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Lombardo M, Serrao S, Bernava GM, Mencucci R, Fruschelli M, Lombardo G. Real-time monitoring of riboflavin concentration using different clinically available ophthalmic formulations for epi-off and epi-on corneal cross-linking. Graefes Arch Clin Exp Ophthalmol 2024; 262:2569-2577. [PMID: 38502352 DOI: 10.1007/s00417-024-06451-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/27/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To assess the feasibility of theranostics to determine the riboflavin concentration in the cornea using clinically available ophthalmic formulations during epithelium-off (epi-off) and transepithelial (epi-on) corneal cross-linking procedures. METHODS Thirty-two eye bank human donor corneas were equally randomized in eight groups; groups 1 to 3 and groups 4 to 8 underwent epi-off and epi-on delivery of riboflavin respectively. Riboflavin ophthalmic solutions were applied onto the cornea according to the manufacturers' instructions. The amount of riboflavin into the cornea was estimated, at preset time intervals during imbibition time, using theranostic UV-A device (C4V CHROMO4VIS, Regensight srl, Italy) and expressed as riboflavin score (d.u.). Measurements of corneal riboflavin concentration (expressed as µg/cm3) were also performed by spectroscopy absorbance technique (AvaLight-DH-S-BAL, Avantes) for external validation of theranostic measurements. RESULTS At the end of imbibition time in epi-off delivery protocols, the average riboflavin score ranged from 0.77 ± 0.38 (the average corneal riboflavin concentration was 213 ± 190 µg/cm3) to 1.79 ± 0.07 (554 ± 103 µg/cm3). In epi-on delivery protocols, the average riboflavin score ranged from 0.17 ± 0.01 to 0.67 ± 0.19 (corneal riboflavin concentration ranged from 6 ± 5 µg/cm3 to 122 ± 39 µg/cm3) at the end of imbibition time. A statistically significant linear correlation (P ≤ 0.05) was found between the theranostic and spectrophotometry measurements in all groups. CONCLUSIONS Real-time theranostic imaging provided an accurate strategy for assessing permeation of riboflavin into the human cornea during the imbibition phase of corneal cross-linking, regardless of delivery protocol. A large variability in corneal riboflavin concentration exists between clinically available ophthalmic formulations both in epi-off and epi-on delivery protocols.
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Affiliation(s)
- Marco Lombardo
- Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy.
- Vision Engineering Italy Srl, Via Livenza 3, 00198, Rome, Italy.
| | - Sebastiano Serrao
- Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy
- Vision Engineering Italy Srl, Via Livenza 3, 00198, Rome, Italy
| | - Giuseppe Massimo Bernava
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Viale F. Stagno D'Alcontres 37, 98158, Messina, Italy
| | - Rita Mencucci
- SOD Oculistica, AOU Careggi, Università di Firenze, Largo Brambilla 3, 50134, Florence, Italy
| | - Mario Fruschelli
- Sezione Oftalmologia, Policlinico Santa Maria alle Scotte, Università di Siena, Dip. Scienze mediche-chirurgiche e neuroscienze, Viale Bracci, 53100, Siena, Italy
| | - Giuseppe Lombardo
- Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy.
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Viale F. Stagno D'Alcontres 37, 98158, Messina, Italy.
