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Prinz J, Kuerten D, Schellhase H, Koutsonas A, Djalali-Talab Y, Walter P, Fuest M. Clinical, Anatomical, and Densitometric Changes following Dresden vs. Accelerated Corneal Cross-Linking in Progressive Keratoconus. Klin Monbl Augenheilkd 2024; 241:209-220. [PMID: 38232738 DOI: 10.1055/a-2206-1420] [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: 01/19/2024]
Abstract
BACKGROUND To compare clinical, anatomical, and densitometric changes following Dresden (DCXL) vs. accelerated (ACXL) corneal UVA cross-linking (CXL; Avedro KXL, Geuder, Heidelberg, Germany) in progressive keratoconus (KC). METHODS AND MATERIAL In this retrospective study, we analyzed 20 patients following DCXL (3 mW/cm², 30 min, 5.4 J/cm²) and 44 patients following ACXL (9 mW/cm², 10 min, 5.4 J/cm²) between January 2016 and February 2020. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), steepest keratometry (Kmax), keratoconus index (KI), thinnest pachymetry (Pthin), and corneal densitometry (CD) were measured before and 3, 6, 12, and 24 months after CXL. RESULTS During the follow-up period, no changes in UCVA, BSCVA, Kmax, KI, or Pthin occurred. CCT significantly decreased 3 months after DCXL (p = 0.032) and ACXL (p = 0.006). At the 12- and 24-month follow-up, CCT remained decreased in the DCXL (p = 0.035, 0.036, respectively) but not in the ACXL group. At the 12-month follow-up, the reduction in CCT was significantly greater in DCXL compared to ACXL (p = 0.012). At the 3-, 6-, 12-, and 24-month follow-ups, we found a significant increase in the anterior stroma CD following DCXL (p = 0.019, 0.026, 0.049, 0.047, respectively) but not ACXL. The CD changes were localized in the central concentric zones (0.0 to 6.0 mm). No intra- or postoperative complications occurred. CONCLUSION ACXL and DCXL effectively halted KC progression. ACXL proved to be a safe time-saving alternative to conventional DCXL. DCXL led to a reduction in CCT and an increment in the CD of the central anterior stroma during 24 months of follow-up.
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Affiliation(s)
- Julia Prinz
- Clinic of Ophthalmology, University Hospital Aachen, Aachen, Germany
| | - David Kuerten
- Clinic of Ophthalmology, University Hospital Aachen, Aachen, Germany
| | - Hannah Schellhase
- Clinic of Ophthalmology, University Hospital Aachen, Aachen, Germany
| | - Antonis Koutsonas
- Clinic of Ophthalmology, University Hospital Aachen, Aachen, Germany
| | | | - Peter Walter
- Clinic of Ophthalmology, University Hospital Aachen, Aachen, Germany
| | - Matthias Fuest
- Clinic of Ophthalmology, University Hospital Aachen, Aachen, Germany
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Lenk J, Herber R, Oswald C, Spoerl E, Pillunat LE, Raiskup F. Risk Factors for Progression of Keratoconus and Failure Rate After Corneal Cross-linking. J Refract Surg 2021; 37:816-823. [PMID: 34914558 DOI: 10.3928/1081597x-20210830-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the occurrence of risk factors for progression of keratoconus and failure rate after corneal cross-linking (CXL) in patients with progressive keratoconus. METHODS This retrospective study observed 230 eyes of 173 patients with a minimum follow-up of 36 months after CXL. A total of 185 eyes underwent CXL once (80%) (control) and 45 (20%) underwent this treatment more than once (Re-CXL-group). Subgroup analysis included standard CXL with the Dresden protocol (S-CXL group, n = 120) and accelerated CXL with a reduced radiation time of 10 minutes and a higher radiation power of 9 mW/cm2 (A-CXL group, n = 110). Risk factors of interest were age, maximum keratometry (Kmax), minimum corneal thickness (MCT), sex, and atopy (including allergic bronchial asthma, food allergy, allergic rhinitis, and neurodermatitis). RESULTS Follow-up for the control group was 76.0 ± 33.2 months. Re-CXL was performed after 46.2 ± 34.1 months overall and after 62.6 ± 41.9 months in the S-CXL subgroup and 29.2 ± 19.2 months in the A-CXL subgroup (P = .02). Kaplan-Meier analysis revealed a cumulative prediction rate of success after CXL of 92.5% (S-CXL) and 86.4% (A-CXL) after 36 months (P = .103). A high preoperative Kmax value (odds ratio = 1.056, P = .003 and odds ratio = 1.067, P = .028) in both subgroups and the presence of neurodermatitis combined with other atopic diseases in the A-CXL group (odds ratio = 11.662, P = .003) were significant risk factors for new progression of keratoconus after CXL. CONCLUSIONS Risk factors for progression of keratoconus after CXL are both high preoperative Kmax values and the presence of neurodermatitis combined with other atopic diseases. Patients with severe atopy should receive the S-CXL procedure. [J Refract Surg. 2021;37(12):816-823.].
