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Bordais J, Cassagne M, Touboul D, Saunier V, Butterworth J, Malecaze F, Soler V, Fournié P. Conventional Epithelial-Off Corneal Crosslinking in Patients With Progressive Keratoconus: 10-Year Outcomes. Cornea 2024; 43:00003226-990000000-00528. [PMID: 38537067 PMCID: PMC11142646 DOI: 10.1097/ico.0000000000003532] [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: 06/23/2023] [Revised: 11/23/2023] [Accepted: 01/29/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE Corneal crosslinking (CXL) is the standard treatment of progressive keratoconus (KC). We evaluated the safety and 10-year outcomes of conventional "epithelial-off" CXL for progressive KC for the first time in a cohort in France. METHODS We conducted a retrospective review of patients undergoing conventional CXL (Dresden protocol) in our tertiary ophthalmology department from 2006 to 2011 with 10-year follow-up. The primary outcome was change in preoperative versus postoperative keratometry measured by maximum keratometry (Kmax), steep keratometry (K2), flat keratometry (K1), mean keratometry (Km), and topographic cylinder. Secondary outcomes were changes in visual and refractive outcomes. We report postoperative complications and adverse events. RESULTS Eighty-nine eyes from 76 patients (67% male patients, mean age 22.7 ± 7.6 years) were included. Mean Kmax (-2.31 ± 2.98 diopters (D); P < 0.00001), K2 (-2.07 ± 3.15 D; P < 0.00001), K1 (-1.00 ± 2.29 D; P = 0.00008), Km (-1.53 ± 2.47 D; P < 0.00001), and topographic cylinder (-1.15 ± 2.53 D; P = 0.00004) significantly decreased 10 years after CXL compared with preoperative baseline. Significant decreases were still observed between 5 and 10 years after for mean Kmax, mean K2, mean K1, and mean Km. Mean distance best spectacle-corrected visual acuity and mean manifest refraction spherical equivalent were significantly improved after 10 years versus before CXL. The 10-year rate of repeat CXL was n = 3/76 patients (4%) (all younger than 18 years at first CXL) and of loss of >3 lines in best spectacle-corrected visual acuity was n = 1/76 patients (1%). CONCLUSIONS Progressive KC was effectively stabilized with a prolonged flattening and maintenance of functional vision improvements after 10 years. Repeat CXL was rare and only required among younger patients.
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Affiliation(s)
- Jérémy Bordais
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Myriam Cassagne
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
- University of Toulouse III, Toulouse, France; and
| | - David Touboul
- Ophthalmology Department, Anterior Segment Unit, Bordeaux University Hospital, Bordeaux, France
| | - Valentine Saunier
- Ophthalmology Department, Anterior Segment Unit, Bordeaux University Hospital, Bordeaux, France
| | - Jacqueline Butterworth
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - François Malecaze
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
- University of Toulouse III, Toulouse, France; and
| | - Vincent Soler
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
- University of Toulouse III, Toulouse, France; and
| | - Pierre Fournié
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
- University of Toulouse III, Toulouse, France; and
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Thomasy SM, Leonard BC, Greiner MA, Skeie JM, Raghunathan VK. Squishy matters - Corneal mechanobiology in health and disease. Prog Retin Eye Res 2024; 99:101234. [PMID: 38176611 PMCID: PMC11193890 DOI: 10.1016/j.preteyeres.2023.101234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
The cornea, as a dynamic and responsive tissue, constantly interacts with mechanical forces in order to maintain its structural integrity, barrier function, transparency and refractive power. Cells within the cornea sense and respond to various mechanical forces that fundamentally regulate their morphology and fate in development, homeostasis and pathophysiology. Corneal cells also dynamically regulate their extracellular matrix (ECM) with ensuing cell-ECM crosstalk as the matrix serves as a dynamic signaling reservoir providing biophysical and biochemical cues to corneal cells. Here we provide an overview of mechanotransduction signaling pathways then delve into the recent advances in corneal mechanobiology, focusing on the interplay between mechanical forces and responses of the corneal epithelial, stromal, and endothelial cells. We also identify species-specific differences in corneal biomechanics and mechanotransduction to facilitate identification of optimal animal models to study corneal wound healing, disease, and novel therapeutic interventions. Finally, we identify key knowledge gaps and therapeutic opportunities in corneal mechanobiology that are pressing for the research community to address especially pertinent within the domains of limbal stem cell deficiency, keratoconus and Fuchs' endothelial corneal dystrophy. By furthering our understanding corneal mechanobiology, we can contextualize discoveries regarding corneal diseases as well as innovative treatments for them.