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Elving S, Fredriksson A, Beckman Rehnman J, Behndig A. Randomized clinical trial comparing customized corneal crosslinking: epi-on in high oxygen and epi-off in room air for keratoconus. J Cataract Refract Surg 2024; 50:746-753. [PMID: 38465837 DOI: 10.1097/j.jcrs.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE To compare clinical outcomes of customized transepithelial (epi-on) corneal crosslinking (CXL) in high oxygen and customized CXL with epithelial removal (epi-off) in room air for keratoconus (KC). SETTING Umeå University Hospital, Umeå, Sweden. DESIGN Prospective, randomized, single-masked, intraindividually comparing study. METHODS 32 participants with bilateral progressive KC were treated with bilateral customized topography-guided CXL, 30 mW/cm 2 ; 7.2 to 15 J/cm 2 and were randomized to epi-on in one eye (32 eyes) and epi-off in the fellow eye (32 eyes). Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), maximal keratometry (Kmax), subjective ocular discomfort, low-contrast visual acuities (LCVAs) at 10% and 2.5% contrast, ocular and anterior corneal wavefront aberrations, manifest refractive spherical equivalent, endothelial cell count (ECC), and adverse events were assessed through 24 months. RESULTS Both treatments showed improvements at 24 months in UDVA; -0.16 ± 0.24 ( P < .001) and -0.13 ± 0.20 logMAR ( P = .006), respectively, CDVA; -0.10 ± 0.11 ( P < .001) and -0.10 ± 0.12 ( P = .001), Kmax; -1.74 ± 1.31 ( P < .001) and -1.72 ± 1.36 D ( P < .001). LCVA 10% improved for both protocols ( P < .001), but LCVA 2.5% improved for epi-on CXL only ( P = .001). ECC was unaltered, and no adverse events occurred. The epi-on eyes had significantly less discomfort symptoms during the whole first week posttreatment ( P < .05). CONCLUSIONS High-oxygen customized epi-on CXL is a viable alternative to room air customized epi-off CXL, with faster improvements in CDVA and LCVA and less early ocular discomfort.
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Affiliation(s)
- Sofie Elving
- From the Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
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Lombardo M, Serrao S, Bernava GM, Lombardo G. Spatial targeted delivery of riboflavin with a controlled corneal iontophoresis delivery system in theranostic-guided UV-A light photo-therapy. JOURNAL OF BIOPHOTONICS 2024; 17:e202400068. [PMID: 38697616 DOI: 10.1002/jbio.202400068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 05/05/2024]
Abstract
Seven human donor eye globes underwent corneal cross-linking using theranostic UV-A device with accessory corneal iontophoresis system for patterned delivery of a 0.22% riboflavin solution. Theranostic-guided UV-A light illumination assessed riboflavin distribution and treated corneas at 10 mW/cm2 for 9 min with a 5.0-mm beam size. Corneal topography maps were taken at baseline and 2-h post-treatment. Analysis utilized corneal topography elevation data, with results showing controlled riboflavin delivery led to a consistent gradient, with 40% higher levels centrally (248 ± 79 μg/cm3) than peripherally (180 ± 72 μg/cm3 at ±2.5 mm from the center). Theranostic-guided UV-A light irradiation resulted in significant changes in corneal topography, with a decrease in best-fit sphere value (-0.7 ± 0.2 D; p < 0.001) and consistent downward shift in corneal elevation map (-11.7 ± 3.7 μm). The coefficient of variation was 2.5%, indicating high procedure performance in achieving significant and reliable corneal flattening.
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Affiliation(s)
- Marco Lombardo
- Studio Italiano di Oftalmologia, Rome, Italy
- Vision Engineering Italy srl, Rome, Italy
| | - Sebastiano Serrao
- Studio Italiano di Oftalmologia, Rome, Italy
- Vision Engineering Italy srl, Rome, Italy
| | | | - Giuseppe Lombardo
- Studio Italiano di Oftalmologia, Rome, Italy
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Messina, Italy
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Roszkowska AM, Scorcia V, Mencucci R, Giannaccare G, Lombardo G, Alunni Fegatelli D, Vestri A, Bifezzi L, Bernava GM, Serrao S, Lombardo M. Assessment of the Predictive Ability of Theranostics for Corneal Cross-linking in Treating Keratoconus: A Randomized Clinical Trial. Ophthalmology 2024:S0161-6420(24)00367-1. [PMID: 38908553 DOI: 10.1016/j.ophtha.2024.06.012] [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: 03/16/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024] Open
Abstract