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Meyer JJ, Jordan CA, Patel DV, Gokul A, Dean SJ, Ahmed S, Subbiah S, McGhee CNJ. Five-year results of a prospective, randomised, contralateral eye trial of corneal crosslinking for keratoconus. Clin Exp Ophthalmol 2021; 49:542-549. [PMID: 34117699 DOI: 10.1111/ceo.13959] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few studies have evaluated corneal crosslinking (CXL) in a prospective, randomised fashion. This study aimed to determine the efficacy and safety of CXL to reduce the progression of keratoconus. METHODS Prospective, unmasked, randomised, contralateral eye controlled trial at a tertiary eye centre. PARTICIPANTS Individuals with bilateral progressive keratoconus. One eye from each subject was randomised to CXL and the contralateral, untreated eye acted as the control. PRIMARY OUTCOME MEASURE change in maximum keratometry. SECONDARY OUTCOME MEASURES uncorrected distance visual acuity, spectacle corrected distance visual acuity, spherical equivalent refraction, simulated keratometry, corneal astigmatism, minimum pachymetry and complications. RESULTS Thirty-eight individuals (mean age 21.1 ± 6.7 years) were enrolled with one eye treated with CXL. At 5 years, there was a mean decrease in maximum keratometry of treated eyes (-1.45 ± 2.25 D) compared to an increase among the controls (1.71 ± 2.46 D; p < 0.001). There were significant differences between the treated and control groups in the mean change of Steep SimK (-1.07 ± 1.22 vs. 0.96 ± 1.97 D; p < 0.001), Flat SimK (-0.61 ± 1.34 vs. 0.43 ± 1.12 D; p < 0.001), corneal astigmatism (-0.45 ± 1.31 vs. 0.63 ± 1.52 D; p < 0.01) and minimum pachymetry (-32.49 ± 26.32 vs. -13.57 ± 24.11 μm; p < 0.01). Complications included sterile infiltrates (n = 2), microbial keratitis (n = 1), persistent corneal haze/scarring at 5 years (n = 4) and loss of ≥2 lines of corrected distance visual acuity (n = 3). CONCLUSIONS CXL is an effective and relatively safe intervention to halt or reduce the progression of keratoconus in the majority of eyes for at least 5 years.
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Affiliation(s)
- Jay J Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Charlotte A Jordan
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Dipika V Patel
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Simon J Dean
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Suheb Ahmed
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Northern Health, Melbourne, Victoria, Australia
| | - Shanu Subbiah
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Iqbal M, Elmassry A, Badawi AE, Gharieb HM, Said OM. Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management. Clin Ophthalmol 2019; 13:2477-2488. [PMID: 31849445 PMCID: PMC6913285 DOI: 10.2147/opth.s232954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/04/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose To analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management. Patients and methods This study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively. Results Forty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by <1 D, 23 eyes (46.9%) improved from 1 D to <2 D and 7 eyes (14.3%) improved by ≥2 D. Both uncorrected distant visual acuity (UDVA) and corrected distant visual acuity (CDVA) showed statistically significant improvement from preoperative 1.34±0.29 (mean±SD) and 0.74±0.23 LogMAR to postoperative 0.99±0.32 and 0.50±0.22 LogMAR (P<0.0001) respectively. Both Kmax and SE refraction showed statistically significant and stable improvement from preoperative 51.95±1.90 and −7.90±3.14 D to postoperative 50.19±1.96 and −6.35±2.49 D (P<0.0001) respectively. Two eyes (4%) showed KC progression at the end of 5th follow-up year. Conclusion SCXL had good effectiveness and stability that halted KC progression over 5-year follow-up period. It had also unexpected improvement in the KC refractive components mainly the spherical and SE components.
