Impact of keratoconus stage on outcome after corneal crosslinking

BACKGROUND

This study aimed to analyze if the outcome after corneal crosslinking (CXL) in progressive keratoconus patients depends on the stage at which the procedure is performed. This knowledge would help to improve success of CXL and to define surgery indications in those patients.

METHODS

In this retrospective study, 124 consecutive eyes of 100 patients with progressive keratoconus undergoing corneal CXL at the University Eye Hospital Tübingen were included. The eyes were graded according to modified Krumeich stages depending on induced myopia or astigmatism, corneal radii, minimum corneal thickness, and morphological changes. The observation period covered November 2008 to September 2018. Preoperatively, 12 and 24 months after CXL, the best corrected visual acuity (BCVA) was determined and astigmatism as well as tomographic parameters (Kmax, Kmin, central corneal thickness (CCT), minimum corneal thickness (MCT)) were measured by means of a Scheimpflug camera system.

RESULTS

BCVA results showed significant differences between the modified Krumeich stages at 12 months (p = 0.014) and at 24 months postoperatively (p = 0.032). Also, astigmatism differed significantly among the stages at 24 months after CXL (p = 0.023). However, no significant differences regarding astigmatism were detectable after 12 months. In terms of Kmax, Kmin, CCT, and MCT, no significant differences between the Krumeich stages were observed.

CONCLUSIONS

BCVA showed a significantly higher improvement after CXL in the early stage of keratoconus compared to a higher stage. However, the postinterventional tomographic values did not differ significantly between the different modified Krumeich stages. The significantly higher improvement in BCVA after CXL in the early stage might indicate that earlier intervention provides a higher subjective benefit to the individual. Further studies with larger sample sizes are needed to confirm these findings.

[Non-antagonistic influence of Krumeich's intrastromal corneal ring in an experimental tissue culture system]

BACKGROUND

Intrastromal insertion of Krumeich's corneal ring between graft and residual host corneal tissue appears to impair preripheral, superficial and superfluous vascularization of donor corneal tissue.

OBJECTIVES

The purpose of this study was to investigate the cytotoxic effects of Krumeich's ring using tissue cultures composed of primary human dermal microvascular endothelial cells from adult donors (HMVEC).

MATERIALS AND METHODS

Soluble growth medium extracts of the individual components of Krumeich's ring alloy were prepared and HMVEC were exposed to these extracts in triplicate for 1 day followed by investigation with 3‑(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Furthermore, HMVEC were cultured for 5 days on either Krumeich's ring or polypropylene (PP) discs coated with individual components of the Krumeich's ring alloy followed by double vital staining with fluorescein diacetate (FDA) and propidium iodide (PI).

RESULTS

The MTT assays revealed that higher doses of the extracts appeared to reduce the viability of HMVEC, while highly diluted extracts of molybdenum (Mo) powder appeared to increase the metabolic activity of HMVEC. The FDA-PI staining showed only a few live HMVEC on either cobalt (Co) or Mo-coated PP discs, compared to the respective titanium (Ti) and chromium (Cr) counterparts. Viable HMVEC appeared to attach to Krumeich's ring after a 5‑day incubation period.

CONCLUSION

The results confirm that Krumeich's ring does not exert measurable cytotoxic effects in our chosen assay system. High dilutions of medium-soluble Mo powder extracts appear to increase the metabolic activity of HMVEC.