PURPOSE To validate the ability of theranostic imaging biomarkers in assessing corneal cross-linking (CXL) efficacy in flattening the maximum keratometry (Kmax) index. DESIGN Prospective, randomized, multicenter, masked clinical trial (ClinicalTrails.gov identifier, NCT05457647). PARTICIPANTS Fifty patients with progressive keratoconus. INTERVENTION Participants were stratified to undergo epithelium-off (25 eyes) and epithelium-on (25 eyes) CXL protocols using an ultraviolet A (UV-A) medical device with theranostic software. The device controlled UV-A light both for performing CXL and assessing the corneal riboflavin concentration (riboflavin score) and treatment effect (theranostic score). A 0.22% riboflavin formulation was applied onto the cornea for 15 minutes and 20 minutes in epithelium-off and epithelium-on protocols, respectively. All eyes underwent 9 minutes of UV-A irradiance at 10 mW/cm2. MAIN OUTCOME MEASURES The primary outcome measure was validation of the combined use of theranostic imaging biomarkers through measurement of their accuracy (proportion of correctly classified eyes) and precision (positive predictive value) to classify eyes correctly and predict a Kmax flattening at 1 year after CXL. Other outcome measures included change in Kmax, endothelial cell density, uncorrected and corrected distance visual acuity, manifest spherical equivalent refraction and central corneal thickness 1 year after CXL. RESULTS Accuracy and precision of the theranostic imaging biomarkers in predicting eyes that had >0.1 diopter (D) of Kmax flattening at 1 year were 91% and 95%, respectively. The Kmax value significantly flattened by a median of -1.3 D (IQR, -2.11 to -0.49 D; P < 0.001); both the uncorrected and corrected distance visual acuity improved by a median of -0.1 logarithm of the minimum angle of resolution (logMAR; IQR, -0.3 to 0.0 logMAR [P < 0.001] and -0.2 to 0.0 logMAR [P < 0.001], respectively). No significant changes in endothelial cell density (P = 0.33) or central corneal thickness (P = 0.07) were noted 1 year after surgery. CONCLUSIONS The study demonstrated the efficacy of integrating theranostics in a UV-A medical device for the precise and predictive treatment of keratoconus with epithelium-off and epithelium-on CXL protocols. Concentration of riboflavin and its UV-A light mediated photoactivation in the cornea are the primary factors determining CXL efficacy. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Unit, Gaetano Martino Hospital, University of Messina, Messina, Italy; Department of Ophthalmology, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Vincenzo Scorcia
- Ophthalmology Unit, Renato Dulbecco Hospital, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Rita Mencucci
- Ophthalmology Unit, Careggi Hospital, University of Firenze, Firenze, Italy
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, University of Roma "La Sapienza," Rome, Italy; Department of Life Sciences, Health and Health Professions, Link Campus University, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, University of Roma "La Sapienza," Rome, Italy
| | - Luca Bifezzi
- Ophthalmology Unit, Renato Dulbecco Hospital, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Sun L, Zhang X, Ding L, Zhao J, Shen Y, Tian M, Jian W, Zhou X. Long-term changes in crystalline lens transparency after accelerated transepithelial corneal cross-linking in patients with keratoconus. Eur J Ophthalmol 2023; 33:1850-1859. [PMID: 37077155 DOI: 10.1177/11206721231170036] [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: 04/21/2023]
Abstract
PURPOSE To investigate the long-term clinical outcomes and changes in crystalline lens transparency after accelerated (45 mW/cm2) transepithelial corneal cross-linking (ATE-CXL) using the Pentacam imaging system in patients with progressive keratoconus. METHODS The study prospectively included 44 keratoconus eyes of 40 patients (mean age: 24.39 ± 5.61 years) who underwent ATE-CXL. The examinations, including assessment of uncorrected distance visual acuity, corrected distance visual acuity, corneal topography, and corneal endothelial cell density count, were conducted preoperatively and 1 month, 3 months, 6 months, 1 year, and 5 years postoperatively. Measurement of crystalline lens density using Pentacam images was also performed pre- and postoperatively. RESULTS All surgeries were uneventful with no postoperative complications. All keratometry values and corneal thickness remained stable during the 5-year follow-up period (all p > 0.05). There were no significant differences in corneal endothelial cell density count, visual acuity, and anterior average lens density in the 0.5-, 1.0-, and 1.5-mm depth zones during the 5-year follow-up period compared with the preoperative values (all p > 0.05). CONCLUSION The results of this study suggest that ATE-CXL at 45 mW/cm2 is safe and effective for the treatment of progressive keratoconus in terms of both crystalline lens density and endothelial cell density.