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Affiliation(s)
- Mohammed Iqbal
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed Elmassry
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amani E Badawi
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hesham M Gharieb
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Omar M Said
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Batista A, Breunig HG, Hager T, Seitz B, König K. Early evaluation of corneal collagen crosslinking in ex-vivo human corneas using two-photon imaging. Sci Rep 2019; 9:10241. [PMID: 31308406 PMCID: PMC6629644 DOI: 10.1038/s41598-019-46572-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/19/2019] [Indexed: 11/09/2022] Open
Abstract
The clinical outcome of corneal collagen crosslinking (CXL) is typically evaluated several weeks after treatment. An earlier assessment of its outcome could lead to an optimization of the treatment, including an immediate re-intervention in case of failure, thereby, avoiding additional discomfort and pain to the patient. In this study, we propose two-photon imaging (TPI) as an earlier evaluation method. CXL was performed in human corneas by application of riboflavin followed by UVA irradiation. Autofluorescence (AF) intensity and lifetime images were acquired using a commercial clinically certified multiphoton tomograph prior to CXL and after 2h, 24h, 72h, and 144h storage in culture medium. The first monitoring point was determined as the minimum time required for riboflavin clearance from the cornea. As control, untreated samples and samples treated only with riboflavin (without UVA irradiation) were monitored at the same time points. Significant increases in the stroma AF intensity and lifetime were observed as soon as 2h after treatment. A depth-dependent TPI analysis showed higher AF lifetimes anteriorly corresponding to areas were CXL was most effective. No alterations were observed in the control groups. Using TPI, the outcome of CXL can be assessed non-invasively and label-free much sooner than with conventional clinical devices.
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Affiliation(s)
- Ana Batista
- Saarland University, Department of Biophotonics and Laser Technology, Campus A5.1, 66123, Saarbruecken, Germany. .,JenLab GmbH, Johann-Hittorf-Straße 8, 12489, Berlin, Germany.
| | - Hans Georg Breunig
- Saarland University, Department of Biophotonics and Laser Technology, Campus A5.1, 66123, Saarbruecken, Germany.,JenLab GmbH, Johann-Hittorf-Straße 8, 12489, Berlin, Germany
| | - Tobias Hager
- Saarland University, Department of Ophthalmology, Medical Center, 66421, Homburg, Saar, Germany
| | - Berthold Seitz
- Saarland University, Department of Ophthalmology, Medical Center, 66421, Homburg, Saar, Germany.,Lions Cornea Bank Saar-Lor-Lux, Trier/Westpfalz, Medical Center, 66421, Homburg, Saar, Germany
| | - Karsten König
- Saarland University, Department of Biophotonics and Laser Technology, Campus A5.1, 66123, Saarbruecken, Germany.,JenLab GmbH, Johann-Hittorf-Straße 8, 12489, Berlin, Germany
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Chen X, Stojanovic A, Xu Y, Zhou W, Raeder S, Enayati S, Utheim TP. Medium- to Long-Term Results of Corneal Cross-Linking for Keratoconus Using Phototherapeutic Keratectomy for Epithelial Removal and Partial Stromal Ablation. J Refract Surg 2018; 33:488-495. [PMID: 28681909 DOI: 10.3928/1081597x-20170504-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/11/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the medium- to long-term outcomes of corneal cross-linking in treatment of keratoconus using transepithelial phototherapeutic keratectomy (PTK-CXL) for epithelial removal and partial stromal ablation to stabilize the cornea, reduce corneal irregularity, and improve corrected vision. METHODS Retrospective analysis of 46 keratoconic eyes that underwent PTK-CXL. Corrected distance visual acuity (CDVA), manifest refraction, steep and flat simulated keratometry (Kmax and Kmin), corneal irregularity index (IRI), corneal higher order aberrations (HOAs), epithelial thickness profile, and corneal biomechanical characteristics were evaluated preoperatively and postoperatively. RESULTS At a mean follow-up time of 21.0 ± 7.6 months (range: 10 to 43 months) postoperatively, CDVA improved from 0.25 ± 0.24 to 0.18 ± 0.22 logMAR (P = .002). CDVA remained unchanged in 32.6% (15 eyes) and 56.5% (26 eyes) gained up to five Snellen lines of CDVA, whereas 6.5% (3 eyes) lost two or more lines of CDVA, respectively. Postoperatively, flattening of Kmax from 50.58 ± 5.26 to 48.96 ± 4.00 diopters (D) and Kmin from 45.80 ± 3.11 to 44.77 ± 2.63 D (P < .001), reduction of IRI from 49.7 ± 24.5 to 43.4 ± 21.4 µm (P = .002), decrease of root mean square HOAs (at 5-mm diameter) from 2.66 ± 1.31 to 2.37 ± 1.37 µm (P = .037), and slight thickening of corneal epithelium were registered, whereas most of the corneal biomechanical measurements did not show statistically significant change. Two eyes demonstrated slight topographic regression. CONCLUSIONS PTK-CXL seems to be effective in arresting the progression of keratoconus, improving CDVA, flattening the cornea, regularizing corneal surface, and reducing corneal HOAs. [J Refract Surg. 2017;33(7):488-495.].
