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Raiskup F, Herber R, Lenk J, Pillunat LE, Spoerl E. Crosslinking with UV-A and riboflavin in progressive keratoconus: From laboratory to clinical practice - Developments over 25 years. Prog Retin Eye Res 2024; 102:101276. [PMID: 38830532 DOI: 10.1016/j.preteyeres.2024.101276] [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: 03/31/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
Changes in the biomechanical and biochemical properties of the human cornea play an important role in the pathogenesis of ectatic diseases. A number of conditions in primarily acquired (keratoconus or pellucid marginal degeneration) or secondarily induced (iatrogenic keratectasia after refractive laser surgeries) ectatic disorders lead to decreased biomechanical stability. Corneal collagen cross-linking (CXL) represents a technique to slow or even halt the progression of ectatic pathologies. In this procedure, riboflavin is applied in combination with ultraviolet A radiation. This interaction induces the production of reactive oxygen species, which leads to the formation of additional covalent bonds between collagen molecules and subsequent biomechanical corneal strengthening. This procedure is so far the only method that partially interferes etiopathogenetically in the treatment of ectatic diseases that slows or stops the process of corneal destabilization, otherwise leading to the need for corneal transplantation. Besides, CXL process increases markedly resistance of collagenous matrix against digesting enzymes supporting its use in the treatment of corneal ulcers. Since the discovery of this therapeutic procedure and the first laboratory experiments, which confirmed the validity of this method, and the first clinical studies that proved the effectiveness and safety of the technique, it has been spread and adopted worldwide, even with further modifications. Making use of the Bunsen-Roscoe photochemical law it was possible to shorten the duration of this procedure in accelerated CXL and thus improve the clinical workflow and patient compliance while maintaining the efficacy and safety of the procedure. The indication spectrum of CXL can be further expanded by combining it with other vision-enhancing procedures such as individualized topographically-guided excimer ablation. Complementing both techniques will allow a patient with a biomechanically stable cornea to regularize it and improve visual acuity without the need for tissue transplantation, leading to a long-term improvement in quality of life.
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Affiliation(s)
- Frederik Raiskup
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Robert Herber
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Janine Lenk
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Lutz E Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Eberhard Spoerl
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Kong CF, Go C, Goolam S, Yeung S. Diagnostic utility of in vivo confocal microscopy in Acanthamoeba keratitis following corneal crosslinking. BMJ Case Rep 2024; 17:e257279. [PMID: 38772872 DOI: 10.1136/bcr-2023-257279] [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: 05/23/2024] Open
Abstract
Acanthamoeba keratitis (AK) is a rare but potentially sight-threatening complication of corneal collagen crosslinking (CXL) for keratoconus. In this report, we describe an early adolescent male who underwent routine CXL for progressive keratoconus in his left eye. Preprocedural left visual acuity (VA) was 6/9. At day 5 postprocedure, multifocal corneal infiltrates were identified. Corneal scrape, bandage contact lens cultures and herpetic and Acanthamoeba PCR were negative. In vivo, confocal microscopy (IVCM) identified Acanthamoeba cysts within the corneal stroma. Intensive amoebicidal therapy was initiated, but recovery was complicated by significant inflammation, resulting in widespread aggressive corneal vascularisation necessitating topical steroids and steroid-sparing agents. At 10 months, his left VA was 6/24. This report emphasises the importance of maintaining a high index of suspicion for AK in cases of post-CXL microbial keratitis and highlights the diagnostic value of IVCM, particularly in culture-negative and PCR-negative cases.
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Affiliation(s)
- Cheng Fei Kong
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Christopher Go
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Saadiah Goolam
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Season Yeung
- Westmead Hospital, Westmead, New South Wales, Australia
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Moramarco A, di Geronimo N, Gardini L, Grendele A, Fontana L. Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature. BMC Ophthalmol 2024; 24:131. [PMID: 38528481 DOI: 10.1186/s12886-024-03400-1] [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: 11/21/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK). METHODS A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision. RESULTS Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery. CONCLUSIONS Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.
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Affiliation(s)
- Antonio Moramarco
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy.
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Natalie di Geronimo
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Gardini
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Arianna Grendele
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Fontana
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Farrokhpour H, Soleimani M, Cheraqpour K, Masoumi A, Tabatabaei SA, Shahriari M, Hobaby S, Baharnoori SM, Chaudhry A, Djalilian AR. A Case Series of Infectious Keratitis After Corneal Cross-linking. J Refract Surg 2023; 39:564-572. [PMID: 37578174 DOI: 10.3928/1081597x-20230717-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
PURPOSE To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL). METHODS This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study. RESULTS Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious keratitis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and Staphylococcus aureus were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventually required cases to undergo keratoplasty. CONCLUSIONS This study supports the need for proper patient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient education and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings. [J Refract Surg. 2023;39(8):564-572.].
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Peng F, Xie Q, Chen J, Fang Y, Xu W, Jiang D, Chen W. Effect of Corneal Collagen Cross-Linking on Subsequent Corneal Fungal Infection in Rats. Transl Vis Sci Technol 2023; 12:12. [PMID: 37163284 PMCID: PMC10179700 DOI: 10.1167/tvst.12.5.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Purpose The purpose of this study was to determine whether corneal collagen cross-linking (CXL) alters fungal susceptibility and increases the severity of keratitis through macrophage activation in rats. Methods Four weeks following CXL pretreatment, the corneal epithelium of adult rats was removed and inoculated with Candida albicans (C. albicans; CXL + inoculation group). The non-CXL-pretreated corneas were also inoculated with C. albicans (inoculation group). Clinical scoring and histopathological examination were performed to determine the severity of fungal keratitis. Immunofluorescence and confocal microscopy imaging were applied to determine the effects of CXL treatment on corneal local macrophage content. Real-time polymerase chain reaction (RT-PCR) and Western blots were used to evaluate mRNA and protein expression. Flow cytometry assays were performed to detect M1- and M2-type macrophages. Results CXL pretreatment (CXL + inoculation) resulted in higher infection success rate and more severe fungal keratitis than inoculation alone (inoculation group). On days 1, 3, and 7 following fungal infection, the increase in macrophage infiltration and IL-1β, MMP-9, and VEGFA expression was greater in the CXL + inoculation group than in the inoculation group. Number of M1- and M2-type macrophages, M1 to M2 ratio, M1-type macrophage genes, inducible nitric oxide synthase (iNOS), and tumor necrosis factor (TNFα) expression were higher in the CXL + inoculation group compared with the inoculation group. Conclusions Our data demonstrate that CXL may increase the colonization of macrophages and activate more M1-type macrophages to increase fungal susceptibility and severity of keratitis. Translational Relevance This study may aid long-term risk assessment and treatment of the complications of CXL.
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Affiliation(s)
- Fangli Peng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- The First Affiliated Hospital of Soochow University, Dongxiaoqiao Longyu Shizi Street Intersection, 100 Meters West, Suzhou, Jiangsu, P. R. China
| | - Qi Xie
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiaqi Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiting Fang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dan Jiang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Fungal Keratitis and Corneal Perforation as a Rare Complication of Corneal Collagen Cross-Linking Treatment. Cornea 2023:00003226-990000000-00254. [PMID: 36881003 DOI: 10.1097/ico.0000000000003270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE The aim of this study was to report a case of fungal keratitis with subsequent corneal perforation after corneal collagen cross-linking (CXL) treatment performed for keratoconus. CASE REPORT A 20-year-old woman presented with redness and discharge in the left eye. She had a history of bilateral CXL procedure performed for keratoconus elsewhere 4 days earlier. The visual acuity was hand motion in the left eye. Slit-lamp examination revealed extended corneal melting with surrounding infiltrates. The patient was hospitalized, and corneal epithelial scraping samples were sent for microbiological assessment. In the meantime, empirical antibiotic therapy (fortified topical antibiotics: vancomycin 50 mg/mL, ceftazidime 50 mg/mL, and fluconazole 2 mg/mL q1 hour) was initiated. In direct microscopy of the corneal scraping, septate hyaline fungal hyphae were detected and topical fluconazole was switched to topical voriconazole (10 mg/mL). Three days after hospitalization, corneal melting progressed to perforation and corneal suturing with 10-0 monofilament was performed to reform the anterior chamber. Complete resolution of keratitis with residual scarring was noticed in 2 weeks. Three months later, penetrating keratoplasty was performed to obtain better visual acuity. CONCLUSIONS CXL with riboflavin has become a common procedure to prevent keratoconus progression by strengthening the biomechanical specialties of the cornea. Although the treatment itself has been used in the management of microbial keratitis and related corneal melting, fungal keratitis and corneal perforation after a CXL procedure for keratoconus might also be detected. Clinicians should be aware of this rare but devastating complication of CXL treatment and start prompt treatment when suspected.