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Affiliation(s)
- Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, United States; Department of Ophthalmology & Vision Science, School of Medicine, University of California - Davis, Davis, CA, United States; California National Primate Research Center, Davis, CA, United States.
| | - Brian C Leonard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, United States; Department of Ophthalmology & Vision Science, School of Medicine, University of California - Davis, Davis, CA, United States
| | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States; Iowa Lions Eye Bank, Coralville, IA, United States
| | - Jessica M Skeie
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States; Iowa Lions Eye Bank, Coralville, IA, United States
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Li N, Fan Z, Peng X. Analysis of the effect of calcium ions on promoting the penetrability of riboflavin into the corneal stroma by iontophoresis. Int Ophthalmol 2024; 44:89. [PMID: 38366000 DOI: 10.1007/s10792-024-03031-x] [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: 09/06/2023] [Accepted: 01/11/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE To investigate the effect of calcium ions on promoting the penetrability of riboflavin into the corneal stroma by iontophoresis and to analyse the possible mechanism. METHODS Forty rabbits were divided into five groups randomly: 0.1% riboflavin-balanced salt solution (BSS) by iontophoresis group, 0.1% riboflavin-saline solution by iontophoresis group, 0.1% riboflavin-zinc gluconate solution by iontophoresis group, 0.1% riboflavin-calcium gluconate solution by iontophoresis group and classical riboflavin instillation after corneal de-epithelialization as the control group. The riboflavin concentrations in corneal stroma were determined and compared by high-performance liquid chromatography (HPLC) after removing epithelium and endothelium. RESULTS Iontophoretic delivery of a 0.1% riboflavin-calcium gluconate solution was the closest to the effect of classical de-epithelialization. The other solvents were unsufficient at enhancing the permeability of the riboflavin. CONCLUSION Calcium ions can promote the penetrability of riboflavin into the corneal stroma by iontophoresis.
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Affiliation(s)
- Na Li
- Department of Ophthalmology, The Third Medical Center of Chinese, PLA General Hospital, Yongding Road 69, Beijing, 100039, China.
| | - Zhengjun Fan
- Department of Ophthalmology, The Sixth Medical Center of Chinese, PLA General Hospital, Beijing, 100048, China
| | - Xiujun Peng
- Department of Ophthalmology, The Sixth Medical Center of Chinese, PLA General Hospital, Beijing, 100048, China
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Liu B, Shang X, Tan X, Luo S, Fang X, Xie Z, Xiao X, He H, Gong L, Wu H, Lin Z. Clinical and Morphological in Vivo Confocal Microscopy Findings following a Modified Biphasic Higher Fluence Transepithelial Corneal Crosslinking. Curr Eye Res 2024; 49:119-130. [PMID: 37882774 DOI: 10.1080/02713683.2023.2276680] [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: 08/03/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
Purpose: To compare the refractive efficacy and morphological changes in the cornea following a novel biphasic higher fluence transepithelial corneal crosslinking (BI-TE-CXL) and transepithelial corneal crosslinking (TE-CXL) in adults keratoconus.Methods: Patients with progressive keratoconus who required corneal crosslinking were assigned to the BI-TE-CXL group (32 eyes, phase 1: 7.2 J/cm2 for 5 min and 20 s of pulsed-light exposure, KXL, Glaukos-Avedro; phase 2: 3.6 J/cm2 for 6 min and 40 s of continuous light exposure at the front curvature apex with a 6 mm diameter light spot, UVX-2000, IROC) or the TE-CXL group (32 eyes, uniform 7.2 J/cm2 for 5 min and 20 s of pulsed-light exposure, KXL, Glaukos-Avedro). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal fluorescein staining (CFS), corneal topography, anterior segment optical coherence tomography (AS-OCT), and in vivo corneal confocal microscopy (IVCM) were performed 3, 6, 12 and 24 months after surgery.Results: The CFS scores in the BI-TE-CXL group were significantly higher than those in the TE-CXL group on the first two days after surgery (p < 0.001). The Kmax (at 12 and 24 months) and CDVA (logMAR) were significantly lower in the BI-TE-CXL group than those in the TE-CXL group (p < 0.05). The corneal demarcation line under AS-OCT was visible in 81.3% of patients in the BI-TE-CXL group and 15.6% in the TE-CXL group. The depth of the demarcation line under IVCM was significantly deeper in the BI-TE-CXL group (248.3 ± 25.0 μm) than that of the TE-CXL group (136.5 ± 15.6 μm) in the central cornea (p < 0.001). The cross-linked collagen structures in the central cornea were still present after 12 months in the BI-TE-CXL group. No significant difference in sub-basal nerve density between the two groups (p > 0.05).Conclusions: Following BI-TE-CXL, CDVA was significantly improved, accompanied by deeper demarcation line depth and persistent crosslinked structures in the central corneal stroma.
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Affiliation(s)
- Bin Liu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
| | - Xumin Shang
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
| | - Xiuxian Tan
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
| | - Shunrong Luo
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
| | - Xie Fang
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
| | - Zhiwen Xie
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
| | - Xianwen Xiao
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
| | - Huan He
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Research Center for Eye Diseases and Key Laboratory of Ophthalmology, Xiamen, Fujian, China
| | - Lan Gong
- Department of Ophthalmology, Eye, Ear, Nose, and, Throat Hospital of Fudan University, Shanghai, China
| | - Huping Wu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
| | - Zhirong Lin
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian, China
- Fujian Key Laboratory of Ocular Surface & Corneal Diseases (affiliated Xiamen Eye Center of, Xiamen University), Xiamen, Fujian, China
- Xiamen Municipal Key Laboratory of Ocular Surface & Corneal Diseases, Xiamen, Fujian, China
- Xiamen Research Center for Eye Diseases and Key Laboratory of Ophthalmology, Xiamen, Fujian, China
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Mohammadpour M, Heirani M, Khoshtinat N, Khorrami-Nejad M. Comparison of two different 360-degree intrastromal corneal rings combined with simultaneous accelerated-corneal cross-linking. Eur J Ophthalmol 2024; 34:126-139. [PMID: 37139606 DOI: 10.1177/11206721231171420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE to compare five-year outcomes of two complete intracorneal implants (MyoRing versus annular-shaped intracorneal implant [AICI]) combined with accelerated corneal cross-linking (A-CXL) in progressive KCN. METHODS In this historical cohort study, preoperative and postoperative visual, refractive, tomographic, biomechanical, and aberrometric parameters of 27 eyes of 27 patients who underwent implantation of two complete rings (13 AICI and 14 MyoRing) combined with A-CXL were recorded. RESULTS The mean age of patients in "AICI plus A-CXL" and "MyoRing plus A-CXL" groups were 28.1 ± 4.6 and 26.3 ± 3.8 years, respectively. All pre- and postoperative visual and refractive parameters between the two groups were not significantly different (p > 0.05). Comparing pre- and postoperative tomographic measurements showed that anterior corneal surface (ACS) flat-K and corneal thickness at pachymetric apex significantly improved for MyoRing plus A-CXL group after five years (p < 0.05). On the other hand, ACS K-max and mean-K values were significantly improved for AICI plus A-CXL group after five years (p < 0.05). Both groups revealed significant improvements in ACS steep-K and corneal astigmatism (p < 0.05). Five years after surgery, the high order aberration in the AICI group (2.60 ± 0.83) was significantly better than the MyoRing group (1.70 ± 0.43) (p = 0.007). CONCLUSIONS Both complete intrastromal rings (MyoRing or AICI) combined with A-CXL significantly Improved visual, refractive, and corneal aberrometric, biomechanical, and tomographic parameters and halt the progression of KCN with comparable long-term outcomes.