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Pediatric Corneal Cross-linking: Comparison of Visual and Topographic Outcomes Between Conventional and Accelerated Treatment. Am J Ophthalmol 2017; 183:11-16. [PMID: 28864070 DOI: 10.1016/j.ajo.2017.08.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare visual and topographic outcomes 1 year after conventional (C-CXL) vs accelerated corneal cross-linking (A-CXL) in pediatric keratoconus (KC). DESIGN Comparative, retrospective, consecutive case series. METHODS Patients with topography-confirmed, progressive KC and a corneal thickness of ≥400 μm at the time of surgery were enrolled. Uncorrected (UCVA) and best phoropter-corrected visual acuity (BCVA) and normal maximum keratometry reading (Kmax) were measured at study entry and at the 12-month follow-up. Treatment failure rate was defined as the percentage of eyes with an increase in Kmax of more than 1.0 diopter during follow-up. The adverse event rate was the percentage of eyes with a loss of ≥2 Snellen lines of BCVA from baseline. This was a single-center analysis of 78 eyes of 58 patients that underwent C-CXL (39 eyes) and A-CXL (39 eyes). No eyes were lost to follow-up after 12 months. RESULTS No significant difference between changes in 12 months after as compared to the time before CXL for UCVA (0.01 log MAR; 95% confidence interval -0.14 to 0.15, P = .944), BCVA (0.05 log MAR; 95% confidence interval -0.05 to 0.15, P = .310), and Kmax (-0.77 diopters; 95% confidence interval -2.20 to 0.65, P = .282) between the C-CXL and A-CXL group were observed. Treatment failure rate was observed in 9 of 39 eyes (23.1%) in C-CXL and in 6 of 39 eyes (15.4%) in A-CXL (P = .389). Adverse events were seen only in 1 eye in the C-CXL group. CONCLUSIONS In this retrospective comparison, the accelerated approach was equally as effective as the conventional protocol to treat pediatric keratoconus.
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Moschos MM, Nitoda E, Georgoudis P, Balidis M, Karageorgiadis E, Kozeis N. Contact Lenses for Keratoconus- Current Practice. Open Ophthalmol J 2017; 11:241-251. [PMID: 28932340 PMCID: PMC5585463 DOI: 10.2174/1874364101711010241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/29/2017] [Accepted: 06/13/2017] [Indexed: 12/14/2022] Open
Abstract
Background: Keratoconus is a chronic, bilateral, usuallly asymmetrical, non-inflammatory, ectatic disorder, being characterized by progressive steepening, thinning and apical scarring of the cornea. Initially, the patient is asymptomatic, but the visual acuity gradually decreases, resulting in significant vision loss due to the development of irregular astigmatism, myopia, corneal thinning and scarring. The classic treatment of visual rehabilitation in keratoconus is based on spectacles and contact lenses (CLs). Objective: To summarize the types of CLs used in the treatment of keratoconus. This is literature review of several important published articles focusing on the visual rehabilitation in keratoconus with CLs. Method: Gas permeable (GP) CLs have been found to achieve better best corrected visual acuity than spectacles, eliminating 3rd-order coma root-mean-square (RMS) error, 3rd-order RMS, and higher-order RMS. However, they have implicated in reduction of corneal basal epithelial cell and anterior stromal keratocyte densities. Soft CLs seem to provide greater comfort and lower cost, but the low oxygen permeability (if the lens is not a silicone hydrogel), and the inability to mask moderate to severe irregular astigmatism are the main disadvantages of them. On the other hand, scleral CLs ensure stable platforms, which eliminate high-order aberrations and provide good centration and visual acuity. Their main disadvantages include the difficulties in application and removal of these lenses along with corneal flattening and swelling. Result: The modern hybrid CLs are indicated in cases of poor centration, poor stability or intolerance with GP lenses. Finally, piggyback CL systems effectively ameliorate visual acuity, but they have been related to corneal neovascularization and giant papillary conjunctivitis. Conclusion: CLs seem to rehabilitate visual performance, diminishing the power of the cylinder and the high-order aberrations. The final choice of CLs is based on their special features, the subsequent corneal changes and the patient’s needs.
