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Greenstein SA, Hersh PS. Update on corneal crosslinking for keratoconus and corneal ectasia. Curr Opin Ophthalmol 2024; 35:273-277. [PMID: 38700496 DOI: 10.1097/icu.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
PURPOSE OF REVIEW To review corneal crosslinking for keratoconus and corneal ectasia, and recent developments in the field. This study will review the mechanism of crosslinking, clinical approaches, current results, and potential future innovations. RECENT FINDINGS Corneal crosslinking for keratoconus was first approved by U.S. FDA in 2016. Recent studies have confirmed the general long-term efficacy of the procedure in decreasing progression of keratoconus and corneal ectasia. New types of crosslinking protocols, such as transepithelial treatments, are under investigation. In addition, adjunctive procedures have been developed to improve corneal contour and visual function in these patients. SUMMARY Crosslinking has been found to be well tolerated and effective with the goal of decreasing progression of ectatic corneal diseases, keratoconus and corneal ectasia after refractive surgery. Studies have shown its long-term efficacy. New techniques of crosslinking and adjunctive procedures may further improve treatments and results.
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Affiliation(s)
- Steven A Greenstein
- Cornea and Laser Eye Institute, CLEI Center for Keratoconus, Teaneck, and the Department of Ophthalmology, Rutgers - New Jersey Medical School, Newark, New Jersey, USA
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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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Manumuraleekrishna, Asif MI, Maharana PK, Nagpal R, Agarwal T, Sinha R, Titiyal JS, Sharma N. Comparative evaluation of biomechanical changes and aberration profile following accelerated collagen cross-linking using hypo-osmolar and iso-osmolar riboflavin: A prospective study. Indian J Ophthalmol 2024; 72:712-717. [PMID: 38648433 PMCID: PMC11168534 DOI: 10.4103/ijo.ijo_1387_23] [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: 05/28/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To compare the changes encountered in corneal biomechanics and aberration profile following accelerated corneal collagen cross-linking (CXL) using hypo-osmolar and iso-osmolar riboflavin in corneal thicknesses of <400 and >400 microns, respectively. METHODS This is a prospective, interventional, comparative study involving 100 eyes of 75 patients with progressive keratoconus. Eyes were divided into two groups based on corneal thickness: group 1 included eyes with a corneal thickness of <400 microns who underwent hypo-osmolar CXL, and group 2 included eyes with a corneal thickness of >400 microns who underwent iso-osmolar CXL. Corneal biomechanical and aberration profiles were evaluated and compared between groups. RESULTS In group 1, all higher-order aberrations (HOA) except secondary astigmatism significantly decreased from baseline; however, in group 2, only coma and trefoil decreased. The corneal resistance factor and corneal hysteresis significantly improved in both groups, which was significantly greater in group 2 than in group 1. The change in inverse radius, deformation amplitude, and tomographic biomechanical index was significantly improved in group 2 as compared to group 1. CONCLUSION Improvement in corrected distance visual acuity and decrease in HOA were significantly better in the hypo-osmolar CXL group; however, the improvement in biomechanical strength of the cornea was significantly better in the iso-osmolar group.
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Affiliation(s)
- Manumuraleekrishna
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nagpal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan Singh Titiyal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kaya Ergen S, Subaşı S, Yılmaz Tuğan B, Yüksel N, Altıntaş Ö. The effect of transepithelial corneal collagen cross-linking treatment on optical quality of the cornea in keratoconus: 12-month clinical results. Int Ophthalmol 2024; 44:146. [PMID: 38499839 DOI: 10.1007/s10792-024-03089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE To evaluate the effect of transepithelial corneal collagen crosslinking (CXL) treatment on the optical performance of the cornea at 12-month follow-up after CXL in patients with progressive keratoconus. METHODS One hundred and ten eyes of 67 patients were included. The following corneal optical aberrations over the 4-mm-diameter pupil were recorded via Sirius dual-scanning corneal tomography: total, anterior and posterior amount of corneal higher order aberrations [HOAs], vertical coma, horizontal coma, vertical trefoil, oblique trefoil, and spherical aberration, and Strehl ratio of point spread function (PSF). RESULTS There were significant improvements in mean root mean square error values for corneal total HOA, total coma, anterior HOA, anterior coma, and vertical coma following CXL (P > 0.05, for all). No significant changes were found in the posterior aberometric parameters. PSF value did not change after CXL (P > 0.05). The corneal topographic measurements not revealed a change in the mean simulated keratometry-1, simulated keratometry-2, and maximum keratometry compared with the baseline measurements (P > 0.05, for all). At 12 months, there was a significant improvement in the uncorrected (UCVA) and best corrected (BCVA) visual acuity (P < 0.001, both). Most corneal aberrations correlated significantly with postoperative BCVA, but changes in HOAs were not statistically associated with improvements in visual acuity. CONCLUSIONS Transepithelial CXL was effective in stabilizing the keratometric indices and improving the most corneal aberrations in keratoconic eyes 1 year after the procedure. While the healing effect on aberrations after CXL was in total and anterior parameters, no significant changes were observed in the posterior surface. In addition, it was observed that transepithelial CXL treatment did not cause a significant change in PSF distribution data.
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Affiliation(s)
- Sebnem Kaya Ergen
- Department of Ophthalmology, Kocaeli State Hospital, Kocaeli, Turkey.
| | - Sevgi Subaşı
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Büşra Yılmaz Tuğan
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Nurşen Yüksel
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Özgül Altıntaş
- Department of Ophthalmology, Acibadem Maslak Hospital, Istanbul, Turkey
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Krok M, Wróblewska-Czajka E, Łach-Wojnarowicz O, Bronikowska J, Czuba ZP, Wylęgała E, Dobrowolski D. Analysis of Cytokine and Chemokine Level in Tear Film in Keratoconus Patients before and after Corneal Cross-Linking (CXL) Treatment. Int J Mol Sci 2024; 25:1052. [PMID: 38256126 PMCID: PMC10816198 DOI: 10.3390/ijms25021052] [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: 11/30/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Keratoconus (KC) is a degenerative corneal disorder whose aetiology remains unknown. The aim of our study was to analyse the expressions of cytokines and chemokines in KC patients before and after specified time intervals after corneal cross-linking (CXL) treatment to better understand the molecular mechanisms occurring before and after CXL in KC patients process of corneal regeneration.; Tear samples were gathered from 52 participants immediately after the CXL procedure and during the 12-month follow-up period. All patients underwent a detailed ophthalmological examination and tear samples were collected before and after CXL at regular intervals: 1 day before and after the surgery, at the day 7 visit, and at 1, 3, 6, 9, and 12 months after CXL. The control group consisted of 20 healthy people. 10 patients were women (50%) and 10 were men (50%). The mean age was 30 ± 3 years of age. Tear analysis was performed using the Bio-Plex 3D Suspension Array System. Corneal topography parameters measured by Scheimpflug Camera included: keratometry values (Ks, Kf), PI-Apex, PI-Thinnest, Cylinder.; All the 12 months post-op values of the KC patients' topographic measurements were significantly lower than the pre-op. As for the tear cytokine levels comparison between the patient and control groups, cytokine levels of TNF-α, IL-6, and CXCL-10, among others, were detected in lower amounts in the KC group. The pre-op level of IL-6 exhibited a significant increase the day after CXL, whereas comparing the day after the procedure to 12 months after CXL, this showed a significant decrease. Both TNF-α and IL-1 showed a significant decrease compared to the day before and after CXL. We observed significantly higher levels of IL-1β, IL-10, IFN-γ and TNF-α in moderate and severe keratoconus than in mild keratoconus (p < 0.05). We also demonstrated a statistically significant positive correlation between both pre-op and 12 months after CXL TNF-α, IFN-γ, IL-6 and Ks and Kf values (p < 0.05, r > 0); Alterations of inflammatory mediators in tear fluid after CXL link with topographic changes and may contribute to the development and progression of KC.
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Affiliation(s)
- Magdalena Krok
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Panewnicka 65 Street, 40-760 Katowice, Poland (E.W.-C.); (E.W.); (D.D.)
- Ophthalmology of Department, District Railway Hospital, 65 Panewnicka Street, 40-760 Katowice, Poland
| | - Ewa Wróblewska-Czajka
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Panewnicka 65 Street, 40-760 Katowice, Poland (E.W.-C.); (E.W.); (D.D.)
- Ophthalmology of Department, District Railway Hospital, 65 Panewnicka Street, 40-760 Katowice, Poland
| | - Olga Łach-Wojnarowicz
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Panewnicka 65 Street, 40-760 Katowice, Poland (E.W.-C.); (E.W.); (D.D.)
| | - Joanna Bronikowska
- Department of Microbiology and Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (J.B.); (Z.P.C.)
| | - Zenon P. Czuba
- Department of Microbiology and Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (J.B.); (Z.P.C.)
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Panewnicka 65 Street, 40-760 Katowice, Poland (E.W.-C.); (E.W.); (D.D.)
- Ophthalmology of Department, District Railway Hospital, 65 Panewnicka Street, 40-760 Katowice, Poland
| | - Dariusz Dobrowolski
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Panewnicka 65 Street, 40-760 Katowice, Poland (E.W.-C.); (E.W.); (D.D.)
- Ophthalmology of Department, District Railway Hospital, 65 Panewnicka Street, 40-760 Katowice, Poland
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Greenstein SA, Yu AS, Gelles JD, Huang S, Hersh PS. Long-Term Outcomes After Corneal Cross-linking for Progressive Keratoconus and Corneal Ectasia: A 10-Year Follow-Up of the Pivotal Study. Eye Contact Lens 2023; 49:411-416. [PMID: 37565471 DOI: 10.1097/icl.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES To report on the topographic and visual outcomes 10 years after corneal cross-linking in patients with progressive keratoconus and corneal ectasia after refractive surgery. METHODS Cross-sectional cohort study of an original, prospective, randomized, clinical trial. Patients treated in a single center cornea and refractive surgery practice as part of the U.S. pivotal trials, which led to the Food and Drug Administration approval of corneal cross-linking, were recruited for a 10-year follow-up examination. LogMar lines (LL) of uncorrected visual acuity (UCVA) and best spectacle--corrected visual acuity (BSCVA), maximum keratometry, and thinnest pachymetry were evaluated. In addition, the Belin ABCD progression display was used to determine progression (95% confidence interval) of the anterior curvature, posterior curvature, and corneal thickness of each individual eye included. RESULTS Nineteen eyes of 13 patients treated with standard cross-linking returned for a 10-year follow-up examination. Mean maximum keratometry changed from 58.2±12.0 diopters (D) to 58.3±10.1 D, thinnest pachymetry changed from 440.6±51.6 µm to 442.3±54.4 μm, UCVA changed from 0.79±0.42 LL to 0.86±0.46 LL, and BSCVA changed from 0.38±0.26 LL to 0.33±0.34 LL, 10 years after cross-linking. Individually, 68.5% of the entire cohort, 81.8% of keratoconus eyes, and 50% of eyes with corneal ectasia remained topographically stable 10 years after standard cross-linking. CONCLUSIONS In the entire cohort, visual acuity and topography remained stable 10 years after cross-linking. Over the long-term, eyes with keratoconus seem to be more stable than those with corneal ectasia.
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Affiliation(s)
- Steven A Greenstein
- Cornea and Laser Eye Institute (S.A.G., A.S.Y., J.D.G., S.H., P.S.H.); CLEI Center for Keratoconus, Teaneck, NJ; and Department of Ophthalmology (S.A.G., J.D.G., P.S.H.), Rutgers New Jersey Medical School, Newark, NJ
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Jamali H, Bagheri M, Khalili MR. Determination of efficacy of repeated CXL and probable risk factors in patients with progressive keratoconus. Int Ophthalmol 2023:10.1007/s10792-023-02715-0. [PMID: 37195564 DOI: 10.1007/s10792-023-02715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/09/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To evaluate the efficacy of Repeated CXL (Re-CXL) and determine probable risk factors that lead to Re-CXL in patients with progressive keratoconus. METHOD In this retrospective study, the medical records of patients who had been re-operated in our center between 2014 to 2020 due to progressive keratoconus were evaluated; seven eyes of seven patients had undergone Re-CXL procedure. Pre- and post-treatment variables were recorded and analyzed using IBM SPSS Statistics software. RESULTS The mean interval between the 1st and 2nd CXL was 49.71 months (range 12-72 months). Out of 7 patients for whom Re-CXL was considered necessary, eye rubbing was detected in 6 patients. Six patients were very young with a mean age of 13 years at primary CXL and 16.83 years at Re-CXL. Visual acuity and astigmatism did not change significantly after the Re-CXL procedure (p-values = 0.18, 0.91, respectively). When measurements of these indices prior to Re-CXL and post Re-CXL were compared, K1 (p-value = 0.01), K2 (p-value = 0.01), Kmean (p-value = 0.01), and Kmax (p-value = 0.008) changed significantly. As to pachymetry (p-value = 0.46), it did not change significantly. Kmax value regressed in all eyes after Re-CXL. CONCLUSION Re-CXL procedure was effective in halting the progression of disease. As to the risk factors, eye rubbed-related mechanism like eye rubbing and VKC, lower age, and pre-operative Kmax value > 58 D are the risk factors of Re-CXL procedure.