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Tillmann A, DanielKampik D, Borrelli M, Seidl M, Menzel-Severing J, Seiler TG, Geerling G. Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus. Am J Ophthalmol Case Rep 2022; 28:101705. [PMID: 36187442 PMCID: PMC9519437 DOI: 10.1016/j.ajoc.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To report two cases of acute corneal melting and perforation requiring emergency penetrating keratoplasty after corneal crosslinking (CXL) in advanced keratoconus. Observations Case 1 was a 34 and case 2 was a 16-year old male, both with progressive keratoconus, who underwent CXL (Dresden protocol). After riboflavin imbibition, patients had a minimal pachymetry of 337 μm and 347 μm, and therefore required stromal swelling by hypoosmolar riboflavin resulting in pachymetries of 470 μm and 422 μm, prior to the 30 minute UV-irradiation with 3mW/cm2. In case 1, on the 7th postoperative day a 4mm linear perforation occurred. Extensive post-hoc examinations revealed no infectious cause. In case 2, a corneal melting developed within 24 hours, from which Staphylococcus aureus was cultured. Conclusions and importance Acute corneal melting and perforation may occur after CXL. Dysfunctional collagen metabolism, atopia, thin preoperative pachymetry and the use of hypoosmolar substances may have initiated this complication in our cases.
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Affiliation(s)
- Anne Tillmann
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
- Corresponding author. University Hospital Duesseldorf, Department of Ophthalmology, Moorenstraße 5, D-40225, Duesseldorf, Germany.
| | | | - Maria Borrelli
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
| | - Maximilian Seidl
- Institute of Pathology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Theo Günter Seiler
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
- Department of Ophthalmology, University of Bern, Bern, Switzerland
- Institute for Refractive and Ophthalmic Surgery (IROC), Zurich, Switzerland
| | - Gerd Geerling
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
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Ang MJ, Darbinian JA, Hoskins EN, Holsclaw DS, Sudesh S, Chandra NS. The Safety Profile of FDA-Approved Epithelium-Off Corneal Cross-Linking in a US Community-Based Healthcare System. Clin Ophthalmol 2022; 16:1117-1125. [PMID: 35431539 PMCID: PMC9012302 DOI: 10.2147/opth.s359224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the occurrence of early post-operative complications following FDA-approved epithelium-off corneal cross-linking in the United States. Materials and Methods This multicenter, retrospective cohort study identified patients who underwent epithelium-off (epi-off) corneal cross-linking (CXL) for keratoconus and post-refractive keratectasia within the Kaiser Permanente Northern California healthcare system between 2016 and 2018. Post-operative complications including delayed epithelial healing, infection, and loss of visual acuity were recorded. Results The study included 878 eyes of 654 patients. The mean age was 27±9.4 years (range 7–71). Five hundred ninety-nine patients (91.6%) had keratoconus while 55 had post-refractive corneal ectasia (8.4%). Forty-seven eyes had prolonged follow-up because of the occurrence of complications in the early post-operative period. The respective rates of delayed epithelial healing, and keratitis were 3.9% (95% CI 2.7–5.3%), and 1.5% (95% CI 0.8–2.5%). Four approaches for management of delayed epithelial healing were compared; epithelium healing duration was the longest in the repeat bandage contact lens (BCL) group (23.8 days) and the shortest in the antibiotic ointment group (14.3 days), with statistically significant differences (p < 0.05) in the healing time between these 2 groups. Conclusion The concern for early clinical complications after epi-off CXL often leads to delayed CXL intervention and further keratoconus progression with increased economic burdens. A large retrospective review of 878 eyes found that FDA-approved epi-off CXL protocol appears to be safe with low occurrence rates of early post-operative complications. The recommended management for delayed epithelial healing is using antibiotic ophthalmic ointment.
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Affiliation(s)
- Michael J Ang
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Jeanne A Darbinian
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Eliza N Hoskins
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Douglas S Holsclaw
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Sudha Sudesh
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Naveen S Chandra
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
- Correspondence: Naveen S Chandra, The Permanente Medical Group, 320 Lennon Lane, Walnut Creek, CA, 94598, 94598, Tel +1 925-906-2550, Fax +1 925-906-2332, Email
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Lu Y, Yin Y, Hu T, Du K, Fu Y, Xiang A, Fu Q, Wu X, Li Y, Wen D. Polymicrobial keratitis after accelerated corneal collagen cross-linking in keratoconus: Case reports and literature review. Eur J Ophthalmol 2021; 32:1375-1385. [PMID: 34821524 DOI: 10.1177/11206721211051922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report two cases of polymicrobial keratitis following corneal collagen cross-linking for keratoconus and to review the literature. METHODS Retrospective case note and literature review. RESULTS The first case involved a 27-year-old male who presented with amebic corneal ulcers 3 days after the collagen cross-linking procedure. Some gram-negative (gram-ve) cocci were found upon staining, and cysts were observed by confocal microscopy at 7 days after surgery. Acanthamoeba infection mixed with gram-ve organisms was diagnosed. In the second case, a 14-year male developed Staphylococcus aureus corneal infection with anterior chamber empyema 3 days after the collagen cross-linking procedure for keratoconus. Occasional gram-positive (gram + ve) cocci and gram-ve bacilli were observed under a microscope. The mixed keratitis in the two patients resolved after systemic and topical antibiotic therapy, but the infection ultimately resulted in corneal scarring. Follow-up keratoplasty was needed to improve vision acuity in both patients. CONCLUSION Although ultraviolet irradiation and the reactive oxygen released by riboflavin during collagen cross-linking have bactericidal effects, a lack of a corneal epithelial barrier, bandage contact lens usage, perioperative hygiene, and an abnormal immune state are risk factors for infectious keratitis after collagen cross-linking. Perioperative management of collagen cross-linking is important to prevent infection.
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Affiliation(s)
- Ying Lu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yewei Yin
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Tu Hu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Kaixuan Du
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yanyan Fu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Aiqun Xiang
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Qiuman Fu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Xiaoying Wu
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yuanjun Li
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Dan Wen
- 159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
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Murchison CE, Petroll WM, Robertson DM. Infectious keratitis after corneal crosslinking: systematic review. J Cataract Refract Surg 2021; 47:1075-1080. [PMID: 33769765 PMCID: PMC8298263 DOI: 10.1097/j.jcrs.0000000000000620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Abstract
Corneal crosslinking is a U.S. Food and Drug Administration--approved therapy to stiffen the cornea and prevent progression of corneal ectasia in patients with keratoconus. The standard procedure involves removal of the corneal epithelium (epithelial-off) prior to treatment. Variations to the standard procedure include accelerated crosslinking and transepithelial procedures. This study reviewed what is known regarding the risk for infection after epithelial-off crosslinking, the spectrum of pathogens, and clinical outcomes. 26 publications were identified. All eyes were fit with a bandage contact lens postoperatively. Available data indicate that the overall frequency of infectious keratitis after epithelium-off crosslinking is low. Bacterial infections are the most common, with a mean time of presentation of 4.8 days postoperatively. The use of steroids and bandage contact lenses in the immediate postoperative period and/or a history of atopic or herpetic disease were associated with infection. These patients require intense postoperative care with prophylactic antiviral therapy when appropriate.
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Affiliation(s)
- Caroline E Murchison
- From the Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas
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11
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Lang SJ, Maier P, Reinhard T. Crosslinking und Keratokonus. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1205-7737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungEin Keratokonus führt zu einer progressiven Vorwölbung und Verdünnung der
Hornhaut. Um dies aufzuhalten, kann ein Crosslinking durchgeführt werden. Dabei
ist eine Behandlung nach dem „Dresdener Protokoll“ eine effektive und sichere
Behandlungsmöglichkeit, aber auch zahlreiche neue Anwendungsprotokolle
(akzeleriertes Crosslinking, transepitheliales Crosslinking) und sogar weitere
Indikationen (refraktive Eingriffe, infektiöse Keratitis) wurden in den letzten
Jahren veröffentlicht.
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12
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Lang SJ, Maier P, Reinhard T. [Crosslinking and Keratoconus]. Klin Monbl Augenheilkd 2021; 238:733-747. [PMID: 33873207 DOI: 10.1055/a-1472-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Keratoconus leads to a progressive protrusion and thinning of the cornea. In order to stop this, corneal crosslinking can be performed if the progression of the disease is proven. Crosslinking according to the "Dresden protocol" includes abrasion of the corneal epithelium, application of riboflavin eye drops and irradiation with UV-A light of an intensity of 3 mW/cm² for 30 minutes. The efficacy has been shown in several prospective randomized studies. One of the more recent developments is accelerated crosslinking, which allows a shorter irradiation time. On the other hand, the possibility of transepithelial crosslinking was presented, which does not require an abrasion of the cornea. This should reduce the occurrence of postoperative pain. The range of indications has also been expanded. Corneal crosslinking is used for post-LASIK keratectasia as well. It is also being considered for use in infectious keratitis. Topographically controlled crosslinking can likewise be used to try to positively influence the refractive power of the cornea. The risks of crosslinking include the occurrence of pain, haze or scarring, endothelial cell damage and, rarely, the occurrence of keratitis.