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Affiliation(s)
- Ling Sun
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xiaoyu Zhang
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Lan Ding
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jing Zhao
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Yang Shen
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Mi Tian
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Weijun Jian
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
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Hafezi F, Torres-Netto EA, Kollros L, Lu NJ, Hafezi N, Mazzotta C, Aydemir ME, Hillen M. Rates of infectious keratitis and other ocular surface adverse events in corneal cross-linking for keratoconus and corneal ectasias performed in an office-based setting: a retrospective cohort study. EYE AND VISION (LONDON, ENGLAND) 2023; 10:36. [PMID: 37653457 PMCID: PMC10472555 DOI: 10.1186/s40662-023-00354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/16/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND This study aimed to compare the complication rates of epithelium-off corneal cross-linking (epi-off CXL) performed in an office-based setting with those of epi-off CXL performed in an operating room. METHODS A retrospective cohort study, comprising 501 consecutive epi-off CXL procedures, performed in a non-sterile procedure room without laminar flow ventilation at the ELZA Institute in Zurich, Switzerland, between November 2015 and October 2021, was conducted. RESULTS No cases of postoperative infectious keratitis were observed, while sterile infiltrates occurred in 10 out of 501 (2.00%) patients, all of whom responded well to topical steroid therapy. Delayed epithelialization (> 7 days) occurred in 14 out of 501 (2.79%) patients. No other adverse events were noted. CONCLUSIONS Office-based epi-off CXL does not appear to be associated with an increased risk of complications when compared to operating room settings.
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Affiliation(s)
- Farhad Hafezi
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland.
- ELZA Institute, Dietikon, Switzerland.
- USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Dept. of Ophthalmology, University of Wenzhou, Wenzhou, China.
| | | | | | - Nan-Ji Lu
- ELZA Institute, Dietikon, Switzerland
| | | | - Cosimo Mazzotta
- Departmental Ophthalmology Unit, Alta Val d'Elsa Hospital, AUSL Tuscany South-East, Siena, Italy
- Postgraduate Ophthalmology School, University of Siena, Siena, Italy
- Siena Crosslinking Center, Monteriggioni, Siena, Italy
| | - M Enes Aydemir
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
- ELZA Institute, Dietikon, Switzerland
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Farrokhpour H, Soleimani M, Cheraqpour K, Masoumi A, Tabatabaei SA, Shahriari M, Hobaby S, Baharnoori SM, Chaudhry A, Djalilian AR. A Case Series of Infectious Keratitis After Corneal Cross-linking. J Refract Surg 2023; 39:564-572. [PMID: 37578174 DOI: 10.3928/1081597x-20230717-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
PURPOSE To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL). METHODS This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study. RESULTS Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious keratitis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and Staphylococcus aureus were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventually required cases to undergo keratoplasty. CONCLUSIONS This study supports the need for proper patient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient education and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings. [J Refract Surg. 2023;39(8):564-572.].
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Abdel-Radi M, Abdelmohsen N, Abdelmotaal H, Abd El-Moneim MT. The effect of accelerated pulsed high-fluence corneal cross-linking on corneal endothelium; a prospective specular microscopy study. BMC Ophthalmol 2023; 23:163. [PMID: 37072730 PMCID: PMC10114460 DOI: 10.1186/s12886-023-02912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/07/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Corneal collagen cross-linking (CXL) is a procedure utilized for halting keratoconus progression with different approved protocols. The current study aimed to assess the corneal endothelial changes following the relatively new accelerated pulsed high-fluence protocol of epithelium-off corneal cross-linking for the treatment of mild to moderate keratoconus. METHODS This prospective case series study enrolled 45 eyes of 27 patients with mild to moderate progressive keratoconus who underwent accelerated pulsed high-fluence CXL (pl-ACXL, 30 mW/ cm2 UVA at 365 nm wavelength, 8 min pulsed mode 1 s on / 1 s off with a total energy of 7.2 J/ cm2). The main outcome measures were corneal endothelial changes assessed by specular microscopy at 3 and 6 months postoperatively including endothelial cell density (ECD), coefficient of variation, percentage of hexagonal cells, average, minimum and maximum endothelial cell sizes. Demarcation line depth was assessed 1 month following surgery. RESULTS The mean age of the studied sample was 24.89 ± 7.21. The mean preoperative ECD (2944.6 ± 247.41 cell/mm2) showed non-significant reduction at 3 and 6 months postoperatively (2931.03 ± 253.82 and 2924.7 ± 224.88 cell/mm2, respectively, P-value = 0.361). There were no significant changes in the mean coefficient of variation, percentage of hexagonal cells, average, minimum and maximum endothelial cell sizes at 3 and 6 months following pl-ACXL (P-value > 0.05). The mean demarcation line depth 1 month after pl-ACXL was 214 ± 17.43 μm. CONCLUSIONS Corneal endothelial changes following accelerated pulsed high-fluence CXL were minimal with stability of endothelial cell count and non-significant morphological changes. TRIAL REGISTRATION Clinicaltrials.gov: NCT04160338 (13/11/2019).