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Affiliation(s)
- Hossein Jamali
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran
| | - Milad Bagheri
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran
| | - Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran.
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Karam M, Alsaif A, Aldubaikhi A, Aljebreen M, Alazaz R, Alkhowaiter N, Almudhaiyan T, Aljassar F. Accelerated Corneal Collagen Cross-Linking Protocols for Progressive Keratoconus: Systematic Review and Meta-analysis. Cornea 2023; 42:252-260. [PMID: 36156043 DOI: 10.1097/ico.0000000000003124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/11/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of this study was to compare the outcomes of 18 mW/cm 2 (5 minutes) versus 9 mW/cm 2 (10 minutes) accelerated corneal collagen cross-linking protocols in patients with progressive keratoconus. METHODS A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and electronic information was searched to identify studies comparing the outcomes of 5- versus 10-minute protocols in patients with progressive keratoconus. Mean changes in uncorrected visual acuity, best-corrected visual acuity, cylinder (diopters), thinnest corneal thickness, corneal keratometry values (K1 and K2), corneal high-order aberration (HOA), spherical aberration, coma, and trefoil were the primary outcome measures. Secondary outcome measures included the mean change in central corneal thickness and postoperative complications. Random effects modeling was used for the analysis. RESULTS Four studies that enrolled 329 eyes were included. The 10-minute protocol had significantly improved outcomes compared with the 5-minute protocol for the mean changes in K1 and K2 ( P < 0.00001), corneal total HOA ( P = 0.0002), and corneal coma ( P = 0.00001). However, no statistically significant differences were found between the 2 protocols in uncorrected visual acuity, best-corrected visual acuity, cylinder, thinnest corneal thickness, spherical aberration, or trefoil. The 5-minute protocol was associated with a significantly lower mean change in the central corneal thickness for secondary outcomes. In addition, no significant differences were found between the 2 protocols for postoperative complications. CONCLUSIONS The 10-minute protocol had better K1, K2, and HOA outcomes than the 5-minute protocol, but no statistically significant differences in the other outcomes.
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Affiliation(s)
- Mohammad Karam
- Cornea Unit, AlBahar Ophthalmology Center, Ibn Sina Hospital, Ministry of Health, State of Kuwait
| | - Abdulmalik Alsaif
- Department of Surgery, Walsall Healthcare NHS Trust, West Midlands, UK
| | - Ahmed Aldubaikhi
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | | | - Rand Alazaz
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nahlaa Alkhowaiter
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tariq Almudhaiyan
- Division of Ophthalmology, Department of Surgery, National Guard Hospital, Riyadh, Saudi Arabia; and
- Department of Ophthalmology, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Aljassar
- Cornea Unit, AlBahar Ophthalmology Center, Ibn Sina Hospital, Ministry of Health, State of Kuwait
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Fasciani R, Crincoli E, Fedeli C, Rebecchi MT, Senneca M, Mosca L, Guccione L, Rizzo S. Binocular Visual Function Changes After Corneal Collagen Cross-linking in Patients With Keratoconus. Cornea 2023; 42:176-180. [PMID: 35588393 DOI: 10.1097/ico.0000000000003053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/08/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE High-order aberrations (HOAs) have been demonstrated to profoundly affect both visual acuity and stereoacuity in patients with keratoconus. Corneal collagen cross-linking (CXL) has been proven to significantly lower HOAs in keratoconus. Yet, to the present date, no evaluation of the effect of the procedure on stereopsis has been performed. The purpose of the study was to assess differences in binocular visual performance in patients with keratoconus before and after CXL. METHODS Patients with keratoconus undergoing standard Dresden protocol epi-off CXL in the ophthalmology department of Policlinico Universitario Agostino Gemelli Hospital received slitlamp examination, uncorrected distance visual acuity and corrected distance visual acuity assessment, corneal tomography, Lang stereotest, TNO stereoacuity assessment, distance and near cover test, and Irvine test before surgery and 6 months after CXL. Stereopsis tests were performed with spectacle correction. RESULTS The analysis included 30 patients (mean age 24.63 ± 3.49 years). The Lang test improved after treatment ( P 0.027), with 6 of 30 patients (20%) showing a positive Lang test before CXL compared with 16 of 30 patients (53.3%) after treatment. Moreover, TNO stereoacuity increased after treatment ( P 0.043), and 14 of 30 patients (46.7%) manifested an improvement of at least 250″ at the TNO test after CXL. In this subgroup of patients, total root mean square values decreased after treatment ( P < 0.001), whereas patients who did not manifest a clinically significant improvement in stereoacuity did not show a reduction in total root mean square values after CXL ( P = 0.11). The results of cover test and Irvine test did not vary after CXL. CONCLUSIONS Patients with keratoconus showing a reduction of HOAs after CXL also manifest a significant improvement in stereoacuity after the treatment.
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Affiliation(s)
- Romina Fasciani
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy; and
| | - Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy; and
| | - Chiara Fedeli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy; and
| | - Maria Teresa Rebecchi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy; and
| | - Marco Senneca
- Catholic University of "Sacro Cuore", Rome, Italy; and
| | - Luigi Mosca
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy; and
| | - Laura Guccione
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy; and
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS," Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy; and
- "Consiglio Nazionale Delle Ricerche, Istituto di Neuroscienze" Pisa - Italy
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Changes in retinal vessel and retinal layer thickness after cross-linking in keratoconus via swept-source OCT angiography. Graefes Arch Clin Exp Ophthalmol 2022; 260:3919-3925. [DOI: 10.1007/s00417-022-05749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
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Ishiguro N, Horiguchi H, Katagiri S, Shiba T, Nakano T. Correlation between higher-order aberration and photophobia after cataract surgery. PLoS One 2022; 17:e0274705. [PMID: 36107829 PMCID: PMC9477362 DOI: 10.1371/journal.pone.0274705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022] Open
Abstract
Cataract surgery impinges on the spatial properties and wavelength distribution of retinal images, which changes the degree of light-induced visual discomfort/photophobia. However, no study has analyzed the alteration in photophobia before and after cataract surgery or the association between retinal spatial property and photophobia. Here, we measured the higher-order aberrations (HOAs) of the entire eye and the subjective photophobia score. This study investigated 71 eyes in 71 patients who received conventional cataract surgery. Scaling of photophobia was based on the following grading system: when the patient is outdoor on a sunny day, score of 0 and 10 points were assigned to the absence of photophobia and the presence of severe photophobia prevents eye-opening, respectively. We decomposed wavefront errors using Zernike polynomials for a 3-mm pupil diameter and analyzed the association between photophobia scores and HOAs with Spearman’s rank sum correlation (rs). We classified patients into two groups: photophobia (PP) unconcerned included patients who selected 0 both preoperatively or postoperatively and PP concerned included the remaining patients. After cataract surgery, photophobia scores increased, remained unchanged (stable), and decreased in 3, 41, and 27 cases, respectively. In the stable group, 35 of 41 cases belonged to PP unconcerned. In PP concerned, there were significant correlations between photophobia score and postoperative root-mean-square values of total HOAs (rs = 0.52, p = 0.002), total coma (rs = 0.52, p = 0.002), total trefoil (rs = 0.47, p = 0.006), and third-order group (rs = 0.53, p = 0.002). In contrast, there was no significant correlation between photophobia scores and preoperative HOAs. Our results suggest that the spatial properties of retinal image modified by HOAs may affect the degree of photophobia. Scattering light due to cataracts could contribute to photophobia more than HOAs, which may mask the effect of HOAs for photophobia preoperatively.
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Affiliation(s)
- Naoko Ishiguro
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Horiguchi
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Satoshi Katagiri
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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Long-term evaluation of posterior corneal surface parameters after accelerated corneal cross-linking with a comparison with uncross-linked keratoconic eyes. Int Ophthalmol 2022; 42:3725-3738. [PMID: 35622219 DOI: 10.1007/s10792-022-02370-x] [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: 08/21/2021] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the 36 months changes in posterior corneal surface parameters in keratoconic eyes after accelerated corneal cross-linking and to compare the data with uncross-linked progressive and non-progressive keratoconic eyes. METHODS Thirty five cross-linked, 30 uncross-linked progressive, and 30 uncross-linked non-progressive keratoconic eyes were included. Maximum keratometry (Kmax), thinnest pachymetry, minimum radius of curvature back (Rminback), asphericity back, posterior elevation and corneal densitometry, back corneal higher order aberrations (HOAs), back surface deviation (Db), final D, posterior radius of curvature (PRC) and 'B' unit values were recorded at baseline and at the 12, 24, 36 months follow-up. Data were analyzed with repeated measures ANOVA and paired t-tests. RESULTS Kmax and thinnest pachymetry were significantly changed in the cross-linked and progressive uncross-linked groups. Rminback, asphericity back, and HOAs did not change in either group. Total posterior corneal densitometry improved; posterior elevation, Db and B unit worsened in the cross-linked group and did not change in the uncross-linked groups. PRC and final D worsened in the cross-linked and progressive uncross-linked groups, and did not change in the non-progressive group. CONCLUSION Despite a decreased Kmax, the posterior corneal surface parameters, posterior elevation values were determined to have significantly worsened in the cross-linked group and this increase was higher than in progressive uncross-linked eyes.
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Salman A, Ghabra M, Darwish TR, Kailani O, Ibrahim H, Ghabra H. Corneal higher-order aberration changes after accelerated cross-linking for keratoconus. BMC Ophthalmol 2022; 22:225. [PMID: 35585526 PMCID: PMC9115916 DOI: 10.1186/s12886-022-02457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Aim To evaluate changes in corneal higher-order aberrations (HOAs) following epithelium-off accelerated corneal cross-linking (A-CXL) and to explore the impact on visual acuity. Methods In this retrospective case series, 32 eyes of 24 patients with keratoconus (KC) underwent A-CXL. Treatment was delivered at 10 mW/cm2 for 9 min with a total dose of 5.4 J/cm2. The following anterior corneal HOAs: total corneal HOAs, trefoil, secondary trefoil, coma, secondary coma, secondary astigmatism and spherical aberrations were analysed using the Scheimpflug-Placido Sirius (CSO, Italy) corneal topographer at baseline and 12 months following treatment. Multivariate analysis was used to evaluate the independent effect of HOA subtypes on changes in uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Results At one year post CXL, UDVA and CDVA were significantly improved, -0.13 ± 0.19 LogMAR (P = 0.0005) and -0.08 ± .0.11 LogMAR (P = 0.0003), respectively. The mean preoperative trefoil, secondary trefoil, secondary coma and secondary astigmatism were 0.95 ± 0.46; µm, 0.20 ± 0.11; µm, 0.29 ± 0.19; µm and 0.42 ± 0.17 µm, respectively. At one year, the mean values decreased significantly to 0.77 ± 0.47 µm, 0.15 ± 0.11 µm, 0.25 ± 0.18 µm and 0.34 ± 0.18 µm, respectively (P < 0.05, for all). No independent relationship between any HOA changes and change in UDVA was observed. A reduction in secondary coma aberration was associated with a change in CDVA (95% CI 0.01–1.34, P = 0.048; β = 0.67). Conclusion A 9-min protocol of Accelerated corneal cross-linking is an effective treatment in improving corneal HOAs at 12 months follow up, in eyes with progressive keratoconus at one year follow-up. A change in secondary coma had a statistically significant and independent effect on CDVA.