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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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Khoo P, Cabrera-Aguas M, Watson SL. Microbial Keratitis After Corneal Collagen Cross-Linking for Corneal Ectasia. Asia Pac J Ophthalmol (Phila) 2021; 10:355-359. [PMID: 33534235 DOI: 10.1097/apo.0000000000000379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to report the clinical profile and microbiological of patients with microbial keratitis post accelerated corneal collagen cross-linking (CXL). METHODS A retrospective case series of all patients diagnosed with microbial keratitis post-CXL who attended the Sydney Eye Hospital, Australia from January 1, 2012 to December 31, 2019 were included. Patients were identified from hospital coding and pathology data. Data were extracted from patients' medical records. RESULTS Eleven eyes from 10 patients with a mean age of 29 ± 11 years (range 16-48) were included. The median time of infection after CXL surgery was 4 days [interquartile range (IQR) 3-83]. Median initial and final Visual acuity at presentation were 1.3 logMAR (IQR 1-2.0) and 0.8 logMAR (IQR 0.6-1.2), respectively. The culture positivity rate was 92%, identifying 13 isolates, predominately made up of coagulase-negative Staphylococcus (n = 6, 50%) and Staphylococcus aureus (n = 3, 25%). The median epithelial healing time was 30 days (IQR 15-53). CONCLUSIONS Post-CXL microbial keratitis was predominately associated with gram-positive bacteria and in some cases delayed epithelialization. Microbial keratitis post-CXL may lead to moderate to poor patient outcomes.
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Affiliation(s)
- Pauline Khoo
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Maria Cabrera-Aguas
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
- Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
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AlQahtani BS, Alshahrani S, Khayyat WW, Abdalla-Elsayed MEA, Altalhi AA, Saifaldein AA, Taha MA. Outcomes of Corneal Topography among Progressive Keratoconus Patients 12 months following Corneal Collagen Cross-Linking. Clin Ophthalmol 2021; 15:49-55. [PMID: 33442228 PMCID: PMC7800689 DOI: 10.2147/opth.s284981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/04/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to assess the overall and specific topographic changes among patients who underwent corneal collagen cross-linking (CXL) due to progressive keratoconus. Methods This retrospective case series study was conducted at a single-arm hospital in King Abdulaziz Medical City, Riyadh. All progressive keratoconus patients who underwent CXL between January 2017 and December 2018 were included consecutively. The epi-off crosslinking technique (Dresden protocol) was applied in all patients. The topographic values were measured preoperatively and 12 months postoperatively. Patients with a history of a previous corneal procedure, corneal trauma, or any corneal scarring were excluded. Results Among our population (29 eyes of 24 patients), 58.6% of eyes were for male patients, and the mean age of the population was 27.76 ± 4.21 years. Based on the topography results, the mean values of corneal thickness at central 3 mm decreased from 473.45 ± 38 µm to 465.72 ± 41.78 µm following CXL (Z = −1.93, 95% confidence interval [CI] = 0.048–0.057, p= 0.053). Clinically significant astigmatism measurements were present in 28 (96.6%) eyes before CXL compared to 26 (89.7%) eyes after CXL. The mean values of astigmatism among the patients were 3.37 ± 2.25 diopters before and 3.67 ± 2.61 diopters after CXL (Z = −1696, 95% confidence interval [CI] = 0.085–0.096, p = 0.09). After CXL, the mean values of the front elevation at the apex changed from 33.90 ± 20.13 µm to 36.10 ± 21.09 µm (Z = −2.792, 95% [CI] = 0.003–0.006, p = 0.005). The mean values of the back elevation at the apex changed from 68.4 ± 35.66 µm to 69.90 ± 35.89 µm (Z = −0.934, 95% CI = 0.343–0.366, p = 0.35). Conclusion The topographic corneal parameters improved significantly in the patients with corneal ectasia after CXL. These results revealed the safety and efficacy of CXL in stabilizing keratoconus progression among Saudi patients at 1 year of follow-up.
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Affiliation(s)
- Bader S AlQahtani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Saeed Alshahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Waleed W Khayyat
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Abdullah A Altalhi
- Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amjad A Saifaldein
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Taha
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Sifaoui I, Rodríguez-Talavera I, Reyes-Batlle M, Rodríguez-Expósito RL, Rocha-Cabrera P, Piñero JE, Lorenzo-Morales J. In vitro evaluation of commercial foam Belcils® on Acanthamoeba spp. Int J Parasitol Drugs Drug Resist 2020; 14:136-143. [PMID: 33099237 PMCID: PMC7578530 DOI: 10.1016/j.ijpddr.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/02/2022]
Abstract
Interest in periocular (eyelid and eyelashes margins) hygiene has attracted attention recently and a growing number of commercials eye cleanser and shampoos have been marketed. In the present study, a particular eye cleanser foam, Belcils® has been tested against trophozoites and cysts on the facultative pathogen Acanthamoeba. Viability was tested by the alamarBlue™ method and the foam was tested for the induction of programmed cell death in order to explore its mode of action. We found that a 1% solution of the foam eliminated both trophozoite and cyst stage of Acanthamoeba spp. After 90 min of incubation, Belcils® induced, DNA condensation, collapse in the mitochondrial membrane potential and reduction of the ATP level production in Acanthamoeba. We conclude that the foam destroys the cells by the induction of an apoptosis-like process. The current eye cleanser could be used as part of AK therapy protocol and as prevention from AK infections for contact lens users and post-ocular trauma patients.
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Affiliation(s)
- Ines Sifaoui
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203, Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET), Spain.
| | - Iván Rodríguez-Talavera
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Área de Oftalmología, Hospital Universitario de Canarias, Tenerife, Spain
| | - María Reyes-Batlle
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203, Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET), Spain
| | - Rubén L Rodríguez-Expósito
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203, Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET), Spain
| | - Pedro Rocha-Cabrera
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Área de Oftalmología, Hospital Universitario de Canarias, Tenerife, Spain
| | - José E Piñero
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203, Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET), Spain
| | - Jacob Lorenzo-Morales
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203, Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET), Spain
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Schear M, Ragam A, Seedor J, Udell I, Shih C. Rapid keratitis and perforation after corneal collagen cross-linking. Am J Ophthalmol Case Rep 2020; 18:100658. [PMID: 32274444 PMCID: PMC7132167 DOI: 10.1016/j.ajoc.2020.100658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 03/09/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To describe a case of rapid keratitis and corneal perforation after epithelium off collagen cross-linking. Observations We report a case of a 17-year-old male who underwent collagen cross-linking with the protocol and device approved by the United States Food and Drug Administration (FDA) that developed a corneal infiltrate 3 days after the procedure. He later developed corneal thinning and perforation on day 5 requiring the use of cyanoacrylate glue and a Kontur lens. Despite initial improvement in the infiltrate with fortified antibiotics he later had leakage of aqueous around the glue and a flat chamber requiring an emergent penetrating keratoplasty on postoperative day 16. Conclusion and importance While collagen cross-linking has been very effective for treating keratoconus and is being recommended more frequently since FDA approval in the United States, severe complications such as corneal perforation requiring early transplant can still occur.
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Affiliation(s)
- Matthew Schear
- Department of Ophthalmology, Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - Ashwinee Ragam
- Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
| | - John Seedor
- Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Ira Udell
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Great Neck, NY, USA
| | - Carolyn Shih
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Great Neck, NY, USA
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18
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Alternaria keratitis after corneal crosslinking. Am J Ophthalmol Case Rep 2020; 17:100616. [PMID: 32083224 PMCID: PMC7021532 DOI: 10.1016/j.ajoc.2020.100616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a case of fungal keratitis after corneal collagen crosslinking (CXL) surgery. Observations We report a case of fungal keratitis after CXL for post-refractive surgery ectasia. The patient presented 12 days after surgery with a corneal ulcer that was culture positive for Alternaria species of fungus. She subsequently developed a bacterial superinfection. The keratitis resolved with medical therapy, although the patient required a penetrating keratoplasty (PKP) due to central corneal scarring. Conclusions and Importance To our knowledge, this is the first case of fungal keratitis as a complication after CXL in the United States and the first case of Alternaria infection after CXL using the Dresden protocol. Infectious keratitis is a rare but serious complication of CXL, and we suggest continued innovation of operative techniques that may reduce the risk of infectious keratitis.
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Corneal crosslinking: Current protocols and clinical approach. J Cataract Refract Surg 2019; 45:1670-1679. [DOI: 10.1016/j.jcrs.2019.06.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/19/2019] [Accepted: 06/21/2019] [Indexed: 12/18/2022]
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Moghadam RS, Akbari M, Alizadeh Y, Medghalchi A, Dalvandi R. The Outcome of Corneal Collagen Cross-Linking in Patients with Advanced Progressive Keratoconus: A 2-Year Follow-up Study. Middle East Afr J Ophthalmol 2019; 26:11-16. [PMID: 31114118 PMCID: PMC6507378 DOI: 10.4103/meajo.meajo_101_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE: The aim of this study was to evaluate the safety and efficacy of collagen cross-linking (CXL) in advanced progressive keratoconus with a maximum keratometry (Kmax) value of more than 58 diopters (D). METHODS: This prospective interventional case series involved patients with advanced progressive keratoconus with a Kmax of more than 58 D. The best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), Kmax, mean keratometry (Kmean) value, corneal astigmatism, and thinnest corneal thickness before surgery and 24 months after CXL were determined for 30 eyes of 27 patients. A Pentacam was used to measure the paraclinical parameters. RESULTS: The mean age of the patients was 24.47 ± 3.33 years. The mean logarithm of the minimum angle of resolution (logMAR) of the uncorrected visual acuity UCVA decreased from 0.73 ± 0.36 D at baseline to 0.48 ± 0.30 D (P = 0.01), while the mean thinnest point thickness of the cornea decreased from 438.65 ± 40.11 μm to 431.43 ± 61.92 μm (P = 0.005) after 24 months. The decreases in the mean logMAR of the BCVA, Kmax and Kmean values, and corneal astigmatism were not statistically significant (P > 0.05) at the 24-month follow-up. Progression was halted in 29 eyes (96.6%); only 1 eye (3.3%) showed an increase in the Kmax value of more than 2.0 D, which was indicative of treatment failure. In contrast, most other eyes showed a decrease in the Kmax value although it was not statistically significant. There were no major complications in any of the patients during the study period. CONCLUSION: Standard CXL treatment was safe and stabilized both the visual acuity and tomographic parameters at the 2-year follow-up in eyes with advanced progressive keratoconus.