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Affiliation(s)
- Mahmoud Abdel-Radi
- Department of Ophthalmology, Assiut University, Assiut University Hospital 6th floor, Assiut, 71516, Egypt.
| | - Naglaa Abdelmohsen
- Department of Ophthalmology, Assiut University, Assiut University Hospital 6th floor, Assiut, 71516, Egypt
| | - Hazem Abdelmotaal
- Department of Ophthalmology, Assiut University, Assiut University Hospital 6th floor, Assiut, 71516, Egypt
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Polido J, Araújo MEXDS, Wakamatsu TH, Alexander JG, Cabral T, Ambrósio R, Freitas D. Long-term Safety and Efficacy of Corneal Collagen Crosslinking in a Pediatric Group With Progressive Keratoconus: A 7-year Follow-up. Am J Ophthalmol 2023; 250:59-69. [PMID: 36682518 DOI: 10.1016/j.ajo.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE To assess effectiveness and safety of corneal crosslinking (CXL) to reduce keratoconus (KC) progression and improve visual acuity among children with progressive KC and to analyze the use of 20% dextran-based (Dextran) and 1% hydroxypropyl methylcellulose-based (HPMC) riboflavin. DESIGN Prospective, clinical cohort study METHODS: Standard CXL (SCXL) was performed in 74 eyes (58 patients, 45 males, mean age 13.0 ± 2.1 years): 53 eyes with HPMC and 21 with Dextran. Examinations were performed at baseline, 3 and 6 months, and 1, 2, 3, 4, 5, and 7 years of follow-up, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), a complete ophthalmologic examination, anterior segment ocular coherence tomography, Scheimpflug corneal tomography, and specular microscopy. RESULTS UDVA and CDVA improved at all periods with statistically significant differences in CDVA at 1, 2, and 3 years. Compared with baseline, maximum K (Max K) reduced throughout the 7-year follow-up. Mean thinnest pachymetry (Th Pachy) decreased significantly at 3 months and remained low; in the Dextran group, the Th Pachy mean value returned to baseline 6 months postoperatively. After CXL, 1.5 diopter progression in max K was 1.4% to 14.6% of eyes; worsening was found at 4 to 7 years postoperatively. CONCLUSION SCXL reduced KC progression in children up to 7 years of follow-up and revealed improvement and stability of UDVA and CDVA in 82% of eyes. For visual acuity and KC stability, no statistically significant difference was observed between Dextran-HPMC. The HPMC group showed persistent cornea thinning, raising concerns about its use in SCXL.
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Affiliation(s)
- Júlia Polido
- From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo
| | - Maria Emília Xavier Dos Santos Araújo
- From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo; Department of Ophthalmology (M.E.X.A), HSPE/IAMSPE, São Paulo
| | - Tais H Wakamatsu
- From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo
| | - João G Alexander
- From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo
| | - Thiago Cabral
- From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo; Department of Ophthalmology EBSERH (T.C.), HUCAM/CCS-UFES, Federal University of Espírito Santo, Vitória.