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Affiliation(s)
- Abdelrahman Salman
- Tratous Specialist Eye Center, Tishreen University, P.O.Box:25, Latakia, Syria.
| | - Marwan Ghabra
- Whipps Cross University Hospital, Leytonstone, London, UK
| | - Taym R Darwish
- Department of Ophthalmology, Tishreen University, Latakia, Syria
| | - Obeda Kailani
- AKC FRCOphth CertLRS Queen Mary's Hospital, King's College Hospital NHS Foundation Trust, London, UK
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Saleh S, Koo EB, Lambert SR, Manche EE. Outcomes After Corneal Crosslinking for Keratoconus in Children and Young Adults. Cornea 2022; 41:408-416. [PMID: 33859086 PMCID: PMC10659218 DOI: 10.1097/ico.0000000000002730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to assess the effect of corneal crosslinking on vision and keratometry in children and young adults with progressive keratoconus. METHODS A retrospective medical records review of patients aged 22 years or younger with keratoconus who underwent corneal crosslinking between January 2013 and November 2019 at Byers Eye Institute at Stanford University was conducted. Outcome measures included logarithm of the Minimum Angle of Resolution corrected distance visual acuity (CDVA); keratometry, including maximum keratometry (Kmax); pachymetry; and total wavefront aberration. Measurements were taken at baseline and at 12 and 24 months postoperatively. RESULTS Fifty-seven eyes of 49 patients aged 12 to 22 years were assessed. The mean preoperative CDVA was logarithm of the Minimum Angle of Resolution 0.38 ± 0.32 (20/48), with a mean postoperative CDVA of 0.29 ± 0.31 (20/39) and 0.31 ± 0.31 (20/41) at 12 and 24 months postoperatively, respectively. Compared with preoperative mean Kmax, there was an improvement of -0.8 diopters (D) to a mean postoperative Kmax of 59.1 ± 9.1 D at 12 months and -1.3 D to 59.7 ± 8.8 D at 24 months. Subanalysis excluding the second eye of patients who underwent bilateral crosslinking showed similar results. Linear mixed modeling showed significant improvement in Kmax at both 12 and 24 months postoperatively. Minimum central corneal thickness initially decreased but stabilized at 24 months after crosslinking. Total wavefront aberration remained stable. CONCLUSIONS Corneal crosslinking stabilizes, and in some cases improves, visual and corneal parameters in pediatric and young adult patients with keratoconus. The procedure is safe and well-tolerated and may prevent keratoconus progression in young patients.
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Affiliation(s)
- Solin Saleh
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA
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15
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Eslami M, Ghaseminejad F, Dubord PJ, Yeung SN, Iovieno A. Delayed Topographical and Refractive Changes Following Corneal Cross-Linking for Keratoconus. J Clin Med 2022; 11:jcm11071950. [PMID: 35407560 PMCID: PMC8999946 DOI: 10.3390/jcm11071950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 12/22/2022] Open
Abstract
Background: The aim of this study was to analyze the long-term topographic and refractive outcomes of corneal cross-linking (CXL) in keratoconus. Methods: We used a retrospective observational study of patients with keratoconus who underwent CXL with a minimum follow-up of 5 years. Patients’ refractive and topography data (corrected distance visual acuity, sphere, cylinder, average and maximum keratometry, and corneal aberrations) were collected. Results: A total of 112 patients/150 eyes (mean age: 33.2 ± 10.7 years; range: 13−61) were included. The mean follow-up was 5.87 ± 1.35 years (range: 5−10). At the last follow-up visit, an improvement in CDVA, spherical and cylindrical refraction, average and steepest keratometry, and corneal aberrations were observed (p < 0.05), with the exception of trefoil. At the last visit, 49 (34.8%) and 31 (22.0%) eyes had an improvement beyond 1D in their spherical and cylindrical power, respectively, and 43 (28.7%) eyes had a flattening of their steepest keratometry. Progressive improvement over time was observed for spherical refraction; max and mean-K; as well as corneal RMS, total, high, coma, and spherical aberrations (p < 0.05). More severe disease at the baseline correlated with an improvement in corneal aberrations over time. Conclusions: In addition to a progressive improvement in refractive and keratometric indices, corneal aberrations also demonstrate a steady decline with long-term follow-up after CXL, which was more pronounced in more severe patients.
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Bhattacharyya A, Sarma P, Kaur H, Hafezi F, Bhattacharyya J, Kirubakaran R, Prajapat M, Medhi B, Das K, Prakash A, Singh A, Kumar S, Singh R, Reddy D, Kaur G, Sharma S. Short- and long-term safety and efficacy of corneal collagen cross-linking in progressive keratoconus: A systematic review and meta-analysis of randomized controlled trials. Taiwan J Ophthalmol 2022. [PMID: 37484615 PMCID: PMC10361434 DOI: 10.4103/2211-5056.361974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of the study is to evaluate the safety and outcomes of corneal collagen cross-linking (CXL) and different CXL protocols in progressive keratoconus (PK) population at short and long-term. MATERIALS AND METHODS A systematic review and meta-analysis was conducted. A total of eight literature databases were searched (up to February 15, 2022). Randomized controlled trials (RCTs) comparing CXL versus placebo/control or comparing different CXL protocols in the PK population were included. The primary objective was assessment of outcomes of CXL versus placebo and comparison of different CXL protocols in terms of maximum keratometry (Kmax) or Kmax change from baseline (Δ), spherical equivalent, best corrected visual acuity (BCVA), and central corneal thickness (CCT) in both at short term (6 months) and long term (1st, 2nd, and 3rd year or more). The secondary objective was comparative evaluation of safety. For the meta-analysis, the RevMan5.3 software was used. RESULTS A total of 48 RCTs were included. Compared to control, CXL was associated with improvement in Δ Kmax at 1 year (4 RCTs, mean difference [MD], -1.78 [-2.71, -0.86], P = 0.0002) and 2 and 3 years (1 RCT); ΔBCVA at 1 year (7 RCTs, -0.10 [-0.14, -0.06], P < 0.00001); and Δ CCT at 1 year (2 RCTs) and 3 years (1 RCT). Compared to conventional CXL (C-CXL), deterioration in Δ Kmax, ΔBCVA and endothelial cell density was seen at long term in the transepithelial CXL (TE-CXL, chemical enhancer). Up to 2 years, there was no difference between TE-CXL using iontophoresis (T-ionto) and C-CXL. At 2 and 4 years, C-CXL performed better compared to accelerated CXL (A-CXL) in terms of improving Kmax. Although CCT was higher in the A-CXL arm at 2 years, there was no difference at 4 years. While exploring heterogeneity among studies, selection of control eye (fellow eye of the same patient vs. eye of different patient) and baseline difference in Kmax were important sources of heterogeneity. CONCLUSION CXL outperforms placebo/control in terms of enhancing Kmax and CCT, as well as slowing disease progression over time (till 3 years). T-ionto protocol, on the other hand, performed similarly to C-CXL protocol up to 2 years.
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17
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Clinical Outcomes of Accelerated Corneal Cross-Linking for Pediatric Keratoconus. J Ophthalmol 2021; 2021:1851883. [PMID: 34840821 PMCID: PMC8616643 DOI: 10.1155/2021/1851883] [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: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
Aim To assess the efficacy and safety of accelerated corneal cross-linking in the treatment of pediatric keratoconus. Method In this retrospective case series, 29 eyes of 20 pediatric patients with keratoconus underwent accelerated corneal cross-linking. Treatment was delivered at 10 mW/cm2 for 9 minutes with a total dose of 5.4 J/cm2. Clinical evaluation included visual acuities and refractive and Scheimpflug corneal tomography assessments. All patients with a minimum follow-up duration of 24 months were included in the study. Results Mean ± standard deviation age was 15.41 ± 2.13 years (range: 8 to 18 years). Uncorrected distance visual acuity improved significantly from 0.56 ± 0.28 to 0.42 ± 0.29 logMAR (P=0.0003), and corrected distance visual acuity improved significantly from 0.34 ± 0.23 to 0.28 ± 0.22 logMAR (P=0.014). The mean manifest refraction spherical equivalent value was significantly reduced (-0.59 ± 0.95 D, P=0.0024). While mean flat keratometry and steep keratometry values were not significantly altered (P > 0.05 for both), the mean maximum keratometry value was significantly decreased from 56.97 ± 5.24 D preoperatively to 55.84 ± 5.37 D at 24 months postoperatively (P=0.003). Maximum keratometry had progressed by >1 D in two eyes (6.89%). Permanent corneal haze was reported in one case (3.44%). Conclusion Our 24-month follow-up demonstrated that accelerated corneal cross-linking appears to halt the progression of keratoconus in pediatric patients without apparent complications. Uncorrected and corrected distance visual acuities were also improved.
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Liu G, Wu Y, Bi H, Wang B, Gu T, Du B, Tong J, Zhang B, Wei R. Time Course of Perceived Visual Distortion and Axial Length Growth in Myopic Children Undergoing Orthokeratology. Front Neurosci 2021; 15:693217. [PMID: 34720848 PMCID: PMC8548729 DOI: 10.3389/fnins.2021.693217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: To establish the time course of the subjective visual function changes during the first month of orthokeratology treatment in myopic children, and to investigate how the time course variations are associated with the objective optical quality changes and the axial length growth (ALG) after 1 year of treatment. Methods: A total of 58 myopic children aged from 8 to 16 years participated in this self-controlled prospective study. All subjects were fitted with designed spherical four-zone orthokeratology lenses. Subjective visual function was evaluated with orientation discrimination threshold (ODT), and objective optical quality was quantified with the high-order aberration root-mean-square (HOA-RMS) and the changing speed of HOA. The measurements were done before the lens fitting and 1 day, 1-, 2-, and 4-weeks after lens wear. Axial length was obtained at baseline and 1-year follow-up, and ALG was defined as the difference. One-way ANOVA was conducted to compare the difference for statistical analysis. Results: After lens fitting, the ODT time courses peaked on day 1 in 28 children, 1 week in 15 children, 2 weeks in 11 children, and 4 weeks in 4 children. In contrast, the HOA-RMS steadily rose during the first month, and the changing speed of HOA was only transiently elevated on day 1 after the initial lens wear. The ALG was 0.12 ± 0.20 mm in subjects whose ODT peaked at day 1, 0.08 ± 0.09 mm in subjects whose ODT peaked on 1-week, and 0.12 ± 0.15 mm in subjects whose ODT peaked on 2-week or later. There was no difference in axial growth among the subjects whose ODT peaked at different days (P = 0.734). Conclusion: While half ODT time course resembled the changing speed of HOA with a transient elevation on day 1, about a quarter of the ODT time course resemble the steadily rising of HOA-RMS, and the rest was located in the middle. The ALGs in children with different types of ODT time courses were similar.
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Affiliation(s)
- Guihua Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yiyuan Wu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Hua Bi
- College of Optometry, Nova Southeastern University, Davie, FL, United States
| | - Biying Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Tianpu Gu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Bei Du
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jianliang Tong
- Doctor's Exchange of Georgia PC, Lawrenceville, GA, United States
| | - Bin Zhang
- College of Optometry, Nova Southeastern University, Davie, FL, United States
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Balakrishnan AC, Badrinarayanan A, Sivaraman V, Kumar RM, Iqbal A. Fluid reservoir thickness and aberration relationship in keratoconic eyes with scleral lenses. Ophthalmic Physiol Opt 2021; 42:178-184. [PMID: 34693558 DOI: 10.1111/opo.12908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE To investigate the effect of varying the fluid reservoir (FR) thickness of scleral lenses (SL) on corrected distance visual acuity (CDVA), contrast sensitivity (CS) and higher-order aberrations (HOAs) in keratoconic eyes. METHODS Forty eyes with keratoconus were fitted with a diagnostic Boston Sight SL having three different FR thicknesses. CDVA, CS and HOAs were measured before and after 30 min of lens wear. An i-Trace aberrometer and anterior segment optical coherence tomography (AS-OCT) were used to measure HOAs and FR thickness, respectively. RESULTS Statistically significant improvements in CDVA and CS were seen with different FR thickness lenses (p < 0.01). Baseline CDVA (0.22 ± 0.15) improved to 0.03 ± 0.06, 0.04 ± 0.07 and 0.07 ± 0.08 with low, standard and high FR lenses, respectively. Post-hoc testing showed better CDVA with low (p = 0.006) and standard FR (p = 0.009) lenses compared to high FR lenses. Before lens wear, CS was 1.27 ± 0.27, which improved to 1.67 ± 0.11, 1.73 ± 0.12 and 1.66 ± 0.89 with low, standard and high FR lenses, respectively. Lenses with standard FR showed better CS compared with those having low (p = 0.009) and high FRs (p < 0.001). A statistically significant reduction of higher order-root mean square aberrations (HO-RMS), coma, spherical aberration, secondary astigmatism and trefoil were found with all FR thickness lenses compared to baseline (p < 0.01). No significant difference was noted between lenses (p = 0.01). All three lenses corrected almost equal amount of HOAs. A moderate positive correlation was observed between CDVA and HO-RMS (r = 0.61, p < 0.001) for low FR lenses. CONCLUSIONS BostonSight SCLERALs were found to be very effective in improving vision, CS and reducing HOAs in keratoconus. Lenses with varying FR thickness showed equal effectiveness in visual performance and reducing HOAs. FR thickness should be considered an important factor to provide better vision and CS by minimising HOAs, as well as to maintain the normal physiology of eyes with keratoconus.