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Affiliation(s)
| | - Mitra Akbari
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Yousef Alizadeh
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Reza Dalvandi
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
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21
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Tzamalis A, Romano V, Cheeseman R, Vinciguerra R, Batterbury M, Willoughby C, Neal T, Ahmad S, Kaye S. Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL. BMJ Open Ophthalmol 2019; 4:e000231. [PMID: 30997402 PMCID: PMC6440609 DOI: 10.1136/bmjophth-2018-000231] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/15/2018] [Accepted: 01/10/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the role of bandage contact lenses (BCL) and topical steroids as risk factors for the development of microbial keratitis after epithelium-off corneal collagen cross-linking (CXL). Methods and Analysis Patients undergoing CXL between February 2011 and July 2017 were included. Patients were divided into two groups: those who were treated postoperatively with a BCL, topical antimicrobial and steroids (group 1) and those who received only a topical antimicrobial until healing of the epithelial defect before introduction of topical steroids (group 2). Results 1273 eyes of 964 patients were included. Group 1 comprised 316 eyes and group 2 comprised 957 eyes. There were no significant differences in the presence of persisting corneal haze or scarring between the two groups (p=0.57). Microbial keratitis occurred in nine eyes (0.71% of eyes) of eight (0.83%) patients (one case was bilateral) out of 1273 eyes. Staphylococcus aureus was cultured from corneal scrapes in seven out of nine (77.8%) cases and from contiguous sites in the two cases. All cases occurred in group 1 (incidence=2.85%) and none in group 2 (p<0.0001). A greater proportion of patients who developed microbial keratitis were atopic (75%, p=0.4). Conclusion The use of BCL and topical steroids prior to healing of the epithelium is a significant risk factor for microbial keratitis. S. aureus is the most common micro-organism and is likely to originate from an endogenous site. Not using a BCL and delaying the introduction of topical steroids until epithelial healing significantly reduce the risk of developing microbial keratitis without increasing the risk of persistent corneal haze.
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Affiliation(s)
- Argyrios Tzamalis
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Vito Romano
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Robert Cheeseman
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Mark Batterbury
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Colin Willoughby
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Timothy Neal
- Department of Medical Microbiology, Royal Liverpool University Hospital, Liverpool, UK
| | - Sajjad Ahmad
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Stephen Kaye
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Guber I, Bergin C, Malde S, Guber J, Hamada S, Lake D. First experience with Oasis Collagen SOFT SHIELD® for epithelial defect after corneal cross-linking. Int Ophthalmol 2019; 39:2149-2151. [DOI: 10.1007/s10792-018-01070-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/31/2018] [Indexed: 02/06/2023]
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Corneal crosslinking without epithelial removal. J Cataract Refract Surg 2018; 44:1363-1370. [PMID: 30228014 DOI: 10.1016/j.jcrs.2018.07.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 07/08/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate the effect of riboflavin-ultraviolet (UV)-A corneal crosslinking (CXL) without epithelial removal on ectatic corneal disease. SETTING Woolfson Eye Institute, Atlanta, Georgia, USA. DESIGN Prospective observational study. METHODS Patients were treated with a new riboflavin formulation without epithelial removal, then exposed to UV light (365 nm) at 4 mW/cm2 with on-off cycling for 30 minutes. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, maximum corneal curvature (maximum keratometry [Kmax]), total higher-order aberrations (HOAs), and coma were measured at 3, 6, 12, and 24 months postoperatively. Progression was defined as an increase of more than 1 diopter (D) in Kmax and loss of more than 1 line of CDVA. RESULTS Five hundred twelve eyes of 308 patients with keratoconus or forme fruste keratoconus and 80 eyes of 55 patients with ectasia after laser in situ keratomileusis (LASIK) were treated with the new riboflavin formulation without epithelial removal; 229 patients received bilateral treatments, 95 of which were simultaneous. The mean UDVA and CDVA improved by 1 to 1.5 Snellen lines at 1 and 2 years postoperatively (P < .0001). Mean Kmax decreased by 0.48 D at 2 years postoperatively (P = .0002). Mean total HOAs and coma decreased by 36% (P < .0001) and 37% (P = .0002), respectively, at 2 years postoperatively. Kmax decreased more than 1 D in three times as many eyes as it increased more than 1 D (P < .0001). No eyes progressed, and there was no loss of effect between 1 and 2 years postoperatively. No vision-threatening events were observed. Pain typically resolved within 24 hours, and visual acuity returned to preoperative levels in 1 to 2 days. CONCLUSION Epithelium-on CXL using this new protocol halted the progression of keratoconus and ectasia after LASIK. It was safer and provided more rapid visual recovery than CXL with epithelial removal, allowing routine bilateral, simultaneous treatment.
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Evaluation of the Effectiveness of Cross-Linking Combined With Photorefractive Keratectomy for Treatment of Keratoconus. Cornea 2018; 37:1143-1150. [PMID: 29952798 PMCID: PMC6092093 DOI: 10.1097/ico.0000000000001663] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of combined epithelium-off cross-linking (CXL) with photorefractive keratectomy (CXL Plus) for correction of the myopic and astigmatic components of keratoconus. METHODS Seventy-nine eyes of 46 patients who underwent CXL Plus were enrolled in this retrospective, multicenter, noncomparative clinical study. Uncorrected distance visual acuity, corrected distance visual acuity, refraction, keratometry, and pachymetry measurements were recorded preoperatively and at 3, 6, 12, and 18 months during follow-up. RESULTS The mean (±SD) preoperative uncorrected distance visual acuity and corrected distance visual acuity were 1.00 ± 0.22 logarithm of the minimum angle of resolution (logMAR) and 0.62 ± 0.38 logMAR, respectively, and improved to 0.71 ± 0.36 logMAR and 0.32 ± 0.18 logMAR postoperatively. The mean k value, mean corneal thickness at the thinnest location, and mean myopic and astigmatic components decreased from 46.58 ± 0.97 D, 473 ± 29 μm, 3.65 ± 1.72 D, and 1.83 ± 0.69 D preoperatively to 43.79 ± 1.17 D, 431 ± 38 μm, 1.02 ± 0.78 D, and 1.15 ± 0.26 D, respectively, during follow-up. Eleven eyes had delayed epithelial healing, 2 had stromal opacities, 1 had primary herpes simplex keratitis, and 5 showed progression of keratoconus. CONCLUSIONS CXL Plus improved the refractive status of keratoconus during 18 months of follow-up, despite its potential early postoperative complications of delayed epithelial healing and corneal haze. CXL Plus reduced the myopic component more than the astigmatic component of keratoconus. However, the safety and stability of the procedure were offset by longer-term postoperative complications and a high rate of postoperative progression of keratoconus.
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Epi-Off versus Epi-On Corneal Collagen Cross-Linking in Keratoconus Patients: A Comparative Study through 2-Year Follow-Up. J Ophthalmol 2018; 2018:4947983. [PMID: 30151277 PMCID: PMC6087595 DOI: 10.1155/2018/4947983] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/29/2018] [Indexed: 11/26/2022] Open
Abstract
Aim To evaluate two different techniques of cross-linking: standard epithelium-off (CXL epi-off) versus transepithelial (CXL epi-on) cross-linking in patient with progressive keratoconus. Methods Forty eyes from 32 patients with progressive keratoconus were prospectively enrolled from June 2014 to June 2015 in this nonblinded, randomized comparative study. Twenty eyes were treated by CXL epi-off and 20 by CLX epi-on, randomly assigned, and followed for 2 years. All patients underwent a complete ophthalmologic testing that included uncorrected and best corrected visual acuity, central and peripheral corneal thickness, corneal astigmatism, simulated maximum, minimum, and average keratometry, corneal confocal microscopy, Schirmer I and break-up time (BUT) tests, and the Ocular Surface Disease Index. Intra- and postoperative complications were recorded. The solution used for CXL epi-off comprised riboflavin 0.1% and dextran 20.0% (Ricrolin), whereas the solution for CXL epi-on (Ricrolin TE) comprised riboflavin 0.1%, dextran 15.0%, trometamol (Tris), and ethylenediaminetetraacetic acid. Ultraviolet-A treatment was performed with a UV-X system at 3 mW/cm2. Results In both groups, a significant improvement in visual function (Group 1: baseline 0.36 ± 0.16 logMAR, two-year follow-up 0.22 ± 0.17 logMAR, p=0.01; Group 2: baseline 0.32 ± 0.18 logMAR, 2-year follow-up 0.27 ± 0.19 logMAR, p=0.01) was recorded. Keratometry remained unchanged in both groups. The mean corneal thickness showed a significant reduction (mean difference of corneal thickness: −55 micron and −71 micron, resp.). One-month after treatment, OSDI© reached 13.56 ± 2.15 in Group 1 (p=0.03) and 11.26 ± 2.12 in Group 2 (p=0.04). At confocal microscopy, abnormal corneal nerve alterations were found in both groups. Fibrotic reaction (43.75%) and activated keratocyte (62.6%) were more commonly recorded in Group 1 than in Group 2 (25.0% and 18.75%), with p=0.668 and 0.356, respectively. Conclusion Our findings demonstrate that both procedures are able to slow keratoconus progression. Both treatment modalities are equivalent in terms of results and related complications. CXL epi-on technique is preferable to CXL epi-off since it preserves the corneal thickness and improves visual acuity, also reducing the postoperative ocular discomfort during the study period.