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Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Heirani
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Khoshtinat
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Yamagata Y, Ide T. A Novel Riboflavin Formulation for Corneal Delivery Without Damaging Epithelial Cells. Transl Vis Sci Technol 2023; 12:10. [PMID: 37930667 PMCID: PMC10629540 DOI: 10.1167/tvst.12.11.10] [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: 06/07/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aimed to evaluate the trans-epithelial permeability enhancement and cell damage caused by a novel riboflavin composition for corneal delivery. Methods We developed a trans-epithelial formulation of riboflavin for corneal delivery using 1,2-dioleoyl-3-dimethylammonium-propane (DODAP) and isostearic acid (ISA). The permeation enhancement was evaluated using an in vitro corneal epithelial cell culture system by measuring the amount of transferred riboflavin with high-performance liquid chromatography. Riboflavin permeation of MedioCROSS TE, a commercially available riboflavin formulation containing benzalkonium chloride, was also evaluated and compared to that of the DODAP/ISA formulation by changing the riboflavin concentration. The trans-epithelial electrical resistance (TEER) was measured after exposure to the samples in an in vitro corneal epithelial cell culture system to assess cytotoxicity. Results The DODAP/ISA formulation demonstrated greater permeation when used together than when each component was used individually. The permeation enhancement effect of the DODAP/ISA formulation was almost the same as that of MedioCROSS TE. However, when a 10-fold higher riboflavin concentration was used in the DODAP/ISA formulation, the permeation enhancement effect surpassed that of MedioCROSS TE. After 24 hours of exposure, the TEER of the DODAP/ISA formulation was higher than that of MedioCROSS TE, indicating that the DODAP/ISA formulation was less cytotoxic than MedioCROSS TE. Conclusions This study indicated that the DODAP/ISA formulation could serve as a less cytotoxic alternative to MedioCROSS TE. Further studies are required to determine the clinical efficacy and safety of the DODAP/ISA formulation in vivo. Translational Relevance This study may provide alternative procedures for corneal collagen crosslinking with less of a cytotoxic effect on corneal epithelial cells.
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Affiliation(s)
- Yutaka Yamagata
- Analytical Research Laboratory, MEDRx Co. Ltd., Kagawa, Japan
| | - Takeshi Ide
- Tokyo Vision Eye Clinic Asagaya, Tokyo, Japan
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Roszkowska AM, Oliverio GW, Hydzik-Sajak K, De Crescenzo M, Aragona P. Five-year results of iontophoresis-assisted transepithelial corneal cross-linking for keratoconus. Int Ophthalmol 2023; 43:3601-3607. [PMID: 37395906 PMCID: PMC10504154 DOI: 10.1007/s10792-023-02768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To assess long-term efficacy and safety of iontophoresis-assisted transepithelial corneal cross-linking (I-CXL) for keratoconus. PATIENTS AND METHODS Twenty-seven eyes of 21 patients (15 M, 6F) affected by progressive keratoconus were evaluated. All subjects were treated with iontophoresis-assisted transepithelial CXL. The patients were examined at baseline and each 6 months after the CXL procedure. Only subjects who completed the follow-up of 5 years were considered in this study. The main outcome measures were uncorrected visual acuity (UCVA), corrected visual acuity (CDVA), corneal transparency and corneal parameters such as K-max, central corneal thickness (CCT) and at the thinnest point, and high-order ocular aberrations (HOAs). The ABCD system was used to determine the progression and re-progression of ectasia. SETTING Ophthalmology Clinic, University Hospital of Messina, Messina, Italy. RESULTS At 5 years, significant improvements of UCVA from 0.53 ± 0.33 logMAR to 0.4 ± 0.33 logMAR (p = 0.001) and HOAs (p = 0.01) were registered. No significant changes of CDVA (p = 0.4), K-max (p = 0.75), CCT (p = 0.5) were observed at the end of follow-up period. The ABCD system showed re-progression in 25.9% of eyes after 5 years. No adverse events such as corneal opacities and infections were reported. CONCLUSIONS Iontophoresis-assisted transepithelial CXL resulted to be safe and effective to stabilize progressive keratoconus in adults at a long-term follow-up.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Clinic, Department of Biomedical Sciences, University of Messina, Messina, Italy.