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Affiliation(s)
- Akshaya C Balakrishnan
- Elite School of Optometry, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Aparna Badrinarayanan
- Department of Contact Lens, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Viswanathan Sivaraman
- Department of Optometry, Contact Lens and Optical Services, Elite School of Optometry, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Ramar Mahesh Kumar
- Department of Contact Lens, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Asif Iqbal
- Department of Contact Lens, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Ferrara Rings for Visual Rehabilitation in Eyes with Keratoconus and Previous Cross-Linking Using the Ferrara Ring Nomogram. Vision (Basel) 2021; 5:vision5040045. [PMID: 34698306 PMCID: PMC8544695 DOI: 10.3390/vision5040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the visual, refractive and tomographic outcomes following the implantation of intrastromal corneal ring segments (ICRS) (Ferrara rings, AJL Ophthalmics, Miñano, Spain) in eyes with a history of keratoconus and corneal cross-linking using the Ferrara ring nomogram. METHODS Retrospective, interventional case series performed at the Corneoplastics Unit, Queen Victoria Hospital, East Grinstead, United Kingdom. RESULTS 21 eyes of 19 patients with a history of keratoconus and prior corneal collagen cross-linking had Ferrara Intrastromal Corneal Ring Segments implanted between December 2015 and October 2017. The number, thickness and length of ring segments was chosen based on the Ferrara ring company nomogram. Mean uncorrected visual acuity (UDVA) improved from 0.88 to 0.52 logMAR (p < 0.001). Mean corrected visual acuity (CDVA) improved from 0.47 to 0.36 logMAR (p = 0.046). The percentage of eyes achieving 20/40 UDVA and CDVA increased from 5% to 38% and from 38% to 67%, respectively. Of the eyes, 52.3% gained at least two lines of CDVA. The spherical equivalent improved from -7.51D to -3.76D (p < 0.001) and the refractive astigmatism magnitude improved from 5.14D to 2.76D (p = 0.004). There were significant improvements in the corneal tomography with mean keratometry (KM) improving from 50.40D (3.53) to 48.24D (3.00) (p = 0.01) and keratometric astigmatism magnitude improving from 5.14D (2.91) to 2.76D (1.67) (p = 0.004). CONCLUSION Insertion of Ferrara rings in keratoconic eyes with a history of prior cross-linking using the company nomogram results in significant improvements in visual, refractive and tomographic outcomes.
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21
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Taşçı YY, Taşlıpınar G, Eyidoğan D, Saraç Ö, Çağıl N. Five-Year Long-Term Results of Standard Collagen Cross-Linking Therapy in Patients with Keratoconus. Turk J Ophthalmol 2021; 50:200-205. [PMID: 32854460 PMCID: PMC7469898 DOI: 10.4274/tjo.galenos.2020.53810] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: We aimed to demonstrate the 5-year visual, topographic, and aberrometry long-term results of standard collagen cross-linking (CCL) treatment in keratoconus patients. Materials and Methods: The files and topographic measurements of patients who underwent standard CCL treatment for progressive keratoconus were retrospectively reviewed. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction values, and topographic values were evaluated. Results: Thirty-seven eyes of 27 patients were included in the study. The female to male ratio was 15 (56%)/12 (44%) and the mean age was 22.16±6.4 (12-39) years. The increase in UCVA and BCVA was statistically significant at postoperative 1-5 years (all p values <0.05). The changes in the spherical equivalent after CCL were not statistically significant (p>0.05), but the decrease in the manifest astigmatism values were significant after CCL at 3-5 years (p<0.05). Decrease in K2 (steep keratometry) and K apex values were statistically significant at 1-5 years (p<0.05). There was a significant decrease in the thinnest corneal thickness compared to the preoperative values up to 6 months and 1-4 years (p<0.05), but the change at 5 years was not significant (p=0.08). Post-CCL reductions in high-order aberrations and spherical aberrations were significant at postoperative 5 years and 3-5 years (p<0.05). Conclusion: In long-term follow-up, CCL treatment is seen to arrest keratoconus progression, increase vision, and improve visual quality by reducing higher-order aberrations and spherical aberrations. For these reasons, CCL treatment continues to be the first treatment modality in patients with progressive keratoconus.
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Affiliation(s)
| | | | - Demet Eyidoğan
- Midyat State Hospital, Clinic of Ophthalmology, Mardin, Turkey
| | - Özge Saraç
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Nurullah Çağıl
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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22
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Salman AM, Darwish TR, Haddad YH, Shabaan RH, Askar MZ. Accelerated versus Standard Corneal Cross-linking for Progressive Keratoconus in Syria. J Ophthalmic Vis Res 2021; 16:338-348. [PMID: 34394862 PMCID: PMC8358747 DOI: 10.18502/jovr.v16i3.9430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the outcomes of accelerated versus standard corneal cross-linking for the treatment of progressive keratoconus. Methods In this retrospective comparative study, 63 eyes of 40 patients with progressive keratoconus were divided into two groups; 27 eyes in group one were treated with an accelerated protocol (10 mW/cm 2 , 9 min) and 36 eyes in group two were treated with the standard method (3 mW/cm 2 , 30 min). Visual acuity, refraction, corneal topography, corneal tomography, and anterior and posterior corneal higher-order aberrations (HOAs) were assessed preoperatively and 18-30 months postoperatively. Results The LogMAR uncorrected and corrected distance visual acuity values were improved in both groups postoperatively. However, the improvement was significantly higher in group one (P < 0.05, all). The flattening in the anterior keratometry readings, flat K, steep K, and average K were significantly higher in group two (P < 0.001, all). The maximum anterior keratometry (AKf) values significantly decreased in both groups, whereas the maximum posterior keratometry (AKb) values increased. The reduction in the minimum corneal thickness (ThKmin) was significantly greater (36.49um) in group two, compared to 10.85um in group one. There was a significant increase in the posterior average keratometry, and a significant decrease in the posterior astigmatism, along 3 mm meridian in S-CXL (P = 0.03, P = 0.008, respectively), while the corresponding values showed no statistical significance in group one (P > 0.05). The anterior corneal trefoil was significantly reduced in group one (P = 0.002), whereas anterior total HOAs and coma were significantly improved in group two (P < 0.0014, all). The posterior corneal spherical aberration decreased significantly in group one (P = 0.02), while group two revealed significant reduction in the posterior trefoil values (P = 0.011). The change in the anterior maximum keratometry was significantly and positively correlated to the preoperative maximum keratometry in group two (P = 0.53, P = 0.003). Conclusion An accelerated cross-linking protocol using 10 mW/cm 2 for 9 min showed more visual improvement and less pachymetric reduction when compared to the standard protocol, however, anterior corneal flattening, posterior corneal steepening, and the change in the posterior astigmatism were significantly higher in the standard protocol; while corneal HOAs were improved in both protocols.
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Affiliation(s)
| | - Taym R Darwish
- Department of Ophthalmology, Tishreen University, Latakia, Syria
| | - Yusra H Haddad
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | | | - Mohammad Z Askar
- Department of Ophthalmology, Damascus University, Damascus, Syria
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Comparison of pulsed and continuous accelerated corneal crosslinking for keratoconus: 1-year results at a single center. J Cataract Refract Surg 2021; 47:641-648. [PMID: 33196569 DOI: 10.1097/j.jcrs.0000000000000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the clinical outcomes between pulsed and continuous accelerated crosslinking (CXL) for keratoconus. SETTING Hospital. DESIGN Retrospective comparison study. METHODS Korean patients who were treated for keratoconus between September 2015 and January 2018 at Seoul St. Mary's Hospital were included. Eyes were subjected to pulsed accelerated crosslinking (30 mW/cm2 for 8 minutes, 1 second on/1 second off) or continuous accelerated crosslinking (30 mW/cm2 for 4 minutes; delivering 7.2 J/cm2). Outcomes were evaluated after 1 year. RESULTS At 1 year, the 2 groups did not exhibit changes in their corrected and uncorrected distance visual acuity values. The pulsed group (25 eyes in 25 patients) exhibited significantly improved values for sphere (P = .009) and spherical equivalent (P = .033), although no statistically significant difference was observed in the continuous group (20 eyes in 20 patients). All keratometry (k)values (SimKf, SimKs, SimKmean, and Kmax) improved in both groups (all P < .05), although the pulsed group had significantly greater changes in the SimKmean value (P = .036) and the Kmax value (P = .03). Both groups had significantly decreased central and thinnest corneal thicknesses (all P < .001), although the pulsed group had a substantially lower thinnest corneal thickness (P = .017). Corneal densitometry measured using the Pentacam device increased in both groups (all P < .001), with a higher densitometry value in the pulsed group (P = .013). Furthermore, the depth of the demarcation line was deeper in the pulsed group (P = .015). CONCLUSIONS Pulsed accelerated crosslinking might provide better postcrosslinking effects than continuous accelerated crosslinking.
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Greenstein SA, Hersh PS. Corneal Crosslinking for Progressive Keratoconus and Corneal Ectasia: Summary of US Multicenter and Subgroup Clinical Trials. Transl Vis Sci Technol 2021; 10:13. [PMID: 34967830 PMCID: PMC8740531 DOI: 10.1167/tvst.10.5.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose The multicenter studies reviewed were designed to evaluate the safety and efficacy of corneal collagen crosslinking (CXL) for the treatment of progressive keratoconus and corneal ectasia after laser refractive surgery. The results of these studies led to approval by the United States Food and Drug Agency for both conditions in 2016. This paper reviews these studies, as well as single-center substudies investigating other aspects of crosslinking outcomes. Methods As part of prospective, randomized, controlled clinical trials, the treatment group received standard CXL, and the sham control group received only riboflavin ophthalmic solution. The primary efficacy criterion was maximum keratometry (Kmax) 1 year after CXL. Secondary outcomes were corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA). Safety and adverse events were analyzed. In single-center substudies, corneal topography, ocular aberrations, corneal haze measurements, corneal thickness, corneal biomechanics, subjective visual function, and outcomes predictors were also investigated. This paper presents a general review of the design and outcomes of crosslinking in these studies. Results In the crosslinking treatment group, Kmax flattened by 1.6 diopters (D) and 0.7 D in eyes with keratoconus and ectasia, respectively. In both studies, there was continued progression in the control group. The CDVA improved by an average of 5.7 logMAR letters (LL) in the keratoconus treatment group and by 5.0 LL in the ectasia group. In both studies, corneal haze was the most frequently reported crosslinking-related adverse finding. This was most prominent at 1 month and generally returned to baseline between 3 and 12 months. In general, corneal topography, ocular aberrations, and subjective visual function improved after crosslinking. Conclusions In the US multicenter trials, CXL was shown to be safe and effective in stabilizing Kmax, CDVA, and UDVA in eyes with progressive keratoconus or corneal ectasia. Translational Relevance Corneal crosslinking was originally developed in the laboratory at the University of Dresden in the late 1990s. The combination of ultraviolet-A light and riboflavin was found to be the most effective of a number of different modalities tested to increase the biomechanical strength of the cornea. The clinical study design for the US multicenter clinical trials of crosslinking demonstrated the safety and effectiveness of this technique for treatment of progressive keratoconus and corneal ectasia, bringing this important advancement to patients in the United States.