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Mirzaei M, Bagheri M, Taheri A. Influence of standard corneal cross-linking in keratoconus patients on macular profile. J Curr Ophthalmol 2018; 30:330-336. [PMID: 30555966 PMCID: PMC6277222 DOI: 10.1016/j.joco.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To determine the effect of corneal cross-linking (CXL) on retinal structure and function. Methods The current study was conducted on 42 eyes of 21 patients with keratoconus (KCN) who were candidates for CXL due to disease progression. The Optovue optical coherence tomography (OCT) (Optovue Inc., Fremont, USA) from macula and multifocal electroretinography (mERG) were performed on all patients prior to surgery and at 1- and 6- month follow-up. Structural and functional parameters of macula including retinal thickness in OCT, and amplitude and latency of electroretinogram were compared between eyes that underwent surgery and control fellow eyes during the study period. Results A statistically significant increase in central foveal, foveal, parafoveal, and perifoveal thickness was observed at 1-month follow-up. The changes were non-significant at 6 months. Although a statistically significant reduction in amplitude and increase in latency in both rings 2 and 3 were observed at 1 month in mERG, only amplitude changes in ring 2 remained significant at 6 months. Conclusion Transient anatomical and functional alterations following CXL were observed in the current study.
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Affiliation(s)
- Mohammad Mirzaei
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Bagheri
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Taheri
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Aounzou S, Chraibi F, El Bahloul M, El Abdellaoui M, Benatiya Andaloussi I, Tahri H. [Infectious keratitis after crosslinking for keratoconus in a patient with systemic lupus]. J Fr Ophtalmol 2018; 41:e215-e218. [PMID: 29853413 DOI: 10.1016/j.jfo.2017.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | - H Tahri
- CHU Hassan II-fès, Fès, Maroc.
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Bregman J, Jeng BH. Microbial Keratitis Secondary to Therapeutic Contact Lens Wear. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0177-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jia HZ, Peng XJ. Efficacy of iontophoresis-assisted epithelium-on corneal cross-linking for keratoconus. Int J Ophthalmol 2018; 11:687-694. [PMID: 29675392 DOI: 10.18240/ijo.2018.04.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/07/2018] [Indexed: 12/16/2022] Open
Abstract
Corneal cross-linking (CXL) is a noninvasive therapeutic procedure for keratoconus that is aimed at improving corneal biomechanical properties by induction of covalent cross-links between stromal proteins. It is accomplished by ultraviolet A (UVA) radiation of the cornea, which is first saturated with photosensitizing riboflavin. It has been shown that standard epithelium-off CXL (S-CXL) is efficacious, and it has been recommended as the standard of care procedure for keratoconus. However, epithelial removal leads to pain, transient vision loss, and a higher risk of corneal infection. To avoid these disadvantages, transepithelial CXL was developed. Recently, iontophoresis has been adopted to increase riboflavin penetration through the epithelium. Several clinical observations have demonstrated the safety and efficacy of iontophoresis-assisted epithelium-on CXL (I-CXL) for keratoconus. This review aimed to provide a comprehensive summary of the published studies regarding I-CXL and a comparison between I-CXL and S-CXL. All articles used in this review were mainly retrieved from the PubMed database. Original articles and reviews were selected if they were related to the I-CXL technique or related to the comparison between I-CXL and S-CXL.
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Affiliation(s)
- Hong-Zhen Jia
- Department of Ophthalmology, Chinese PLA Navy General Hospital, Beijing 100048, China
| | - Xiu-Jun Peng
- Department of Ophthalmology, Chinese PLA Navy General Hospital, Beijing 100048, China
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Maharana PK, Sahay P, Sujeeth M, Singhal D, Rathi A, Titiyal JS, Sharma N. Microbial Keratitis After Accelerated Corneal Collagen Cross-Linking in Keratoconus. Cornea 2018; 37:162-167. [PMID: 29111996 DOI: 10.1097/ico.0000000000001439] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the pattern of microbial keratitis after accelerated corneal collagen cross-linkage (aCXL) in patients with keratoconus. METHOD The medical records of cases of keratoconus that underwent aCXL from June 2014 to May 2017 were reviewed. Cases that developed microbial keratitis after aCXL were included in the study. The clinical, microbiological profile and the treatment outcomes were evaluated. RESULTS Of 532 eyes that underwent aCXL, 7 cases developed microbial keratitis during the study period. Median age at presentation was 11 years (range 8-17). Association with vernal keratoconjunctivitis was noted in 57.1% of cases (n = 4/7). The median time at the onset of infection was 3 days after aCXL (range 1-4). Microbiological reports revealed mixed infection in 3 cases [coagulase-negative Staphylococcus (CoNS) + Aspergillus fumigatus, Staphylococcus aureus and Mucor spp., Staph. aureus and Acanthamoeba], Staph. aureus in 2 cases, and CoNS and Alternaria spp. in 1 case each. Resistance to fourth-generation fluoroquinolones was noted in 83.3% of cases of bacterial keratitis (n = 5/6). All cases were initially managed with empirical antibiotic treatment that was later tailored based on microbiological reports. One case eventually required therapeutic penetrating keratoplasty for corneal perforation. At 6 months, the corrected distance visual acuity was >6/60 in 3 cases while 4 cases had corrected distance visual acuity <6/60. CONCLUSIONS Microbial keratitis after aCXL is rare; however, the infection tends to be severe with high preponderance of mixed infection and resistance to fourth-generation fluoroquinolones.
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Affiliation(s)
- Prafulla K Maharana
- Cornea, Cataract, and Refractice Services, the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kasparova EA, Sobkova OI, Yang B. [Corneal collagen cross-linking in the treatment of infectious keratitis and corneal ulcers]. Vestn Oftalmol 2018; 133:113-119. [PMID: 29319677 DOI: 10.17116/oftalma20171336113-118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent years, collagen cross-linking (CXL) of the cornea has acquired a new usage - in the treatment of infectious keratitis and corneal ulcers. This review was aimed at compiling the previously published data and assessing the effectiveness of the method.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - O I Sobkova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - Biao Yang
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
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Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes. J Curr Ophthalmol 2017; 29:235-247. [PMID: 29270469 PMCID: PMC5735256 DOI: 10.1016/j.joco.2017.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose To review the historical background and basic principles of collagen cross-linking, to bring together the data regarding the outcomes and complications of collagen cross-linking and finally to explore the efficacy and safety of new variations of this technique. Methods A literature review was performed using PubMed and Scopus. The following keywords were used for literature search: cross linking, crosslinking, cross-linking, keratoconus, keratectasia. Results In contrast to traditional treatment modalities for keratoconus (KCN), this new technique addresses the progression of the disease. Several clinical studies have been conducted to assess the efficacy of corneal collagen cross-linking (CXL) in the last decade. The results were promising as collagen cross-linking showed significant improvement in visual acuity and keratometric values. Moreover, initial results show that it is a safe procedure with few reported complications. Conclusion CXL is an emerging treatment method in ophthalmology that offers the possibility to effectively treat progressive KCN.
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Zhu Y, Reinach PS, Zhu H, Tan Q, Zheng Q, Qu J, Chen W. High-intensity corneal collagen crosslinking with riboflavin and UVA in rat cornea. PLoS One 2017. [PMID: 28644862 PMCID: PMC5482453 DOI: 10.1371/journal.pone.0179580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Corneal collagen cross-linking (CXL) halts human corneal ectasias progression by increasing stromal mechanical stiffness. Although some reports describe that this procedure is effective in dealing with some infectious and immunologic corneal thinning diseases, there is a need for more animal models whose corneal thickness more closely resemble those occurring in these patients. To meet this need, we describe here high-intensity protocols that are safe and effective for obtaining CXL in rat corneas. Initially, a range of potentially effective UVA doses were evaluated based on their effectiveness in increasing tissue enzymatic resistance to dissolution. At UVA doses higher than a threshold level of 0.54 J/cm2, resistance to enzymatic digestion increased relative to that in non-irradiated corneas. Based on the theoretical threshold CXL dose, a CXL regimen was established in which the UVA tissue irradiance was 9 mW/cm2, which was delivered at doses of either 2.16, 2.7 or 3.24 J/cm2. Their dose dependent effects were evaluated on ocular surface morphological integrity, keratocyte apoptotic frequency, tissue thickness and endothelial cell layer density. Doses of 2.16 and 2.7 J/cm2 transiently decreased normal corneal transparency and increased thickness. These effects were fully reversed after 14 days. In contrast, 3.24 J/cm2 had more irreversible side effects. Three days after treatment, apoptotic frequency in the CXL-2.16 group was lower than that at higher doses. Endothelial cell losses remained evident only in the CXL-3.24 group at 42 days posttreatment. Stromal fiber thickening was evident in all the CXL-treated groups. We determined both the threshold UVA dose using the high-intensity CXL procedure and identified an effective dose range that provides optimal CXL with minimal transient side effects in the rat cornea. These results may help to provide insight into how to improve the CXL outcome in patients afflicted with a severe corneal thinning disease.