- Ophthalmology Clinic, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland.
| | | | - Katarzyna Hydzik-Sajak
- Ophthalmology Clinic, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Michele De Crescenzo
- Ophthalmology Clinic, Department of Biomedical Sciences, University of Messina, Messina, Italy
| | - Pasquale Aragona
- Ophthalmology Clinic, Department of Biomedical Sciences, University of Messina, Messina, Italy
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Qin D, Han Y, Wang L, Yin H. Recent advances in medicinal compounds related to corneal crosslinking. Front Pharmacol 2023; 14:1232591. [PMID: 37841929 PMCID: PMC10570464 DOI: 10.3389/fphar.2023.1232591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
Corneal crosslinking (CXL) is the recognized technique to strengthen corneal collagen fibers through photodynamic reaction, aiming to halt progressive and irregular changes in corneal shape. CXL has greatly changed the treatment for keratoconus (KCN) since it was introduced in the late 1990's. Numerous improvements of CXL have been made during its developing course of more than 20 years. CXL involves quite a lot of materials, including crosslinking agents, enhancers, and supplements. A general summary of existing common crosslinking agents, enhancers, and supplements helps give a more comprehensive picture of CXL. Either innovative use of existing materials or research and development of new materials will further improve the safety, effectiveness, stability, and general applicability of CXL, and finally benefit the patients.
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Affiliation(s)
- Danyi Qin
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yi Han
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongbo Yin
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Blaser F, Zweifel S, Wiest MRJ, Bajka A, Said S, Barthelmes D, Muth DR. Severe Complications after Corneal Collagen Cross-Linking (CXL). Klin Monbl Augenheilkd 2023; 240:369-378. [PMID: 37164391 PMCID: PMC10129411 DOI: 10.1055/a-2040-4290] [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: 11/05/2022] [Accepted: 01/22/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To present a case series of rare and severe complications after corneal collagen cross-linking (CXL) of keratoconus patients. METHODS Single-center descriptive case series covering the period of 2012 to 2022 at the Department of Ophthalmology at the University Hospital, Zurich, Switzerland. RESULTS We present four eyes of four patients that showed severe unusual complications within the first month after CXL. Three patients had been treated with the classical epithelium-off "Dresden" protocol. One patient had been treated with the accelerated epithelium-off protocol. One patient presented with extensive corneal edema due to rubbing the eye after treatment. Two patients showed a bacterial infectious keratitis: one due to Streptococcus pneumoniae and the other due to Staphylococcus hominis, Micrococcus luteus, and Streptococcus epidermidis. The latter of the two patients exhibited extensive infectious crystalline keratopathy. The fourth patient showed a severe ulcerative lesion where no infectious cause could be found. Therefore, an autoimmune keratolytic process had to be suspected. Apart from the corneal edema, which resolved ad integrum, the other complications resulted in permanent corneal scarring and thinning. One patient needed an emergency amniotic transplant. CONCLUSION Severe complications after CXL remain rare. Most common causes are complications that are not directly associated with the treatment as such. Those indirect complications occur after the treatment during the healing course of the epithelium. Associations with bandage contact lenses, topical steroids, atopic disease, and inappropriate patient behavior are often suspected. Correctly performed corneal scrapings with repeated microbiological analysis and a detailed patient history are essential for establishing the correct diagnosis, especially in complicated cases that do not respond to a standard therapeutic regimen. This case series supports the efforts that are currently taken to improve the CXL technique in a way that postoperative complications are further reduced. A more efficient epithelium-on technique might be a step in that direction.