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Affiliation(s)
- Steven A Greenstein
- CLEI Center for Keratoconus, Cornea and Laser Eye Institute-Hersh Vision Group, Teaneck, NJ, USA.,Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter S Hersh
- CLEI Center for Keratoconus, Cornea and Laser Eye Institute-Hersh Vision Group, Teaneck, NJ, USA.,Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
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Derakhshan A, Heravian J, Abdolahian M, Bamdad S. Long-term Outcomes of Collagen Crosslinking for Early Keratoconus. J Ophthalmic Vis Res 2021; 16:151-157. [PMID: 34055251 PMCID: PMC8126731 DOI: 10.18502/jovr.v16i2.9077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the long-term outcomes of collagen crosslinking in early keratoconus. Methods Thirty eyes of twenty patients with early keratoconus were enrolled. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), objective refraction, subjective refraction, corneal topography and pachymetry were assessed before and 3, 6, 12 months and 9 years after performing collagen crosslinking surgery. Results The patients' mean age was 31.2 ± 5.59 years at nine-year follow-up (range, 25–44 years). The means of preoperative UCVA and BSCVA were 0.57 ± 0.34 and 0.15 ± 0.12 logMAR, respectively, and these values remained stable at the final follow-up (P = 0.990 and P = 0.227, respectively). The mean objective spherical equivalent decreased considerably from –6.00 ± 4.05 D preoperatively to –5.22 ± 3.71 D at the final follow-up (P< 0.05). The mean subjective spherical equivalent was –4.25 ± 2.87 D preoperatively and this value was stable at the last follow-up (P = 0.92). No considerable difference was found between the post- and preoperative mean objective cylinder values (P = 0.34). The mean subjective cylinder value changed significantly from –4.05 ± 1.85 D preoperatively to –3.1 ± 1.42 D at the final follow-up (P< 0.05). The mean central corneal thickness was 496.97 ± 45.95 µm preoperatively and this value was stable at nine-year follow-up (P = 0.183). No significant difference was found between the pre- and postoperative mean maximum and mean minimum corneal curvature values (P = 0.429 and P = 0.248, respectively). There were no significant postoperative complications. Conclusion Corneal crosslinking in early keratoconus seems to be a safe procedure that can effectively stabilize UCVA, BSCVA, subjective SE and CCT, while improving objective spherical equivalent.
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Affiliation(s)
- Akbar Derakhshan
- Cornea Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Khatam-Al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Heravian
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Optometry, School of Paramedical Science, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Milad Abdolahian
- Department of Optometry, School of Paramedical Science, Mashhad University of Medical Sciences, Mashhad, Iran.,Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Bamdad
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Asgari S, Hashemi H, Mohamadi A, Jafarzadehpur E, Miraftab M, Shahhoseini S, Mehravaran S, Fotouhi A. Scotopic contrast sensitivity and glare after accelerated corneal cross‐linking. Clin Exp Optom 2021; 101:52-56. [DOI: 10.1111/cxo.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/26/2017] [Accepted: 03/31/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Soheila Asgari
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran,
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran,
| | - Alireza Mohamadi
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran,
| | | | - Mohammad Miraftab
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran,
| | - Saied Shahhoseini
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran,
| | - Shiva Mehravaran
- Stein Eye Institute, University of California, Los Angeles, California, USA,
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
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Sideroudi H, Labiris G, Giarmoulakis A, Bougatsou N, Mikropoulos D, Kozobolis V. Repeatability, reliability and reproducibility of posterior curvature and wavefront aberrations in keratoconic and cross‐linked corneas. Clin Exp Optom 2021; 96:547-56. [DOI: 10.1111/cxo.12044] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 12/14/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Georgios Labiris
- Eye Institute of Thrace, Alexandroupolis, Greece,
- Department of Opthalmology, Democritus University of Thrace, Alexandroupolis, Greece,
| | | | | | | | - Vassilios Kozobolis
- Eye Institute of Thrace, Alexandroupolis, Greece,
- Department of Opthalmology, Democritus University of Thrace, Alexandroupolis, Greece,
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Alternative Indications for Corneal Crosslinking. J Cataract Refract Surg 2021; 47:1360-1366. [PMID: 33929804 DOI: 10.1097/j.jcrs.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Corneal crosslinking (CXL) is the current mainstay treatment for progressive keratoconus. In the past 15 years, a variety of other indications have been tested. A systematic review was conducted to examine these alternative indications for CXL. In total, of 143 papers on crosslinking as a treatment for infectious keratitis, bullous keratopathy, pellucid marginal degeneration, post- laser in situ keratomileusis (LASIK) ectasia, and as a way to improve vision either on its own or in combination with other interventions were included. Post-LASIK ectasia is a definite indication for crosslinking. Surprisingly, only limited research has been performed on pellucid marginal degeneration, with no randomized trials available to date. Other interesting applications are the combined use of refractive lasers and crosslinking for suspicious or ectatic corneas and crosslinking as a standalone intervention for minor refractive errors. CXL might offer a solution for refractory bacterial keratitis. In bullous keratopathy, it seems to offer only a transient benefit.
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Kumar M, Shetty R, Lalgudi VG, Khamar P, Vincent SJ, Atchison DA. The effect of scleral lenses on vision, refraction and aberrations in post-LASIK ectasia, keratoconus and pellucid marginal degeneration. Ophthalmic Physiol Opt 2021; 41:664-672. [PMID: 33769593 DOI: 10.1111/opo.12802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/21/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To quantify the effect of a single scleral lens design on visual acuity and ocular higher-order aberrations in eyes with post-LASIK ectasia, keratoconus and pellucid marginal degeneration (PMD) that could not achieve satisfactory vision with spectacles or soft contact lenses. METHODS Forty-six eyes of 28 participants fitted with diagnostic scleral lenses (KeraCare) were analysed, including 19, 15 and 12 eyes with post-LASIK ectasia, keratoconus and PMD, respectively. Corrected distance visual acuity (CDVA) and ocular aberrations were measured prior to lens wear and during lens wear after 60 min of settling. An i-Trace aberrometer was used to determine aberrations over a 4.5 mm diameter pupil. RESULTS Before lens wear, the median (95% confidence interval) values across all groups were: CDVA 0.30 (0.30, 0.40) logMAR, spherical equivalent refraction -2.75 (-5.25, -2.12) D, cylindrical refraction 3.75 (2.50, 5.00) D, higher-order-root-mean-square error (HO-RMS) 0.90 (0.64, 1.03) μm and vertical coma co-efficient C(3,-1) -0.32 (-0.42, -0.12) μm. RMS coma of 0.52 (0.40, 0.74) μm was higher for the keratoconus group than for the other groups (p < 0.05). During lens wear, values improved considerably across all groups: CDVA 0.0 (0.0, 0.00) logMAR, spherical equivalent refraction -0.50 (-0.75, +0.50) D, cylindrical refraction 0.50 (0.00, 0.50) D, HO-RMS 0.32 (0.26, 0.42) μm and C(3,-1) +0.12 (+0.02, +0.19) μm (all p < 0.001 compared to pre-lens wear). While reduced significantly, RMS coma remained higher in the keratoconus group at 0.35 (0.31, 0.52) μm than in the post-LASIK ectasia and PMD groups at 0.17 (0.12, 0.21) μm and 0.07 (0.02, 0.46) μm, respectively (p < 0.05). CONCLUSIONS The KeraCare scleral contact lens reduced ocular aberrations and improved visual acuity in patients with post-LASIK ectasia, keratoconus and PMD. The sign of vertical coma changed in keratoconus and PMD.
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Affiliation(s)
| | | | | | | | - Stephen J Vincent
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Atchison
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Comparative Results of "Epi-Off" Conventional versus "Epi-Off" Accelerated Cross-Linking Procedure at 5-year Follow-Up. J Ophthalmol 2020; 2020:4745101. [PMID: 32774904 PMCID: PMC7396097 DOI: 10.1155/2020/4745101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The aim of our study was to compare the long-term efficacy and safety of “epi-off” conventional and “epi-off” accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. Methods “Epithelial-off” (“Epi-off”) CXL using the conventional technique (3 mW/cm2, 30 minutes) was performed in 93 eyes of 93 patients (S-CXL group) and “epi-off” accelerated method (9 mW/cm2, 10 minutes) in 76 eyes of 76 patients with progressive KCN (A-CXL group). Cases with different stages of keratoconus and topographic evidence of progression were included. Main outcomes comprised refraction, keratometry measurements, uncorrected (UCVA) and best-corrected visual acuity (BCVA), and topographical indices. Micromorphological analysis was assessed by anterior segment ocular coherence tomography (AS-OCT). The follow-up period was 5 years. Results In both groups, Kflat presented similar results: decrease at 1 year (p=0.465), at 2 years (p=0.672), at 3 years (p=0.198), at 4 years (p=0.32), and at 5 years (p=0.864). In both groups, Ksteep presented a similar decrease at 1 year (p=0.709), at 2 years (p=0.455), at 3 years (p=0.43), at 4 years (p=0.57), and at 5 years (p=0.494), with no statistically significant difference. Decrease in Kavg was similar in both groups at all analyzed time points (p=0.18 at 1 year, p=0.093 at 2 years, p=0.57 at 3 years, p=0.154 at 4 years, and p=0.247 at 5 years). Kmax had a similar decrease in both groups at 1 year (p=0.06), at 2 years (p=0.09), at 3 years (p=0.126), at 4 years (p=0.113), and at 5 years (p=0.114). There was no statistically significant difference between the cylinder decrease in both groups (p=0.349 at 1 year, p=0.6782 at 2 years, p=0.299 at 3 years, p=0.0943 at 4 years, and p=0.144 at 5 years). The BCVA values were statistically significantly higher than the preoperative values in both groups at all time points (p < 0.05). Topographical indices such as thinnest corneal point (TP), corneal volume (CV), index vertical asymmetry (IVA), index of vertical asymmetry (ISV), index of height asymmetry (IHA), index of height decentration (IHD), Belin/Ambrosio Enhanced Ectasia Display (BAD_D), and Ambrosio retinal thickness (ART Max) were significantly statistically decreased compared with baseline at all time points, in both groups. Conclusion “Epi-off” accelerated and conventional CXL have the same efficacy in terms of improvement in visual and topographic outcomes.
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Corneal higher-order aberrations after crosslinking and intrastromal corneal ring segments for keratoconus. J Cataract Refract Surg 2020; 46:979-985. [DOI: 10.1097/j.jcrs.0000000000000209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nalcı H, Hoşal MB, Gündüz ÖU. Effects of Upper Eyelid Blepharoplasty on Contrast Sensitivity in Dermatochalasis Patients. Turk J Ophthalmol 2020; 50:151-155. [PMID: 32631001 PMCID: PMC7338742 DOI: 10.4274/tjo.galenos.2019.95871] [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] [Indexed: 12/01/2022] Open
Abstract
Objectives To evaluate the impact of upper eyelid blepharoplasty on contrast sensitivity in dermatochalasis patients. Materials and Methods Best corrected visual acuity, ophthalmologic examination, eyelid examination, lash ptosis, contrast sensitivity using sine-wave contrast sensitivity chart, keratometric parameters, and corneal aberrations of 34 eyes of 34 patients who underwent upper eyelid blepharoplasty due to dermatochalasis in our clinic between the years 2014 and 2018 were evaluated preoperatively and at postoperative 3 months. Results Twenty-three (68%) of the patients were females and 11 (32%) were males. Mean age was 63.1±7 (52-81) years. Mean best corrected visual acuity was 0.036±0.06 (0-0.15) logMAR preoperatively and postoperatively (p>0.05). Contrast sensitivity values of the patients at the frequencies of 1.5, 3, 6, 12, and 18 cycles per degree were 44.38±19.5, 59.03±27.2, 41.44±34.1, 15.15±19.3, and 5.15±4.26 preoperatively and 44.80±20.9, 76.85±33.4, 63.21±46.4, 28.21±31.1, and 10.5±9.5 postoperatively, respectively. The difference between contrast sensitivity values was statistically significant at the frequencies of 3, 6, 12, and 18 cpd (p=0.005, =0.001, <0.001, and <0.001, respectively). Although lash ptosis of the patients improved significantly after the surgery, there was no correlation between lash ptosis improvement and change in contrast sensitivity (p>0.05). Keratometric values and corneal high order aberrations did not change significantly after the surgery (p>0.05). Conclusion Contrast sensitivity significantly increases after upper eyelid blepharoplasty, especially at higher spatial frequencies which are known to deteriorate due to age-related changes in the lens and retina in older adults. Our results show that blepharoplasty may have additional functional indications for elderly dermatochalasis patients in terms of improving the functions such as performing daily tasks and reading.