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Affiliation(s)
- Yirui Zhu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang, China
| | - Peter S. Reinach
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang, China
| | - Hanlei Zhu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang, China
| | - Qiufan Tan
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang, China
| | - Qinxiang Zheng
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang, China
| | - Jia Qu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang, China
- * E-mail: (JQ); (WC)
| | - Wei Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang, China
- * E-mail: (JQ); (WC)
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Wu MF, Deichelbohrer M, Tschernig T, Laschke MW, Szentmáry N, Hüttenberger D, Foth HJ, Seitz B, Bischoff M. Chlorin e6 mediated photodynamic inactivation for multidrug resistant Pseudomonas aeruginosa keratitis in mice in vivo. Sci Rep 2017; 7:44537. [PMID: 28295043 PMCID: PMC5353637 DOI: 10.1038/srep44537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
Following corneal epithelium scratches, mouse corneas were infected with the multidrug resistant (MDR) P. aeruginosa strain PA54. 24 hours later, 0% (for control group), 0.01%, 0.05% or 0.1% Chlorin e6 (Ce6), a second generation photosensitizer derived from chlorophyll, was combined with red light, for photodynamic inactivation (PDI). 1 hour or 2 days later, entire mouse eyes were enucleated and homogenized for counting colony forming units (CFU) of P. aeruginosa. For comparison, 0.1% Ce6 mediated PDI was started at 12 hours post infection, and 0.005% methylene blue mediated PDI 24 hours post infection. Clinical scores of corneal manifestation were recorded daily. Compared to the control, CFU 1 hour after PDI started 24 hours post infection in the 0.01% Ce6 and 0.05% Ce6 groups were significantly lower (more than one log10 reduction), the CFU 2 days post PDI higher in the 0.1% Ce6 group, clinical score lower in the 0.1% Ce6 group at 1 day post PDI. These findings suggest that PDI with Ce6 and red light has a transient efficacy in killing MDR-PA in vivo, and repetitive PDI treatments are required to fully resolve the infection. Before its clinical application, the paradoxical bacterial regrowth post PDI has to be further studied.
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Affiliation(s)
- Ming-Feng Wu
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.,Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mona Deichelbohrer
- Institute for Anatomy and Cell Biology, Saarland University, Homburg/Saar, Germany
| | - Thomas Tschernig
- Institute for Anatomy and Cell Biology, Saarland University, Homburg/Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical &Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Hans-Jochen Foth
- Department of Physics, University of Kaiserslautern, Kaiserslautern, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Markus Bischoff
- Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
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Çerman E, Özcan DÖ, Toker E. Sterile corneal infiltrates after corneal collagen cross-linking: evaluation of risk factors. Acta Ophthalmol 2017; 95:199-204. [PMID: 27775234 DOI: 10.1111/aos.13218] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/10/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate possible risk factors leading to sterile corneal infiltrates following corneal collagen cross-linking (CXL). METHODS A total of 588 eyes of 459 patients treated with Epi-off (n = 461) or Epi-on (n = 127) CXL were retrospectively evaluated. Risk factors, including preoperative blepharitis and vernal conjunctivitis, the postoperative use of topical non-steroidal anti-inflammatory drugs (NSAIDs), as well as Kmax and pachymetry measurements, were assessed. In vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) analyses were performed in patients with sterile infiltrates. RESULTS Sterile infiltrates developed in 19 cases (3.2%). No patients in the Epi-on group developed sterile infiltrates. The evaluation of acceleration of the CXL procedure as a risk factor revealed no specific difference in the incidence of infiltrates among four different Epi-off groups (3 mW/cm2 -30 min, 9 mW/cm2 -10 min, 18 mW/cm2 -5 min, 30 mW/cm2 -4 min procedures; p > 0.05, all). Blepharitis, vernal conjunctivitis, Kmax and pachymetry were not identified as risk factors (p > 0.05). Postoperative use of NSAIDs was a significant contributor (p = 0.007), and it increased the chance of sterile infiltrates 4.09 times (95% CI, 1.463-11.428). In vivo confocal microscopy (IVCM) showed non-specific inflammation with dendritic cells at the epithelium and at Bowman's layer. In AS-OCT, a hyper-reflective band at the level of the anterior stroma to a depth of 100-140 μm was observed. CONCLUSION The evaluation of the risk factors such as blepharitis, the use of NSAIDs, vernal conjunctivitis, the duration of CXL procedure and amount of light intensity showed that epithelial damage is possibly the common pathway in the pathogenesis, as no sterile infiltrates in Epi-on CXL occurred, and the postoperative use of NSAIDs increased the risk of developing sterile infiltrates about four times.
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Affiliation(s)
- Eren Çerman
- Department of Ophthalmology; Marmara University School of Medicine; Istanbul Turkey
| | | | - Ebru Toker
- Department of Ophthalmology; Marmara University School of Medicine; Istanbul Turkey
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Abstract
PURPOSE To analyze the variations in tear quantity and quality after corneal collagen cross-linking (CXL) in patients with keratoconus. METHODS This is a prospective observational study of 24 eyes with keratoconus that underwent epithelium-off CXL. The variables studied were tear film osmolarity, subjective symptoms (Ocular Surface Disease Index), tear breakup time, Schirmer test (SCH) score, tear clearance, fluorescein staining, and lissamine green staining. Variables were determined preoperatively and 3, 6, and 12 months after CXL. RESULTS All the studied variables remained stable after 1-year follow-up (no significant difference in comparison with baseline values; Mann-Whitney U test). There was a positive paired correlation between the SCH score and tear clearance at 3; 0.532 (P < 0.01), 6; 0.434 (P = 0.04), and 12 months; 0.675 (P < 0.01). There was no correlation between the SCH score and tear breakup time, apart from a positive correlation at 12 months; 0.601 (P = 0.05). A negative correlation was found between osmolarity and the SCH score at 3; -0.589 (P < 0.01) and 12 months; -0.049 (P = 0.04). The Ocular Surface Disease Index did not correlate with any of the studied variables (Spearman test). CONCLUSIONS CXL, at least during the first postoperative year, does not modify the parameters currently used to evaluate tear film function. There is no correlation between objective and subjective parameters in the analysis of the tear film function.
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Jiang LZ, Qiu SY, Li ZW, Zhang X, Tao XC, Mu GY. Therapeutic and inducing effect of corneal crosslinking on infectious keratitis. Int J Ophthalmol 2016; 9:1820-1823. [PMID: 28003986 DOI: 10.18240/ijo.2016.12.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/09/2016] [Indexed: 11/23/2022] Open
Abstract
The corneal crosslinking (CXL) with riboflavin and ultraviolet-A (UVA) is a new therapy method to successfully treat infectious keratitis in clinical practice. However, there are rare reports on the complications of CXL such as the secondary keratitis. The diverse clinical outcomes on keratitis have highlighted the necessity to further evaluate the efficacy and complications of CXL. We reviewed the positive and negative reports on UVA/riboflavin related with keratitis and provided our opinion on the therapeutic and side effect of UVA/riboflavin crosslinking on keratitis.
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Affiliation(s)
- Liang-Zhu Jiang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China; Department of Ophthalmology, the People's Hospital of Linyi, Linyi 276000, Shandong Province, China
| | - Shi-Yan Qiu
- Department of Pediatrics, the People's Hospital of Linyi, Linyi 276000, Shandong Province, China
| | - Zhi-Wei Li
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
| | - Xiao Zhang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
| | - Xiang-Chen Tao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
| | - Guo-Ying Mu
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
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Corneal collagen crosslinking for corneal ectasias: a review. Eur J Ophthalmol 2016; 27:253-269. [PMID: 28009397 DOI: 10.5301/ejo.5000916] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To review the published literature on corneal collagen crosslinking (CXL). METHODS Importance has been placed on seminal publications, systemic reviews, meta-analyses, and randomized controlled clinical trials. Where such evidence was not available, cohort studies, case-controlled studies, and case series with follow-up greater than 12 months were examined. RESULTS Corneal collagen crosslinking with riboflavin and ultraviolet A (UVA) 370 nm radiation appears to be capable of arresting the progression of ectatic corneal disorders, with most studies reporting significant improvements in visual, keratometric, and topographic measurements. Its mode of action at the molecular level is undetermined. Follow-up is limited to 5-10 years but suggests sustained stability and enhancement in corneal shape with time. Nearly all published long-term data and comparative studies are with epithelium-off techniques. Epithelium-on investigations suggest some efficacy but less than with epithelium-off treatments and long-term data are unavailable. Accelerated techniques with higher UVA fluencies and shorter treatments times, delivering the same UVA energy dosage, are the subject of recent investigation, with some laboratory and clinical studies suggesting reduced efficacy compared to the standard 3 mW/cm2 for 30 minutes irradiation procedure. Combined methodologies of CXL with techniques such as photorefractive keratectomy and intrastromal rings show promise but long-term follow-up is indicated. Sight-threatening complications of CXL are rare. CONCLUSIONS Studies of epithelium-off CXL with irradiation at 3 mW/cm2 for 30 minutes support its efficacy. Refinement in techniques may allow for safer and more rapid procedures with less patient discomfort but require further investigation.