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Affiliation(s)
- Marilita M Moschos
- Department of Ophthalmology, Medical School, National & Kapodistrian University of Athens, Greece
| | - Eirini Nitoda
- Department of Ophthalmology, Medical School, National & Kapodistrian University of Athens, Greece
| | | | - Miltos Balidis
- Institute of Ophthalmology and Ocular Microsurgery 'Ophthalmica', Thessaloniki, Greece
| | | | - Nikos Kozeis
- Institute of Ophthalmology and Ocular Microsurgery 'Ophthalmica', Thessaloniki, Greece
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Lombardo M, Giannini D, Lombardo G, Serrao S. Randomized Controlled Trial Comparing Transepithelial Corneal Cross-linking Using Iontophoresis with the Dresden Protocol in Progressive Keratoconus. Ophthalmology 2017; 124:804-812. [PMID: 28283279 DOI: 10.1016/j.ophtha.2017.01.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare clinical outcomes of transepithelial corneal cross-linking using iontophoresis (T-ionto CL) and standard corneal cross-linking (standard CL) for the treatment of progressive keratoconus 12 months after the operation. DESIGN Prospective randomized controlled clinical trial. PARTICIPANTS Thirty-four eyes of 25 participants with progressive keratoconus were randomized into T-ionto CL (22 eyes) or standard CL (12 eyes). METHODS T-ionto CL was performed using an iontophoresis device with dextran-free 0.1% riboflavin-5-phosphate solution with enhancers and by irradiating the cornea with a 10 mW/cm2 ultraviolet A device for 9 minutes. Standard CL was performed according to the Dresden protocol. MAIN OUTCOME MEASURES The primary outcome measure was stabilization of keratoconus after 12 months through analysis of maximum simulated keratometry readings (Kmax, diopters). Other outcome measures were corrected distance visual acuity (CDVA, logarithm of the minimum angle of resolution [logMAR]), manifest spherical equivalent refraction (D), central corneal thickness (CCT, micrometers) and endothelial cell density (ECD). Follow-up examinations were arranged at 3 and 7 days and 1, 3, 6, and 12 months. RESULTS Twelve months after T-ionto CL and standard CL, Kmax on average flattened by -0.52±1.30 D (P = 0.06) and -0.82±1.20 D (P = 0.04), respectively. The mean change in CDVA was -0.10±0.12 logMAR (P = 0.003) and -0.03±0.06 logMAR (P = 0.10) after T-ionto CL and standard CL, respectively. The manifest spherical equivalent refraction changed on average by +0.71±1.44 D (P = 0.03) and +0.21±0.76 D (P = 0.38), respectively. The CCT and ECD measures did not change significantly in any group at 12 months. Significant differences in the outcome measures between treatments were found in the first week postoperatively. No complications occurred in the T-ionto CL group; 1 eye (8%) had sterile corneal infiltrates, which did not affect the final visual acuity, in the standard CL group. CONCLUSIONS Significant visual and refractive improvements were found 12 months after T-ionto CL, though the average improvement in corneal topography readings was slightly lower than the Dresden protocol in the same period.
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Affiliation(s)
| | | | - Giuseppe Lombardo
- Consiglio Nazionale delle Ricerche, Istituto per i Processi Chimico-Fisici, Messina, Italy; Vision Engineering Italy srl, Rome, Italy
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10
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Rate of corneal collagen crosslinking redo in private practice: risk factors and safety. J Ophthalmol 2015; 2015:690961. [PMID: 25874118 PMCID: PMC4383466 DOI: 10.1155/2015/690961] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/20/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022] Open
Abstract
Objective. To report the rate of progression of keratectasia after primary crosslinking (CXL) and evaluate the safety and efficiency of CXL redo. Materials and Methods. We conducted a retrospective analysis of the patients who underwent CXL between 2010 and 2013 at the Beirut Eye Specialist Hospital, Lebanon. Progression of keratectasia was based on the presence of an increase in maximum keratometry of 1.00 D, a change in the map difference between two consecutive topographies of 1.00 D, a deterioration of visual acuity, or any change in the refraction. Primary and redo CXL were done using the same protocol. Results. Among the 221 eyes of 130 patients who underwent CXL, 7 eyes (3.17%) of five patients met the criteria of progression. All patients reported a history of allergic conjunctivitis and eye rubbing and progressed within 9 to 48 months. No complications were noted and all patients were stable 1 year after CXL redo. Conclusion. Allergic conjunctivitis and eye rubbing were the only risk factors associated with keratoconus progression after CXL. A close followup is thus mandatory, even years after the procedure. CXL redo seems to be a safe and efficient technique to halt the progression after a primary CXL.
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Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
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Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
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