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Affiliation(s)
- Hilal Nalcı
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Melek Banu Hoşal
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ömür Uçakhan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Hatch W, El-Defrawy S, Ong Tone S, Stein R, Slomovic AR, Rootman DS, Rabinovitch T, Kranemann C, Chew HF, Chan CC, Bujak MC, Cohen A, Lebovic G, Jin Y, Singal N. Accelerated Corneal Cross-Linking: Efficacy, Risk of Progression, and Characteristics Affecting Outcomes. A Large, Single-Center Prospective Study. Am J Ophthalmol 2020; 213:76-87. [PMID: 31945333 DOI: 10.1016/j.ajo.2020.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE We examined the efficacy and preoperative characteristics that affect outcomes of accelerated (9 mW/cm2 for 10 minutes) corneal cross-linking (CXL). DESIGN Prospective single-center observational cohort study. METHODS We enrolled 612 eyes of 391 subjects with progressive keratoconus (n = 589), pellucid marginal degeneration (n = 11), and laser in situ keratomileusis-induced ectasia (n = 12). We evaluated best spectacle-corrected visual acuity (BSCVA), topography, refraction, endothelial cell density, corneal thickness, haze, intraocular pressure, and visual function before and 12 months after the CXL procedure. We tabulated the proportion of those with progression of maximum keratometry (Kmax). We included participant's race, age, sex, and the presence of preoperative apical scarring and environmental allergies in a multivariable linear regression model to determine the effect of these characteristics on outcomes. RESULTS At 1 year there was no significant change in mean Kmax (n = 569). Progression of Kmax was higher in subgroups with a baseline Kmax >58 diopters (n = 191) and those 14-18 years of age (n = 53). Preoperative BSCVA, Kmax, refraction, corneal cylinder, coma, central corneal thickness, and vision function were statistically and clinically significant predictors of outcomes (P < .001). Preoperative apical scarring led to worsening haze (P = .0001), more astigmatism (P = .002), more central corneal thinning (P = .002), and was protective to the endothelium (P = .008). Race, age, and sex affected some outcomes. CONCLUSION Mean Kmax was stable at 1 year after accelerated CXL. Younger patients and those with a higher preoperative Kmax need to be monitored closely for progression. Preoperative BSCVA, topography, refraction, CCT, and apical scarring were significant predictors of outcomes.
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Corneal Haze After Transepithelial Collagen Cross-linking for Keratoconus: A Scheimpflug Densitometry Analysis. Cornea 2020; 39:1117-1121. [PMID: 32282356 DOI: 10.1097/ico.0000000000002334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantitate corneal haze and analyze the postoperative time course of corneal haze after transepithelial corneal collagen cross-linking (TECXL) in patients with keratoconus. METHODS Patients underwent TECXL and were randomized into 2 groups. One group received intraoperative riboflavin 0.10% every minute, and the second group received riboflavin 0.10% every 2 minutes during ultraviolet exposure. Scheimpflug densitometry was measured preoperatively, and at 1, 3, 6, and 12 months to assess the postoperative time course. Densitometry measurements were also correlated with visual acuity, pachymetry, and topography outcomes. RESULTS Fifty-nine eyes of 43 patients with keratoconus were analyzed. Preoperative mean corneal densitometry was 20.45 ± 2.79. Mean densitometry increased at 1 month (22.58 ± 3.79; P < 0.001), did not significantly change between 1 and 3 months (22.64 ± 3.83; P = 0.8), and significantly improved between 3 and 12 months postoperatively (mean6 21.59 ± 3.39; P = 0.002, mean12 20.80 ± 3.27; P = 0.002). There was no difference between preoperative and 1-year densitometry measurements (P = 0.21). There was no significant difference between the 1-minute and 2-minute subgroups. In addition, corneal densitometry at either 3 months or 1 year did not correlate with uncorrected distance visual acuity (P = 0.4), corrected distance visual acuity (P = 0.1), or maximum keratometry (P = 0.5), 1 year after corneal collagen cross-linking (CXL). CONCLUSIONS After TECXL, corneal haze increased slightly at 1 month, plateaued between 1 and 3 months, and returned to baseline between 3 and 12 months. In general, corneal haze in this study was substantially less than the haze previously reported for the standard cross-linking procedure. CXL-associated corneal haze did not correlate with the postoperative visual or topographic outcomes 1 year after CXL.
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Peyman A, Feizi A, Ganjalikhani-Hakemi M, Hosseini-Nasab F, Pourazizi M. Outcome of Corneal Collagen Cross-Linking in Keratoconus: Introducing the Predictive Factors. J Curr Ophthalmol 2020; 32:19-25. [PMID: 32510009 PMCID: PMC7265260 DOI: 10.4103/joco.joco_48_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/22/2019] [Accepted: 11/10/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose: To evaluate the multiple pretreatment characteristics and topographic factors of keratoconus (KC) patients and their relationship to clinical outcomes of corneal collagen cross-linking (CXL). Methods: In this prospective study, 61 patients (106 eyes) with KC as candidates for CXL were included. Demographic data including age, sex, place of birth and residence, atopic constitution, family history, rubbing history, sleep apnea, and blood group were collected via a structured checklist. Complete ophthalmologic examination and tear collection to assess tear interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) level were performed. Topometric parameters were evaluated using a rotating Scheimpflug topography device. Changes in best corrected visual acuity (BCVA) and maximum keratometry (K-max) were considered the main predicted variables. Predictive variables were analyzed by univariate and multivariate regression. Results: The use of multivariate analysis changes in K-max was significantly associated with rubbing frequency (coefficient = 0.94, P = 0.02), blood group (coefficient = 4.52, P = 0.005), pretreatment corneal asphericity (coefficient = −3.99, P ≤ 0.001), and pretreatment central keratoconus index (CKI) (coefficient = −55.38, P = 0.001). Regarding the changes in BCVA, the multivariate analysis showed a significant association with place of birth (coefficient = −0.08, P = 0.03), pretreatment BCVA (coefficient = −0.67, P < 0.001), pretreatment central corneal thickness (CCT) (coefficient = −0.005, P = 0.04), and pretreatment keratoconus index (KI) (coefficient = 0.53, P = 0.04). Other parameters assessed in the multivariable analysis did not appear to have an individual effect on treatment outcomes. Conclusion: Our results demonstrated that blood group, rubbing of eye, place of birth, corneal asphericity, pretreatment BCVA, CKI, KI, and CCT were statistically associated with the outcome of KC following CXL.
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Affiliation(s)
- Alireza Peyman
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Fahimeh Hosseini-Nasab
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
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Fodor M, Vitályos G, Losonczy G, Hassan Z, Pásztor D, Gogolák P, Kolozsvári BL. Tear Mediators NGF along with IL-13 Predict Keratoconus Progression. Ocul Immunol Inflamm 2020; 29:1090-1101. [PMID: 32130054 DOI: 10.1080/09273948.2020.1716024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: To find immunomediator combinations which could sensitively indicate keratoconus progression.Methods: Tear samples of 42 patients with keratoconus were collected at baseline and at the end of a one-year follow-up. The concentrations of 13 mediators were measured by CBA. Based on Pentacam HR examination, eyes were divided into a non-progressive and a progressive group.Results: At the end of the follow-up, significant differences were observed in the release of IFNγ, IL-13, IL-17A, CCL5, MMP-13 and PAI-1 between the two groups. Changes in five Pentacam parameters correlated positively with changes in IFNγ, IL-13, IL-17A, CXCL8, CCL5, TIMP-1 and t-PA. We found that tear level of IL-13 in combination with NGF can predict the progression of keratoconus with 100% specificity and 80% sensitivity.Conclusion: The findings of our longitudinal study may underscore the importance of NGF and IL-13 tear levels in the prediction of keratoconus progression.
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Affiliation(s)
- Mariann Fodor
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Géza Vitályos
- Department of Orthodontics, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Gergely Losonczy
- Department of Ophthalmology, Zuyderland Hospital, Eyescan BV, Sittard, The Netherlands
| | - Ziad Hassan
- Orbident Refractive Surgery and Medical Center, Debrecen, Hungary
| | - Dorottya Pásztor
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter Gogolák
- Department of Immunology, University of Debrecen, Debrecen, Hungary
| | - Bence Lajos Kolozsvári
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Özülken K, Aksoy Aydemir G, Aydemir E, Kızıltoprak H, Yüksel E. Comparison of Two Different Accelerated Corneal Cross-linking Procedure Outcomes in Patients with Keratoconus. Balkan Med J 2020; 37:131-137. [PMID: 31909581 PMCID: PMC7161613 DOI: 10.4274/balkanmedj.galenos.2020.2019.8.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Corneal cross-linking treatment is the unique treatment method that can cease the progression of keratoconus disease. Because of the long duration of conventional treatment, accelerated cross-linking treatment methods are being developed. Aims To compare two different accelerated corneal cross-linking protocols in terms of postoperative visual acuity and topographic findings (higher-order aberrations and keratometry values). Study Design Retrospective comparative study. Methods Sixty-five eyes of 43 patients (30 men and 13 women) who underwent two different accelerated corneal cross-linking protocols (10 min, 9 mW/cm2 and 5 min, 18 mW/cm2) for progressive keratoconus were retrospectively analyzed. Patients were divided into two groups according to the accelerated corneal cross-linking treatment protocol: group 1 (10 min, 9 mW/cm2, 32 eyes of 21 patients) and group 2 (5 min, 18 mW/cm2, 33 eyes of 22 patients). Uncorrected visual acuity and best-corrected visual acuity values and topographic findings (central corneal thickness and flat and steep keratometry values) were recorded preoperatively and 6 months after corneal cross-linking treatment. High-order aberration values measured with Pentacam preoperatively and 6 months after corneal cross-linking were also recorded. Results In both groups, a significant improvement was detected in the uncorrected visual acuity and best-corrected visual acuity levels preoperatively and 6 months postoperatively (group 1: p=0.001, p=0.001 and group 2: p=0.001, p=0.001, respectively). In addition, central corneal thickness values decreased significantly in both groups (p=0.006 and 0.001). Trefoil values showed no significant difference preoperatively and 6 months postoperatively in group 1 (p=0.160 and 0.620, respectively). In groups 1 and 2, coma values were found to decrease significantly in the 6th postoperative month compared with preoperative values (p=0.001 and 0.020, respectively). There was no significant difference between preoperative and 6th month postoperative horizontal and vertical trefoil values in both groups (p=0.850 and 0.140, respectively). There was no significant difference between the two groups in terms of preoperative and 6th month postoperative higher-order aberrations, refractive errors, keratometry values, and uncorrected visual acuity and best-corrected visual acuity levels. Conclusion Both accelerated corneal cross-linking procedures provide similar improvement in topographic findings, coma values and visual acuity.
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Affiliation(s)
- Kemal Özülken
- Department of Ophthalmology, TOBB ETU School of Medicine, Ankara, Turkey
| | - Gözde Aksoy Aydemir
- Clinic of Ophthalmology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Emre Aydemir
- Clinic of Ophthalmology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Hasan Kızıltoprak
- Clinic of Ophthalmology, Bingöl Maternity and Child Diseases Hospital, Bingöl, Turkey
| | - Erdem Yüksel
- Department of Ophthalmology, Kastamonu University School of Medicine, Kastamanonu, Turkey
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Omar IAN, Zein HA. Accelerated Epithelium-Off Corneal Collagen Cross-Linking For Keratoconus: 12-Month Results. Clin Ophthalmol 2019; 13:2385-2394. [PMID: 31824132 PMCID: PMC6900281 DOI: 10.2147/opth.s232118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The main aim of the study was to report visual, refractive, topographic, and aberrometric results of accelerated CXL in patients with keratoconus who were followed for 12 months and to highlight the important parameters that can be used in follow-up. Settings It was a prospective interventional non-randomized case series study, in which 40 keratoconus eyes of 40 patients were studied in the period between April 2016 and July 2018. Methods All eyes were examined preoperatively and post-accelerated CXL to evaluate visual acuity, refractive state, keratometric values, keratoconus indices, and corneal higher order aberrations (HOAs). Results The mean age of the studied patients was 28.4 ± 8.6 years (18-37years). One year after cross-linking, 11.6% of the eyes gained two lines of the UCVA, 26.4% of the eyes gained one line, 49.8% showed no change, 7.1% lost one line, and 5.1% lost two lines. Postoperative BCVA showed 13.7% of the eyes gained at least two lines, 32.5% gained one line, 49.9% had no change, and 3.9% lost one line. The keratometric values changed significantly after CXL; K1 decreased by a mean of 0.41D, K2 by 0.62D while Kmax by 1.57 D. The significant changes in keratoconus indices were in index of vertical asymmetry (IVA), index of surface variance (ISV), and keratoconus index (KI). Vertical coma, spherical aberrations, and trefoil decreased significantly at 12 months compared to baseline values (p = 0.04, 0.017, 0.025, respectively). Conclusion Keratoconus indices especially ISV, IVA, and KI along with HOAsparticularly vertical coma, spherical aberrations, and trefoil can add value beside keratometric readings in the follow-up of eyes treated with accelerated CXL.