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Tomographic indices as possible risk factors for progression in pediatric keratoconus. J AAPOS 2016; 20:523-526. [PMID: 27794469 DOI: 10.1016/j.jaapos.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine whether corneal tomography can help predict the risk of progression of keratoconus in children. METHODS The medical records of pediatric patients with keratoconus presenting to a large tertiary institution in the UK from 2009 to 2014 were reviewed retrospectively. Patients underwent serial clinical examination and corneal tomography. The minimum follow-up period was 5 months. Patients with a history of eye surgery including corneal crosslinking were excluded. The following tomographic parameters were analyzed: thinnest corneal thickness (TCT), average central corneal keratometry (Km), and maximum central posterior elevation (MCPE). The rate of progressive corneal thinning, in μm/month, was calculated as the difference between TCT on presentation and at the most recent visit divided by the time in months. RESULTS A total of 36 eyes of 19 patients (10-16 years of age) were included. Mean follow-up was 19 months (range, 5-30 months). Six eyes (17%) developed corneal scarring and 1 eye (3%) developed acute hydrops. Of the 29 eyes that did not develop corneal scarring or hydrops, 24 (83%) demonstrated progressive corneal thinning over the period of the study. Eyes with TCT of <450 μm, Km above 50 D, and MCPE above 50 μm at presentation demonstrated the highest rates of progressive corneal thinning over the study period. CONCLUSIONS In pediatric keratoconus, lower TCT, higher Km, and higher MCPE on corneal tomography seem to be risk factors for faster rates of progressive corneal thinning.
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Galvis V, Tello A, Carreño NI, Ortiz AI, Barrera R, Rodriguez CJ, Ochoa ME. Corneal Cross-Linking (with a Partial Deepithelization) in Keratoconus with Five Years of Follow-Up. OPHTHALMOLOGY AND EYE DISEASES 2016; 8:17-21. [PMID: 27199574 PMCID: PMC4869599 DOI: 10.4137/oed.s38364] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/13/2016] [Accepted: 03/15/2016] [Indexed: 02/04/2023]
Abstract
We performed a retrospective interventional case series including 80 eyes of 48 patients with keratoconus (KC) who were treated with modified corneal cross-linking (CXL) for KC (with a partial deepithelization in a pattern of stripes). The average follow-up was 5.8 years (with a minimum of 5 years). At the last follow-up visit, compared with preoperative values, there were no significant changes in spherical equivalent, average keratometry, corneal thickness, corneal hysteresis, or corneal resistance factor. The distance-corrected visual acuity was 20/39 preoperatively and 20/36 postoperatively (P = 0.3). The endothelial cell count decreased by 4.7% (P < 0.005). These findings suggest that this modified corneal CXL technique is a safe and effective alternative to halt the progression of KC up to five years after the procedure. However, some concerns remain as to whether this technique can affect in some degree the corneal endothelial cells.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia.; Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia.; Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
| | - Néstor I Carreño
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia.; Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
| | - Alvaro I Ortiz
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia.; Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
| | - Rodrigo Barrera
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
| | | | - Miguel E Ochoa
- Faculty of Health Sciences. Universidad Autonoma de Bucaramanga, Floridablanca, Colombia
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Sadoughi MM, Feizi S, Delfazayebaher S, Baradaran-Rafii A, Einollahi B, Shahabi C. Corneal Changes After Collagen Crosslinking for Keratoconus Using Dual Scheimpflug Imaging. J Ophthalmic Vis Res 2016; 10:358-63. [PMID: 27051478 PMCID: PMC4795383 DOI: 10.4103/2008-322x.176894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate corneal changes after collagen crosslinking (CXL) therapy for keratoconus (KCN) using the Galilei dual Scheimpflug analyzer. Methods: This prospective, nonrandomized clinical study included 35 eyes of 32 keratoconus patients who had undergone CXL. The eyes were saturated with riboflavin solution and were subjected for 30 minutes to ultraviolet-A (UV-A) light with irradiance of 3 mW/cm2. Effectiveness of the treatment was assessed by measuring uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest cylinder/sphere, keratometry, pachymetry, posterior and anterior elevations by the Galilei dual Scheimpflug analyzer. Prior to treatment and 8 months after therapy, Scheimpflug analysis was performed using the Galilei system. The four sets of data including keratometry values, pachymetry, elevation parameters and surface indices were statistically analyzed and compared. Results: Mean patient age was 22.3 ± 3.8 years and mean postoperative follow-up was 8.1 ± 3.2 months. There was a significant increase in UCVA (0.54 ± 0.35 Log MAR preoperatively to 0.49 ± 0.34 LogMAR postoperatively, P = 0.01) and BCVA (0.21 ± 0.19 Log MAR preoperatively to 0.16 ± 0.17 LogMAR postoperatively, P = 0.01). Mean cycloplegic spherical equivalent refractive error was −4.13 ± 2.65 Diopter (D) preoperatively and − 4.67 ± 2.96 D postoperatively (P < 0.001). During the follow-up period, no significant difference was observed in pachymetric and elevation data postoperatively. Conclusion: Corneal stabilization could be achieved by collagen crosslinking therapy for keratoconus in terms of corneal thickness, keratometry values, elevation parameters and surface indices.
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Affiliation(s)
| | - Sepehr Feizi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Delfazayebaher
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Baradaran-Rafii
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Einollahi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Camelia Shahabi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Can Riboflavin Penetrate Stroma Without Disrupting Integrity of Corneal Epithelium in Rabbits? Iontophoresis and Ultraperformance Liquid Chromatography With Electrospray Ionization Tandem Mass Spectrometry. Cornea 2016; 34:932-6. [PMID: 26075452 DOI: 10.1097/ico.0000000000000438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine riboflavin concentrations in corneas and aqueous humor from rabbits with standard and transepithelial methods and iontophoresis without disrupting the integrity of the corneal epithelium before corneal collagen cross-linking. METHODS Twenty-four eyes of 12 adult New Zealand rabbits were used. They were assigned to 4 groups, each including 6 eyes. Group 1 was exposed to the standard method and given riboflavin 0.1% after epithelial debridement. Group 2 was exposed to the transepithelial method and given benzalkonium chloride (BAC), ethylenediaminetetraacetic acid (EDTA), trometamol (TRIS), hydroxypropylmethylcellulose (HPMC), and riboflavin 0.2% 3 times at 1.5-minute intervals followed by riboflavin 0.2%. Group 3 was given riboflavin 0.1% by using 1-mA electric current for 10 minutes with the help of iontophoresis without using substances disrupting the integrity of the corneal epithelium. Group 4 received the same treatment as did group 3, except that it was given riboflavin 0.2%. Following these treatments, riboflavin concentrations in aqueous humor and corneas were measured with ultraperformance liquid chromatography coupled with electrospray ionization tandem mass spectrometry (UPLC-ESI-MS/MS). RESULTS Riboflavin concentrations in the cornea and aqueous humor were higher in group 1 (42.4 ± 5.4 μg/g) than in the other groups. They were significantly higher in group 4 (34.2 ± 6.6 μg/g) than in group 2 (24.4 ± 1.2 μg/g) (P = 0.009) and group 3 (23.6 ± 6.1 μg/g) (P = 0.026). There was not a significant difference in corneal riboflavin concentrations between group 2 and group 3 (P = 0.937). CONCLUSIONS Intrastromal and aqueous riboflavin concentrations after administration of riboflavin 0.2% through iontophoresis without disrupting the integrity of the corneal epithelium were lower than those after the standard method, but higher than those after the transepithelial method. In this study, in which riboflavin concentrations were measured with a very sensitive method, iontophoresis was observed to increase the transmission of riboflavin molecules into the cornea without using substances disrupting epithelial integrity.
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Keratoconus und dessen Behandlung mit Hornhautvernetzung und Kontaktlinsen: ein Überblick. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-015-0290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Keratoconus and Other Corneal Diseases: Pharmacologic Cross-Linking and Future Therapy. Handb Exp Pharmacol 2016; 242:137-161. [PMID: 27815790 DOI: 10.1007/164_2016_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The ability to cross-link collagen fibers and use this technique to strengthen the cornea has become of great interest to ophthalmologists in the last decade. For progressive diseases such as keratoconus, collagen cross-linking confers the possibility of halting progression and stabilizing the cornea, a benefit that is not observed with any other current treatment. Collagen cross-linking uses riboflavin combined with ultraviolet A light to induce the formation of bonds between collagen fibrils that strengthen the cornea. This chapter will discuss the theory, technique, indications, and complications of corneal cross-linking. Much of what will be discussed is in areas of active research that will likely be further clarified as more experience is gained with this procedure.