| | - Renato Ambrósio
- From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo; and the Department of Ophthalmology (R.A.), Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denise Freitas
- From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo
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Roszkowska AM, Lombardo G, Mencucci R, Scorcia V, Giannaccare G, Vestri A, Alunni Fegatelli D, Bernava GM, Serrao S, Lombardo M. A randomized clinical trial assessing theranostic-guided corneal cross-linking for treating keratoconus: the ARGO protocol. Int Ophthalmol 2022:10.1007/s10792-022-02628-4. [PMID: 36587174 DOI: 10.1007/s10792-022-02628-4] [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: 10/15/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023]
Abstract
The Assessment of theranostic guided riboflavin/UV-A corneal cross-linking for treatment of keratoconus (ARGO; registration number NCT05457647) clinical trial tests the hypothesis that theranostic-guided riboflavin/UV-A corneal cross-linking (CXL) can provide predictable clinical efficacy for halting keratoconus progression, regardless of treatment protocol, i.e., either with or without epithelial removal. Theranostics is an emerging therapeutic paradigm of personalized and precision medicine that enables real-time monitoring of image-guided therapy. In this trial, the theranostic software module of a novel UV-A medical device will be validated in order to confirm its accuracy in estimating corneal cross-linking efficacy in real time. During CXL procedure, the theranostic UV-A medical device will provide the operator with an imaging biomarker, i.e., the theranostic score, which is calculated by non-invasive measurement of corneal riboflavin concentration and its UV-A light mediated photo-degradation. ARGO is a randomized multicenter clinical trial in patients aged between 18 and 40 years with progressive keratoconus aiming to validate the theranostic score by assessing the change of the maximum keratometry point value at 1-year postoperatively. A total of 50 participants will be stratified with allocation ratio 1:1 using a computer-generated stratification plan with blocks in two treatment protocols, such as epithelium-off or epithelium-on CXL. Following treatment, participants will be monitored for 12 months. Assessment of safety and performance of theranostic-guided corneal cross-linking treatment modality will be determined objectively by corneal tomography, corneal endothelial microscopy, visual acuity testing and slit-lamp eye examination.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Department, Faculty of Medicine, Health Sciences of Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705, Krakow, Poland. .,Dipartimento BIOMORF, Università di Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Giuseppe Lombardo
- CNR-IPCF, Istituto per I Processi Chimico-Fisici, Viale F. Stagno D'Alcontres 37, 98158, Messina, Italy
| | - Rita Mencucci
- SOD Oculistica, AOU Careggi, Università di Firenze, Largo Brambilla 3, 50134, Florence, Italy
| | - Vincenzo Scorcia
- UO Oculistica, AOU Mater Domini, Università Magna Graecia di Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giuseppe Giannaccare
- UO Oculistica, AOU Mater Domini, Università Magna Graecia di Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Annarita Vestri
- Dipartimento di Sanità Pubblica e Malattie Infettive, Università di Roma "La Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Danilo Alunni Fegatelli
- Dipartimento di Sanità Pubblica e Malattie Infettive, Università di Roma "La Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giuseppe Massimo Bernava
- CNR-IPCF, Istituto per I Processi Chimico-Fisici, Viale F. Stagno D'Alcontres 37, 98158, Messina, Italy
| | | | - Marco Lombardo
- Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy
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Lombardo G, Bernava GM, Serrao S, Lombardo M. Theranostic-guided corneal cross-linking: Preclinical evidence on a new treatment paradigm for keratoconus. JOURNAL OF BIOPHOTONICS 2022; 15:e202200218. [PMID: 36059083 DOI: 10.1002/jbio.202200218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Theranostics is an emerging therapeutic paradigm of personalized medicine; the term refers to the simultaneous integration of therapy and diagnostics. In this work, theranostic-guided corneal cross-linking was performed on 10 human sclero-corneal tissues. The samples were soaked with 0.22% riboflavin formulation and underwent 9 minutes UV-A irradiance at 10 mW/cm2 using theranostic device, which provided both a measure of corneal riboflavin concentration and a theranostic score estimating treatment efficacy in real time. A three-element viscoelastic model was developed to fit the deformation response of the cornea to air-puff excitation of dynamic tonometry and to calculate the mean corneal stiffness parameter before and after treatment. Significant correlation was found between the theranostic score and the increase in mean corneal stiffness (R = 0.80; P < .001). Accuracy and precision of the theranostic score in predicting the induced corneal tissue stiffening were both 90%. The riboflavin concentration prior to starting the UV-A photo-therapy phase was the most important variable to allow corneal cross-linking to be effective. Theranostic UV-A light mediated imaging and therapy enables the operator to adopt a precise approach for achieving highly predictable biomechanical strengthening on individual corneas.
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Affiliation(s)
- Giuseppe Lombardo
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Viale F, Messina, Italy
- Vision Engineering Italy srl, Rome, Italy
| | | | | | - Marco Lombardo
- Vision Engineering Italy srl, Rome, Italy
- Studio Italiano di Oftalmologia, Rome, Italy
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