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Affiliation(s)
- Frank Blaser
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandrine Zweifel
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Anahita Bajka
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sadiq Said
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Barthelmes
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Rudolf Muth
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Sayegh KH, Sammouh FK, Ayash JG, El Chakik GF, Haddam MS, Warrak EL. Corneal Haze Secondary to Corneal Collagen Cross-linking in Keratoconus Patients: Treatment and Outcomes. Middle East Afr J Ophthalmol 2022; 29:186-189. [PMID: 38162561 PMCID: PMC10754113 DOI: 10.4103/meajo.meajo_314_21] [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: 12/09/2021] [Revised: 03/26/2023] [Accepted: 04/25/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate the outcome of patients presenting with mild-to-moderate corneal haze after undergoing corneal collagen cross-linking (CXL) for keratoconus (KCN) and their response to a proposed standardized topical steroid-based treatment. METHODS This study included 19 eyes of 14 patients presenting with corneal haze after undergoing CXL for KCN. Corrected distance visual acuity, corneal thickness and Kmax values by Pentacam® Scheimpflug tomography, as well as subjective corneal haze changes were evaluated before and after a topical steroid- and cyclosporine-based treatment. RESULTS Visual acuity improved after the completion of the treatment by 0.043 logMAR (P = 0.017) and Kmax values decreased by 1.17D (P = 0.0024), while the corneal thinnest pachymetry remained stable. Data collected from the examiner's slit-lamp examination description revealed that seven eyes had a decrease in haze compared to 12 eyes with stable or no changes in the haze. CONCLUSION Our findings suggest an improvement in visual acuity and possible corneal flattening with decreasing Kmax after the completion of topical steroids with taper course treatment in patients suffering from corneal haze post-CXL. This paper also highlights the importance of postcross-linking anti-inflammatory treatment and close follow-up.
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Affiliation(s)
- Kevin H. Sayegh
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of Balamand, Lebanon, Advanced Eye Care Hospital, Lebanon
| | - Fady K. Sammouh
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of Balamand, Lebanon, Advanced Eye Care Hospital, Lebanon
| | - Jad G. Ayash
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of Balamand, Lebanon, Advanced Eye Care Hospital, Lebanon
| | - Ghina F. El Chakik
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of Balamand, Lebanon, Advanced Eye Care Hospital, Lebanon
| | - Majd S. Haddam
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of Balamand, Lebanon, Advanced Eye Care Hospital, Lebanon
| | - Elias L. Warrak
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of Balamand, Lebanon, Advanced Eye Care Hospital, Lebanon
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11
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EpiSmart® Crosslinking for Keratoconus: A Phase 2 Study. Cornea 2022:00003226-990000000-00116. [PMID: 36173242 DOI: 10.1097/ico.0000000000003136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to assess changes in visual acuity after epithelium-on ("epi-on") corneal crosslinking after a diagnosis of keratoconus. METHODS Subjects with corneal ectatic diseases were enrolled in a prospective, randomized, controlled, open-label, multicenter trial. Subjects were randomized to 1 of 3 treatment groups and treated with an epi-on crosslinking system including riboflavin/sodium iodide and pulsed UVA exposure (EpiSmart® , CXL Ophthalmics, Encinitas, CA). The UVA treatment groups were 2.4 J/cm2 over 20 minutes, 3.6 J/cm2 over 20 minutes, and 3.6 J/cm2 over 30 minutes. The primary end point was logarithm of the minimum angle of resolution corrected distance visual acuity (CDVA). Secondary end points were logarithm of the minimum angle of resolution uncorrected distance visual acuity (UCVA), maximum corneal curvature (Kmax), and minimum corneal thickness. Data were assessed 6 and 12 months post-operatively, using t-tests for differences from baseline. RESULTS Two thousand two hundred twenty-eight subjects were treated with epi-on crosslinking. One thousand nine hundred twenty-two subjects had a diagnosis of keratoconus; other treated eyes had postsurgical and other ectasias. At 6 and 12 months, the subjects with keratoconus demonstrated significant improvements in CDVA, UCVA, and Kmax; minimum corneal thickness was unchanged. One hundred ninety-five subjects (8.7%) reported at least 1 adverse event (AE). A mild corneal epithelial defect was reported in 31 cases (1.4%) and was the only AE reported in >1% of subjects. There were no serious AEs related to the treatment. CONCLUSIONS EpiSmart® epi-on crosslinking resulted in mean improvements in CDVA, UCVA, and Kmax at both 6 and 12 months and an excellent safety and efficacy profile in subjects with keratoconus, with few significant side effects. Differences between UVA treatment groups were not significant.