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Abstract
Keratoconus as the most common cause of ectasia is one of the leading cause of corneal transplants worldwide. The current available therapies do not modify the underlying pathogenesis of the disease, and none of the available approaches but corneal transplant hinder the ongoing ectasia. Several studies document Crosslink defect between collagen fibrils in the pathogenesis of keratoconus. Collagen cross link is a relatively new approach that with the application of the riboflavin and ultraviolet A, new covalent bands reform. Subjective and objective results following this method seem to be promising. Endothelial damage besides other deep structural injury, which is the major concern of this technique have not yet been reported, when applying the standard method.
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Affiliation(s)
- Mahgol Farjadnia
- Department of Cornea, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Naderan
- Department of Cornea, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
: Collagen cross-linking (CXL) is a procedure that primarily aims to increase corneal stiffness. Although used for a variety of conditions, it is most commonly applied to the treatment of keratoconus. Collagen cross-linking involves irradiation of the cornea with ultraviolet A (UVA) irradiation after it has been soaked with riboflavin (vitamin B), a photosensitizer. In conventional treatment, based on the Dresden protocol, a minimum corneal thickness threshold of 400 μm is recommended and UVA (370 nm) irradiation of 3 mW/cm irradiance is applied for 30 min, resulting in a cumulative dose of 5.4 J/cm. Evidence presented in this review shows that conventional CXL stabilizes the vision and corneal topographic parameters in the majority of treated patients, with only a small failure rate. It has a good safety profile with no endothelial cell loss and a small risk of corneal infiltration and infection. To reduce the treatment duration, accelerated protocols of similar efficacy have been sought. In accelerated protocols, UVA irradiation of higher irradiance, typically 9 mW/cm, is applied for a shorter time, typically 10 min. The evidence, limited to small studies with short follow-up, shows that they may also stabilize the vision and the ectasia, with no additional safety concerns highlighted. Randomized controlled studies are, however, required to confirm the encouraging results and noninferiority to conventional treatment.
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Xu K, Chan TCY, Vajpayee RB, Jhanji V. Corneal Collagen Cross-linking: A Review of Clinical Applications. Asia Pac J Ophthalmol (Phila) 2015; 4:300-6. [PMID: 26381468 DOI: 10.1097/apo.0000000000000145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Corneal collagen cross-linking (CXL) has been shown to slow down or stop the progression of keratoconus. In addition, CXL has been applied in cases of corneal ectasia. Recent reports of the use of CXL in cases of infectious keratitis have generated further interest in this treatment modality. This review discusses the principle, clinical uses, and complications associated with CXL.
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Affiliation(s)
- Kunyong Xu
- From the *Department of Ophthalmology, Queen's University, Kingston, Canada; †Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Canada; ‡Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; §Hong Kong Eye Hospital, Hong Kong; ¶Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia; ∥Vision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre University of Melbourne, Melbourne, Australia; and **Department of Ophthalmology, Prince of Wales Hospital, Hong Kong
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Wu MF, Stachon T, Wang J, Song X, Colanesi S, Seitz B, Wagenpfeil S, Langenbucher A, Szentmáry N. Effect of Keratocyte Supernatant on Epithelial Cell Migration and Proliferation After Corneal Crosslinking (CXL). Curr Eye Res 2015; 41:466-73. [PMID: 26236938 DOI: 10.3109/02713683.2015.1050739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the effect of keratocyte supernatant (harvesting time, riboflavin concentration and UV-A-light illumination) on migration and proliferation of human corneal epithelial cells (HCECs) by CXL, in vitro. METHODS Primary human keratocytes isolated from 8 normal and 6 keratoconus corneas were cultured. Thereafter, keratocytes in 0%, 0.05% or 1% riboflavin solution were split into samples without and with 370 nm UVA-light-illumination. After removal of the riboflavin solution, keratocytes were incubated in the mentioned keratocyte culture medium at 37 °C and keratocyte supernatant was harvested after 5 and 24 hours. Keratocyte supernatant without riboflavin and UVA treatment, was used as control. HCECs were cultured until reaching confluence, the HCEC culture medium was replaced by the keratocyte supernatant and HCEC migration was analyzed using the wound-healing assay. HCEC proliferation was determined by the cell proliferation ELISA BrdU (colorimetric) kit. Statistical analysis was performed using a linear mixed model in the framework of a Generalized Estimating Equations (GEE) approach to analyze the effect of harvesting time, riboflavin concentration and UV-A-light illumination using IBM-SPSS version 22. RESULTS Riboflavin concentration, UVA-light illumination and harvesting time of normal or keratoconus keratocyte supernatant had no significant impact on HCEC proliferation (p > 0.10). Riboflavin concentration did not show significant impact on HCEC migration using normal or keratoconus keratocyte supernatant (p > 0.10), however, longer harvesting time of normal or keratoconus keratocyte supernatant significantly increased (p = 0.01 for both) and UVA-light illumination of keratoconus keratocyte supernatant (p < 0.001) significantly decreased HCEC migration. CONCLUSION Harvesting time, riboflavin concentration and UV-A-light illumination of normal and keratoconus keratocyte cultures has no impact on proliferation of HCECs, in the short term. However, 24 hours harvesting time (both for normal and keratoconus keratocytes) increases and UVA-light-illumination of keratoconus keratocyte cultures decreases HCEC migration.
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Affiliation(s)
- Ming-Feng Wu
- a Department of Ophthalmology , Saarland University Medical Center , Homburg/Saar , Germany
| | - Tanja Stachon
- a Department of Ophthalmology , Saarland University Medical Center , Homburg/Saar , Germany
| | - Jiong Wang
- a Department of Ophthalmology , Saarland University Medical Center , Homburg/Saar , Germany .,b Department of Ophthalmology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Xuefei Song
- a Department of Ophthalmology , Saarland University Medical Center , Homburg/Saar , Germany
| | - Sarah Colanesi
- a Department of Ophthalmology , Saarland University Medical Center , Homburg/Saar , Germany
| | - Berthold Seitz
- a Department of Ophthalmology , Saarland University Medical Center , Homburg/Saar , Germany
| | - Stefan Wagenpfeil
- c Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center , Homburg/Saar , Germany
| | - Achim Langenbucher
- d Department of Experimental Ophthalmology , Saarland University , Homburg/Saar , Germany and
| | - Nóra Szentmáry
- a Department of Ophthalmology , Saarland University Medical Center , Homburg/Saar , Germany .,e Department of Ophthalmology , Semmelweis University , Budapest , Hungary
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Stachon T, Wang J, Song X, Langenbucher A, Seitz B, Szentmáry N. Impact of crosslinking/riboflavin-UVA-photodynamic inactivation on viability, apoptosis and activation of human keratocytes in vitro. J Biomed Res 2015; 29:321-5. [PMID: 26243519 PMCID: PMC4547381 DOI: 10.7555/jbr.29.20130173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/01/2014] [Accepted: 01/15/2015] [Indexed: 11/03/2022] Open
Abstract
Riboflavin-UVA photodynamic inactivation is a potential treatment alternative in therapy resistant infectious keratitis. The purpose of our study was to determine the impact of riboflavin-UVA photodynamic inactivation on viability, apoptosis and activation of human keratocytes in vitro. Primary human keratocytes were isolated from human corneal buttons and cultured in DMEM/Ham's F12 medium supplemented with 10% fetal calf serum. Keratocytes underwent UVA light illumination (375 nm) for 4.10 minutes (2 J/cm²) during exposure to different concentrations of riboflavin. Twenty-four hours after treatment, cell viability was evaluated photometrically, whereas apoptosis, CD34 and alpha-smooth muscle actin (α-SMA) expression were assessed using flow cytometry. We did not detect significant changes in cell viability, apoptosis, CD34 and α-SMA expression in groups only treated with riboflavin or UVA light. In the group treated with riboflavin-UVA-photodynamic inactivation, viability of keratocytes decreased significantly at 0.1% riboflavin (P<0.01) while the percentage of CD34 (P<0.01 for both 0.05% and 0.1% riboflavin) and alpha-SMA positive keratocytes (P<0.01 and P<0.05 for 0.05% and 0.1% riboflavin, respectively) increased significantly compared to the controls. There was no significant change in the percentage of apoptotic keratocytes compared to controls at any of the used riboflavin concentrations (P=0.09 and P=0.13). We concluded that riboflavin-UVA-photodynamic-inactivation decreases viability of myofibroblastic transformation and multipotent haematopoietic stem cell transformation; however, it does not have an impact on apoptosis of human keratocytes in vitro.
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Affiliation(s)
- Tanja Stachon
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar 66424, Germany.
| | - Jiong Wang
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar 66424, Germany
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei 43060, China
| | - Xufei Song
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar 66424, Germany
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Achim Langenbucher
- Experimental Ophthalmology, Saarland University, Homburg, Saar 66424, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar 66424, Germany
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar 66424, Germany
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