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Affiliation(s)
| | - Hosny Ahmed Zein
- Ophthalmology Department, Faculty of Medicine, Minia University, El-Minya, Egypt
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Hersh PS, Lai MJ, Gelles JD, Lesniak SP. Transepithelial corneal crosslinking for keratoconus. J Cataract Refract Surg 2019; 44:313-322. [PMID: 29703286 DOI: 10.1016/j.jcrs.2017.12.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/17/2017] [Accepted: 12/10/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate outcomes of corneal crosslinking (CXL) using a transepithelial technique for the treatment of keratoconus. SETTING Cornea and refractive surgery subspecialty practice. DESIGN Prospective case series. METHODS Transepithelial CXL was performed in keratoconic eyes using riboflavin 0.1% and topical anesthetic containing benzalkonium chloride to facilitate riboflavin diffusion through the epithelium. Eyes were randomized to receive riboflavin administration either every 1 minute or every 2 minutes during ultraviolet-A exposure at 3mW/cm2. The principal outcome was change in maximum keratometry (K) and secondary outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, mean K, and comparison of randomized groups. RESULTS Eighty-two eyes of 56 patients were treated. At 1 year, maximum K decreased significantly by 0.45 diopters (D) ± 1.94 (SD); it improved by 2.0 D or more in 11 eyes (13%) and worsened by 2.0 D or more in 4 eyes (5%). The mean UDVA significantly improved by 0.7 lines, whereas the CDVA improved by 0.2 lines. Two eyes showed both continued progression with loss of CDVA. Only the 1-minute subgroup showed significant improvements in maximum K (-0.73 D) and UDVA. Transient corneal erosion and epitheliopathy were reported in 21% of eyes. CONCLUSIONS Transepithelial CXL resulted in significant improvements in maximum K and UDVA over 1 year. There was a suggestion that increased riboflavin dosing might improve procedure outcomes. Further study is required to determine the relative advantages and disadvantages of different transepithelial approaches to the standard CXL protocol with epithelial removal.
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Affiliation(s)
- Peter S Hersh
- From the Cornea and Laser Eye Institute-Hersh Vision Group (Hersh), CLEI Center for Keratoconus (Hersh, Lai, Gelles), Teaneck, and the Department of Ophthalmology, Rutgers-New Jersey Medical School (Hersh, Lesniak), Newark, New Jersey, USA.
| | - Michael J Lai
- From the Cornea and Laser Eye Institute-Hersh Vision Group (Hersh), CLEI Center for Keratoconus (Hersh, Lai, Gelles), Teaneck, and the Department of Ophthalmology, Rutgers-New Jersey Medical School (Hersh, Lesniak), Newark, New Jersey, USA
| | - John D Gelles
- From the Cornea and Laser Eye Institute-Hersh Vision Group (Hersh), CLEI Center for Keratoconus (Hersh, Lai, Gelles), Teaneck, and the Department of Ophthalmology, Rutgers-New Jersey Medical School (Hersh, Lesniak), Newark, New Jersey, USA
| | - Sebastian P Lesniak
- From the Cornea and Laser Eye Institute-Hersh Vision Group (Hersh), CLEI Center for Keratoconus (Hersh, Lai, Gelles), Teaneck, and the Department of Ophthalmology, Rutgers-New Jersey Medical School (Hersh, Lesniak), Newark, New Jersey, USA
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Revisiting the Safety of the Corneal Collagen Crosslinking Procedure: Evaluation of the Effect of Ultraviolet A Radiation on Retinal Function and Structure. Cornea 2019; 39:237-244. [DOI: 10.1097/ico.0000000000002157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ozulken K, Yuksel E, Tekin K, Kiziltoprak H, Aydogan S. Comparison of Wavefront-Optimized Ablation and Topography-Guided Contoura Ablation With LYRA Protocol in LASIK. J Refract Surg 2019; 35:222-229. [PMID: 30984979 DOI: 10.3928/1081597x-20190304-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the refractive outcomes and aberration data analysis of wavefront-optimized (WFO) ablation and topography-guided Contoura ablation (TGCA) (Contoura on the WaveLight laser; WaveLight GmbH, Erlangen, Germany) in patients who had laser-assisted in situ keratomileusis (LASIK) for myopia or myopic astigmatism. METHODS In this comparative contralateral eye study, patients who underwent LASIK with TGCA in one eye and with WFO ablation in the fellow eye were analyzed. Aberration measurements and corneal topography were analyzed using the WaveLight Oculyzer II diagnostic device (Alcon Laboratories, Inc., Fort Worth, TX). Total corneal higher order aberrations (HOAs) including vertical and oblique astigmatism (Z2 2, Z2 -2), coma (Z3 1, Z3 -1), trefoil (Z3 3, Z3 -3), spherical aberration, and Q value were analyzed. These measurements were taken preoperatively and 3 months postoperatively. RESULTS This study comprised 32 patients. There were no significant differences between both procedures according to postoperative uncorrected and corrected distance visual acuity values, refractive errors, and manifest refraction spherical equivalents within ±0.50 diopters (D) of emmetropia (P > .05). The preoperative corneal HOAs and Q values were also similar between the groups (P > .05). At 3 months postoperatively, the vertical and horizontal coma values in the WFO ablation group were statistically significantly higher compared to the TGCA group (P = .013 and .020, respectively). Less stromal tissue was ablated in the TGCA group compared to the WFO ablation group (P < .001). CONCLUSIONS Although WFO ablation and TGCA protocols had statistically similar visual outcomes, the TGCA protocol was associated with a significantly lower induction in vertical and horizontal coma and smaller amount of tissue ablation compared to WFO ablation. [J Refract Surg. 2019;35(4):222-229.].
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Kirgiz A, Eliacik M, Yildirim Y. Different accelerated corneal collagen cross-linking treatment modalities in progressive keratoconus. EYE AND VISION 2019; 6:16. [PMID: 31172016 PMCID: PMC6545739 DOI: 10.1186/s40662-019-0141-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/12/2019] [Indexed: 12/14/2022]
Abstract
Background To compare the outcomes of two different protocols of accelerated corneal crosslinking (CXL) on visual, corneal high order aberrations (HOA) and topographic parameters in patients with progressive keratoconus. Methods In this prospective comparative study, sixty-six eyes of 66 patients with progressive keratoconus were divided into two groups; 37 eyes in Group 1 received 18 mW/cm2 for five minutes, and 29 eyes in Group 2 were treated with 9 mW/cm2 for 10 min. The uncorrected distant visual acuity (UCVA), best-corrected distant visual acuity (BCVA), corneal HOAs and topography parameters were measured preoperatively and postoperatively at the end of 12 months. The data for the two groups were compared statistically. Results The mean UCVA and BCVA were significantly improved at the postoperative 12 months compared with the preoperative values in both groups (P < 0.05 for all). A significant improvement in corneal HOAs was observed in both groups (P < 0.05 for all). The change in corneal coma value was significantly higher in Group 2 (P < 0.05). The change in keratometric values K1, K2, AvgK and maximum keratometry (AKf) were significantly higher in Group 2 (P < 0.05 for all). The regression model showed that the most important factor predicting the change in AKf was the type of CXL (β = − 0.482, P = 0.005). Conclusions Accelerated CXL using 10 min of UVA irradiance at 9 mW/cm2 showed better topographic improvements and coma values than five minutes of UVA irradiance at 18 mW/cm2 independent of keratoconus severity.
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Affiliation(s)
- Ahmet Kirgiz
- 1Department of Ophthalmology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey.,3University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Eliacik
- 2Department of Ophthalmology, Istanbul Medipol University, Istanbul, Turkey
| | - Yusuf Yildirim
- 3University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Corneal crosslinking and intracorneal ring segments for keratoconus: A randomized study of concurrent versus sequential surgery. J Cataract Refract Surg 2019; 45:830-839. [DOI: 10.1016/j.jcrs.2019.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 11/18/2022]
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Salouti R, Khalili MR, Zamani M, Ghoreyshi M, Nowroozzadeh MH. Assessment of the changes in corneal biomechanical properties after collagen cross-linking in patients with keratoconus. J Curr Ophthalmol 2019; 31:262-267. [PMID: 31528759 PMCID: PMC6742757 DOI: 10.1016/j.joco.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 02/13/2019] [Accepted: 02/24/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose To assess the changes in biomechanical properties of the cornea after treatment of keratoconus patients with UV-A/riboflavin corneal collagen cross-linking (CXL) using Corvis ST (Oculus, Wetzlar, Germany) and Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Inc., Buffalo, NY, USA) devices. Methods In this prospective, observational case series, 48 eyes from 48 consecutive patients with progressive keratoconus were enrolled. Patients with history or signs of ocular disorders other than keratoconus, previous eye surgery, systemic diseases, or inability to cooperate with any measurement device were excluded. Corvis ST and ORA images were obtained at baseline and 4 months after CXL. The primary outcome measures comprised Corvis ST corneal biomechanical factors [time of highest concavity (T), time of applanation 1 (T1), time of applanation 2 (T2), length of applanation 1 (L1), length of applanation 2 (L2), velocity of applanation 1 (V1), velocity of applanation 2 (V2), deformation amplitude (DA), peak distance (PD), and radius (R)] and the ORA parameters [corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-related IOP (IOPg), cornea-compensated IOP (IOPcc), and waveform score (WS)]. Results The mean [± standard deviation (SD)] age of patients was 20 ± 5 years, and 27 (56%) were male. At baseline, the averages of the refraction, mean keratometry, and keratometric astigmatism were −3.0 ± 1.8 diopter (D), 47.0 ± 1.8 D, and 3.5 ± 1.5 D, respectively. According to Corvis ST, L2 increased from 0.83 ± 0.25 mm at baseline to 1.15 ± 0.57 mm after CXL; and V2 decreased from −0.81 ± 0.08 to −0.94 ± 0.26 m/s (P = 0.001 and P = 0.032, respectively). ORA parameters showed significant decrease in the CRF (from 7.82 ± 1.72 to 7.21 ± 1.05 mmHg; P = 0.036) and increase in the WS (from 4.58 ± 2.55 to 6.12 ± 1.92; P = 0.002). Conclusions According to in vivo observation with Corvis ST and ORA, CXL induces significant changes in corneal biomechanical properties in cases with keratoconus. The parameters with significant changes (L2 and V2) may reflect increased stiffness of the treated cornea. The importance of such observations should be elucidated in future studies.
