanced saline solution. The pressure was checked with a portable tonometer. We used 0.1% riboflavin in 20% dextran for 30 min or 0.1% riboflavin in 1% HPMC for 10 min. The fluorescence intensity in multiphoton microscopy was used to evaluate concentration into the cornea, and ultrasonic pachymetry was performed before and after using riboflavin. Results Riboflavin concentration up to 340 μm was higher in the HPMC group (p 0.146). From 340 microns to 500 μm, the concentration was higher in the dextran group (p 0.248). There was no statistically significant difference between the groups when considering all the corneal thickness studied (p 0.528). Pachymetric measurements in the group with dextran showed a 12.9% corneal thickness decrease after 30 min, while the HPMC group showed a 9.1% increase after 10 min. Conclusion We concluded that 1% HPMC riboflavin for 10 min had the same level of safety when compared to the Dresden protocol with dextran riboflavin for 30 min. Ultrasonic pachymetry during corneal crosslinking has fundamental importance in controlling corneal hydration due to changes in thickness caused by different types of riboflavin. This study used different methods than previous studies to better simulate corneal physiological conditions and used 1% HPMC concentration which differs from previous studies performed with 1.1% HPMC.
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Affiliation(s)
| | | | - Milton Ruiz Alves
- University of São Paulo USP, Ophthalmology, Medical School, São Paulo, Brazil
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Alifa R, Piñero D, Velázquez J, L. Alió del Barrio J, Cavas F, Alió JL. Changes in the 3D Corneal Structure and Morphogeometric Properties in Keratoconus after Corneal Collagen Crosslinking. Diagnostics (Basel) 2020; 10:diagnostics10060397. [PMID: 32545294 PMCID: PMC7345591 DOI: 10.3390/diagnostics10060397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
Keratoconus is an ectatic disorder that is presently considered one of the most prevalent reasons for keratoplasty. Corneal collagen crosslinking (CXL) is the only proven treatment option available that is capable of halting the progression of the disease by stabilizing the cone in 90% of cases, and by also reducing refractive error and maximal keratometry. This study assesses, by means of a 3D morphogeometric analysis procedure developed by our research team, the corneal structure changes that occur immediately after CXL treatment and during a 6 month follow-up period. A total of 19 eyes from 19 patients diagnosed with keratoconus who underwent CXL were included, and several variables derived from the morphogeometric analysis were calculated and evaluated for the pre-operative, 3 month postoperative, and 6 month postoperative states. Significant reductions were detected in central corneal thickness and corneal spherical-like root mean square (RMS) 3 months after surgery, with non-significant regression of the effect afterward. Significant reductions in the total corneal area/volume were found, with some levels of regression after 6 months in certain volumetric parameters. In conclusion, the eyes with higher values for morphogeometric parameters—posterior apex deviation (PAD), anterior minimum thickness point deviation (AMTPD), and posterior minimum thickness point deviation (PMTPD)—seemed more likely to undergo aberrometric improvement as a result of CXL surgery.
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Affiliation(s)
- Ramón Alifa
- Doctorate Program in Industrial Technologies, International School of Doctorate, Technical University of Cartagena, 30202 Cartagena, Spain;
| | - David Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain;
| | - José Velázquez
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
| | - Jorge L. Alió del Barrio
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (J.L.A.d.B.); (J.L.A.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03202 Alicante, Spain
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
- Correspondence: ; Tel.: +34-968-328856
| | - Jorge L. Alió
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (J.L.A.d.B.); (J.L.A.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03202 Alicante, Spain
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