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Niazi S, Doroodgar F, Nazari SH, Rahimi Y, Del Barrio JLA, Gatzioufas Z, Findl O, Vinciguerra P, Vinciguerra R, Moshirfar M, Ambrósio R, Alio JL. Refractive surgical approaches to keratoconus: A systematic review and network meta-analysis. Surv Ophthalmol 2024:S0039-6257(24)00045-6. [PMID: 38710236 DOI: 10.1016/j.survophthal.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
Advancements in diagnostic methods and surgical techniques for keratoconus (KC) have increased non-invasive treatment options. Successful surgical planning for KC involves a combination of clinical science, empirical evidence, and surgical expertise. Assessment of disease progression is crucial, and halting the progression should be the focus if it is progressive. While surgeons used to rely on experience alone to decide the surgical method, comparing the network of primary factors, such as visual acuity, across studies can help them choose the most appropriate treatments for each patient and achieve optimal outcomes. Meticulous tabulation methods facilitate interpretation, highlighting the importance of selecting the correct surgical and rehabilitation approach based on each patient's condition and stage of the disease. We detail the outcomes of a comprehensive network meta-analysis comparing the effectiveness of various combined therapeutic refractive treatments for KC at identical stages of the disease, spanning four distinct follow-up intervals. Additionally, the comprehensive analysis suggests that for corneas with optimal best corrected visual acuity (BCVA) preoperatively (classified as regular), combining phakic intraocular lenses with intracorneal ring segments (ICRS) and corneal cross-linking (CXL) could offer the best therapeutic approach provided the disease stage does not exceed stage 3. For irregular corneas, although initial follow-ups show a significant difference in BCVA with surface ablation, longer-term follow-ups recommend combining surface ablation with ICRS and CXL, especially at higher stages.
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Affiliation(s)
- Sana Niazi
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Doroodgar
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yekta Rahimi
- Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge L Alió Del Barrio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | | | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140, Vienna, Austria
| | - Paolo Vinciguerra
- Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Renato Ambrósio
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil; Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil; BrAIN: Brazilian Artificial Intelligence Networking in Medicine, Rio de Janeiro & Maceió, Brazil; Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil; Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jorge L Alio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Zhang X, Sun L, Tian M, Shen Y, Li M, Zhao J, Zhou X. Accelerated (45 mW/cm 2) Transepithelial Corneal Cross-Linking for Progressive Keratoconus Patients: Long-Term Topographical and Clinical Outcomes. Front Med (Lausanne) 2020; 7:283. [PMID: 32637419 PMCID: PMC7318888 DOI: 10.3389/fmed.2020.00283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022] Open
Abstract
Aims: We characterized long-term clinical outcomes of accelerated (45 mW/cm2) transepithelial corneal cross-linking (ATE-CXL) for the treatment of progressive keratoconus. Methods: Forty-two eyes from 37 patients treated for keratoconus were observed. ATE-CXL was performed using riboflavin and pulsed-light ultraviolet treatment (45 mW/cm2, 7.2 J/cm2). Structural and functional measurements were made after 1 week and 1, 3, 6, 12, 24, 36, and 48 months subsequently. Corneal topographic parameters were observed using Scheimpflug topography (Pentacam software). Results: Surgery was uneventful in all subjects. Mean uncorrected (UDVA) and corrected distance visual acuity (CDVA) (logMAR) were 0.99 ± 0.58 and 0.44 ± 0.27 (P = 0.022), 0.24 ± 0.29 and 0.27 ± 0.35 (P = 0.601), at baseline and last follow-up, respectively. The pre-operative mean maximum keratometry (Kmax) value was 57.29 ± 9.13 diopters (D), and the thinnest corneal thickness (TCT) was 456.21 ± 44.66 μm. Mean Kmax was 56.67 ± 9.36 D, 4 years post-operatively (P = 0.781). TCT changed to 453.17 ± 46.76 μm at 4 years post-operatively (P = 0.780). Multiple linear regression indicated that patients with thinner pre-operative TCT (≤ 450 μm) showed decreasing post-operative average keratometry (Kavg) and increasing post-operative TCT. Patients with posterior central elevation (PCE) >80 μm showed decreasing post-operative Kavg as well as post-operative PCE. No complications were observed during follow-up. Conclusion: Stabilization after ATE-CXL was achieved for the treatment of keratoconus. The clinical efficacy of ATE-CXL in advanced keratoconus patients with thin corneal thickness and greater PCE will require further investigation.
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Affiliation(s)
- Xiaoyu Zhang
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ling Sun
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Mi Tian
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yang Shen
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhao
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Microwave treatment of the cornea leads to localised disruption of the extracellular matrix. Sci Rep 2018; 8:13742. [PMID: 30213993 PMCID: PMC6137159 DOI: 10.1038/s41598-018-32110-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/31/2018] [Indexed: 11/11/2022] Open
Abstract
Microwave keratoplasty is a thermo-refractive surgical procedure that can correct myopia (short-sightedness) and pathologic corneal steepening by using microwave energy to cause localised shrinkage around an annulus of the cornea leading to its flattening and vision correction. The effects on the corneal extracellular matrix, however, have not yet been evaluated, thus the current study to assess post-procedure ultrastructural changes in an in-vivo rabbit model. To achieve this a series of small-angle x-ray scattering (SAXS) experiments were carried out across whole transects of treated and untreated rabbit corneas at 0.25 mm intervals, which indicated no significant change in collagen intra-fibrillar parameters (i.e. collagen fibril diameter or axial D-period), whereas inter-fibrillar measures (i.e. fibril spacing and the degree of spatial order) were markedly altered in microwave-treated regions of the cornea. These structural matrix alterations in microwave-treated corneas have predicted implications for corneal biomechanical strength and tissue transparency, and, we contend, potentially render microwave-treated corneas resistant to surgical stabilization using corneal cross-linking procedures currently employed to combat refractive error caused by corneal steepening.
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Affiliation(s)
- Davin Johnson
- Department of Ophthalmology, CHUM-Notre Dame Hospital, Montreal, Canada
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