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Affiliation(s)
- Ramin Salouti
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran
| | - Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Zamani
- Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran
| | - Maryam Ghoreyshi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Hossein Nowroozzadeh
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Wisse RPL, Gadiot S, Soeters N, Godefrooij DA, Imhof SM, van der Lelij A. Higher-order aberrations 1 year after corneal collagen crosslinking for keratoconus and their independent effect on visual acuity. J Cataract Refract Surg 2018; 42:1046-52. [PMID: 27492104 DOI: 10.1016/j.jcrs.2016.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of corneal collagen crosslinking (CXL) in progressive keratoconus patients on higher-order aberrations (HOAs) and the effect of change in HOAs on visual acuity between baseline and 1 year after CXL. SETTING Tertiary academic referral center, Utrecht, the Netherlands. DESIGN Prospective cohort study. METHODS This study included consecutive keratoconus patients who were treated with epithelium-off CXL and followed for a minimum of 1 year. The following corneal HOAs were measured with Scheimpflug tomography (Pentacam HR type 70900): coma, trefoil, spherical aberration, and total corneal HOAs. A 2-tailed paired-samples t test was used to compare baseline and postoperative aberrations. Multivariable linear regression was applied to assess the independent effects of HOA subtypes on changes in uncorrected (UDVA) and corrected (CDVA) distance visual acuity. RESULTS Overall, the degree of corneal HOAs in the patient cohort (N = 187) was relatively unchanged after CXL, with a mean change of -1.34% (P = .272). Horizontal coma contributed most to the total amount of HOAs but was virtually unchanged on average. The HOA subtype of spherical aberrations decreased significantly (-15.68%) (P < .001). There was no effect of the change in HOAs on the change in CDVA; however, there was a significant effect of the change in horizontal coma on the change in UDVA (P = .003; B -0.475). CONCLUSIONS Corneal HOAs in general were relatively unchanged from baseline to 1 year after CXL in eyes with progressive keratoconus. A change in horizontal coma had a strong and independent effect on UDVA. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Robert P L Wisse
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Stijn Gadiot
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nienke Soeters
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel A Godefrooij
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia M Imhof
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Allegonda van der Lelij
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
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Rosenblat E, Hersh PS. Intraoperative corneal thickness change and clinical outcomes after corneal collagen crosslinking: Standard crosslinking versus hypotonic riboflavin. J Cataract Refract Surg 2018; 42:596-605. [PMID: 27113884 DOI: 10.1016/j.jcrs.2016.01.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/11/2016] [Accepted: 01/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine intraoperative changes in corneal thickness and outcomes of corneal collagen crosslinking (CXL) using 2 intraoperative regimens: riboflavin-dextran or hypotonic riboflavin. SETTING Cornea and refractive surgery practice, Teaneck, New Jersey, USA. DESIGN Prospective randomized case series. METHODS Eyes with keratoconus or corneal ectasia were treated. All eyes received preloading with riboflavin 0.1% in 20% dextran. During ultraviolet-A (UVA) exposure, patients were randomly assigned to 1 of 2 study arms; that is, riboflavin-dextran or hypotonic riboflavin. Intraoperative pachymetry was measured before and after the corneal epithelium was removed, after initial riboflavin loading, and after UVA light exposure. Patients were evaluated for maximum keratometry (K), uncorrected distance visual acuity (UDVA), corrected distance visual acuity, corneal thickness, and endothelial cell count (ECC). RESULTS Forty-eight eyes were treated. After removal of the epithelium and riboflavin loading, the mean pachymetry was 430 μm and 432 μm in the standard group and hypotonic group, respectively. Immediately after 30-minute UVA administration, the mean pachymetry was 302 μm and 342 μm, respectively. There was no statistically significant difference in the postoperative maximum K change, UDVA, corneal thickness, or ECC between the 2 groups. CONCLUSIONS The cornea thinned substantially during the CXL procedure. The use of hypotonic riboflavin rather than riboflavin-dextran during UVA administration decreased the amount of corneal thinning during the procedure by 30%, from 128 μm to 90 μm. However, there were no significant differences in clinical efficacy or changes in ECC or function between groups postoperatively. In general, corneal thinning during CXL did not seem to compromise the safety of the endothelium. FINANCIAL DISCLOSURES Dr. Hersh is a consultant to Avedro, Inc. Dr. Rosenblat has no financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Elan Rosenblat
- From the Cornea and Laser Eye Institute-Hersh Vision Group, CLEI Center for Keratoconus, Teaneck, and the Department of Ophthalmology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Peter S Hersh
- From the Cornea and Laser Eye Institute-Hersh Vision Group, CLEI Center for Keratoconus, Teaneck, and the Department of Ophthalmology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
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Tekin K, Kiziltoprak H, Koc M, Goker YS, Kocer AM, Yilmazbas P. The effect of corneal infiltrates on densitometry and higher-order aberrations. Clin Exp Optom 2018; 102:140-146. [PMID: 30107640 DOI: 10.1111/cxo.12828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/05/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND This study aimed to measure the effects of persistent corneal subepithelial infiltrates associated with epidemic keratoconjunctivitis on corneal densitometry and total corneal higher order aberrations (HOAs), and to compare these measurements with the data obtained from their fellow unaffected healthy eyes. METHODS This prospective cross-sectional study included those who had persistent subepithelial infiltrates in only the affected eyes for at least three months and clinically normal fellow unaffected eyes. Corneal densitometry was measured with the densitometry software of the Pentacam HR-Scheimpflug corneal topographer over a 12 mm diameter of cornea. Further, total corneal HOAs including coma (Z[1,3], Z[3,-1]), trefoil (Z[3], Z[3,-3]), spherical aberration, higher order root mean square (HO-RMS), and total RMS in the Zernike analysis were analysed by the same Pentacam HR device. RESULTS Forty-six eyes of 23 participants were analysed in this study. The mean corneal densitometry values were statistically significantly higher in all annular concentric areas (0-2, 2-6, 6-10, and 10-12 mm) of the anterior and central corneal layers in the eyes with subepithelial infiltrates when compared to normal fellow eyes (p < 0.05, for each one). Additionally, there were statistically significant differences between the eyes with subepithelial infiltrates and normal fellow eyes with regard to coma, trefoil, HO-RMS, and total RMS in the Zernike analysis (p < 0.05, for each one). CONCLUSION This study quantitatively demonstrated that persistent corneal subepithelial infiltrates associated with epidemic keratoconjunctivitis decrease corneal transparency and corneal optical quality in affected eyes.
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Affiliation(s)
- Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Hasan Kiziltoprak
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mustafa Koc
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Yasin Sakir Goker
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Ali Mert Kocer
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pelin Yilmazbas
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Uysal BS, Sarac O, Yaman D, Akcay E, Cagil N. Optical Performance of the Cornea One Year Following Keratoconus Treatment with Corneal Collagen Cross-Linking. Curr Eye Res 2018; 43:1415-1421. [PMID: 30012019 DOI: 10.1080/02713683.2018.1501802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of the study is to assess changes in optical performance of the cornea in patients with keratoconus following treatment with corneal collagen crosslinking (CXL). MATERIALS AND METHODS One hundred and eleven eyes of 111 consecutive keratoconus patients with 12-month follow-up after CXL were included. The changes in the visual acuity, manifest refractive errors, and corneal topographic parameters were evaluated. Sirius dual-scanning corneal tomography was used to determine the effectiveness of CXL on each patient's total corneal optical quality; preoperative and 12-month postoperative measurements were analyzed over a 4-mm stimulated pupil and were compared with regards to higher order corneal aberrations (total amount of higher order aberrations [HOAs], vertical coma, horizontal coma, vertical trefoil, oblique trefoil, and spherical aberration), vertical and horizontal modulation transfer function (MTF), and Strehl ratio of point spread function (PSF). RESULTS At 12 months, there was a significant improvement in mean uncorrected visual acuity (UCVA) (P < 0.001), best corrected visual acuity (BCVA) (P < 0.001), spherical equivalent refraction (P = 0.007), and manifest astigmatic refraction (P < 0.001). The corneal topographic measurements revealed a significant decrease in the mean simulated keratometry-1, simulated keratometry -2, and maximum keratometry compared with the baseline measurements (P < 0.001, for all). In addition, there were significant improvements in mean root mean square error values for corneal total HOA (P < 0.001), vertical coma (P < 0.001), and vertical trefoil (P = 0.008) following CXL. Mean MTF and Strehl ratio did not change after CXL (P > 0.05). The improvement in UCVA significantly correlated with the changes in vertical trefoil (r = -0.191, P = 0.044), and the improvement in BCVA and the changes in manifest astigmatic correction were also significantly correlated (r = -0.247, P = 0.009) 12 months after CXL. CONCLUSIONS CXL treatment for keratoconus led to an improvement in visual, refractive, topographic, and most corneal HOAs outcomes at the 12-month follow-up. However, these improvements were not enough to increase corneal MTF and the Strehl ratio of PSF.
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Affiliation(s)
- Betul Seher Uysal
- a Department of Ophthalmology , Yıldırım Beyazıt University, Atatürk Training and Research Hospital , Ankara , Turkey
| | - Ozge Sarac
- a Department of Ophthalmology , Yıldırım Beyazıt University, Atatürk Training and Research Hospital , Ankara , Turkey
| | - Derya Yaman
- a Department of Ophthalmology , Yıldırım Beyazıt University, Atatürk Training and Research Hospital , Ankara , Turkey
| | - Emine Akcay
- a Department of Ophthalmology , Yıldırım Beyazıt University, Atatürk Training and Research Hospital , Ankara , Turkey
| | - Nurullah Cagil
- a Department of Ophthalmology , Yıldırım Beyazıt University, Atatürk Training and Research Hospital , Ankara , Turkey
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Ameerh MAA, Bdour MDA, Al-Till M, Faouri MA. Trans-epithelial corneal collagen cross-linking with iontophoresis for progressive keratoconus. Int Ophthalmol 2018; 39:1089-1095. [PMID: 29675563 DOI: 10.1007/s10792-018-0920-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/07/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the efficacy of trans-epithelial corneal collagen cross-linking (CXL) with Iontophoresis among patients with progressive keratoconus. METHODS It is a prospective interventional study, which is based on 41 eyes of 23 patients, suffering from progressive keratoconus and treated with trans-epithelial corneal cross-linking, using iontophoresis with ETDA and trometamol-enriched riboflavin 5 phosphates 0.1% hypotonic solution (Ricrolin+, Soot Italia SpA, Italy). RESULTS The mean of uncorrected distance visual acuity and best corrected distant visual acuity was improved at 6 months with statistically significant differences from baseline (p < 0.05). There was no statistically significant difference in keratometric values, including K1, K2, Km, topographic astigmatism, and central corneal thickness. Patients, who had completed 1 year (21 eyes of 12 patients) of the treatment, showed similar results. CONCLUSION The data indicated that corneal collagens cross-linking with iontophoresis using Ricroli+ may be an effective method in halting the progression of keratoconus without the side effects of epithelial removal, which may be encountered in the standard epi-off CXL procedure.
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Eissa SA, Yassin A. Prospective, randomized contralateral eye study of accelerated and conventional corneal cross-linking in pediatric keratoconus. Int Ophthalmol 2018; 39:971-979. [PMID: 29564806 DOI: 10.1007/s10792-018-0898-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare the outcomes of two different cross-linking (CXL) protocols, in pediatric keratoconus eyes. MATERIALS AND METHODS In this prospective randomized contralateral eye interventional study, 68 eyes of 34 patients, 9-16 years old, underwent CXL and enrolled between October 2011 and October 2013. Group A represents conventional riboflavin-ultraviolet A (UVA)-induced CXL with 30 min of exposure to UVA irradiation of 3 mW/cm2. Group B represents accelerated cross-linking with 5 min of continuous UVA irradiation of 18 mW/cm2. In either group, total energy delivered was adjusted to 5.4 J/cm2. Follow-up of all patients was accomplished throughout the postoperative 3 years, and the data from the preoperative, 12, 24, and 36 months visits were analyzed and compared in both groups. Uncorrected visual acuity, corrected distance visual acuity, steepest keratometry (Kmax), corneal astigmatism (simulated K), total wavefront aberrations, central corneal thickness (CCT), corneal densitometry, manifest refraction spherical equivalent, and endothelial cell density (ECD) were evaluated at baseline, 12, 24, and 36 months post-CXL. RESULTS At 1-year assessment, the mean value of UCVA, CDVA, and Kmax showed a statistically significant difference between both groups, without any documented change in the variables throughout the remaining follow-up (1-3-year) period. Twelve months postoperatively, mean LogMAR UCVA and CDVA were (0.11 ± 1.60) and (0.03 ± 1.60), respectively, in accelerated CXL group, compared to conventional CXL group values of (0.20 ± 1.00) and (0.06 ± 1.22), showing a statistically significant difference (P < 0.05). Mean Kmax in accelerated CXL group (45.47 ± 0.44) showed a statistically significant difference (P < 0.05) compared to conventional CXL group (46.41 ± 1.59) at 12 months post-CXL. On the other hand, wavefront aberrations, simulated K, corneal densitometry, ECD, and CCT changes showed nonstatistically significant difference in conventional CXL group, compared to accelerated CXL group (P > 0.05) throughout the follow-up course. CONCLUSIONS Both conventional and accelerated CXL improved UCVA and CDVA, attenuated disease progression, and reduced corneal steepness and wavefront aberrations at 1, 2, and 3 years postoperatively. In no case did keratoconus progress over the 36-month follow-up.
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Affiliation(s)
- Sherif A Eissa
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Kasr Al Aini, Manial, Cairo, 11451, Egypt.
| | - Amr Yassin
- Magrabi Eye Hospital, Abha, Kingdom of Saudi Arabia
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