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12
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Hypertension secondary to nitric oxide depletion produces oxidative imbalance and inflammatory/fibrotic outcomes in the cornea of C57BL/6 mice. J Physiol Biochem 2022; 78:915-932. [PMID: 35943663 PMCID: PMC9684300 DOI: 10.1007/s13105-022-00916-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
Arterial hypertension (AH) leads to oxidative and inflammatory imbalance that contribute to fibrosis development in many target organs. Here, we aimed to highlight the harmful effects of severe AH in the cornea. Our experimental model was established by administration of NG-nitro-L-arginine-methyl-ester (L-NAME) to C57BL/6 mice, which were monitored weekly for arterial blood pressure and intraocular pressure (IOP). Morphological studies of ocular tissues were accompanied by analyses of reactive oxygen species generation, and localization/expression of NAPDH oxidase isoforms (NOX1, NOX2, NOX4) and inflammatory biomarkers (PPARα, PPARγ, IL-1β, IL-6, IL-10, TNF-α, and COX-2). Masson's trichrome and Sirius Red staining were used to explore the fibrotic status of the cornea. The expression of collagen isoforms (COL1α1, COL1α2, COL3α1, COL4α1, COL4α2) and relevant metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) were also quantified to evaluate the participation of collagen metabolism in AH-related corneal damage. Hypertensive animals showed an increase in IOP values, and a thinner cornea compared with normotensive controls. Moreover, AH increased NADPH oxidase activity and reactive oxygen species generation in the cornea, which was accompanied by transcriptional upregulation of NOX isoforms and inflammatory biomarkers, while reducing PPAR expression. L-NAME-treated animals also developed corneal fibrosis with overexpression of collagen isoforms and reduction of factors responsible for collagen degradation. This is the first study reporting structural changes in the cornea and elevated IOP in L-NAME-treated mice. Overexpression of the NADPH oxidase system and collagen deposition might play a substantial role in the pathogenic mechanisms contributing to ocular disturbances in a context of severe hypertension.
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13
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Alcazar J, Gomart G, Dormegny L, Sauer A, Bourcier T. Infectious crystalline keratopathy caused by two different organisms after corneal cross-linking. J Fr Ophtalmol 2022; 45:e441-e443. [DOI: 10.1016/j.jfo.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 10/16/2022]
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14
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Lopes BT, Padmanabhan P, Eliasy A, Zhang H, Abass A, Elsheikh A. In vivo Assessment of Localised Corneal Biomechanical Deterioration With Keratoconus Progression. Front Bioeng Biotechnol 2022; 10:812507. [PMID: 35757796 PMCID: PMC9213735 DOI: 10.3389/fbioe.2022.812507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose: To evaluate the regional corneal biomechanical deterioration with keratoconus (KC) progression as measured by the Stress-Strain Index (SSI) maps. Methods: The preoperative examinations of 29 progressive KC cases that were submitted to corneal cross-linking (CXL) were evaluated. The examinations included the tomography and the SSI measured by the Pentacam HR and the Corvis ST (Oculus, Wetzlar, Germany), respectively. The results were recorded twice, the latter of which was at the last visit before the CXL procedure. The patient-specific SSI maps were built, using data at each examination, based on finite element modelling and employing inverse analysis to represent the regional variation of biomechanical stiffness across the cornea. Results: All cases presented significant shape progression (above the 95% CI of repeatability) in anterior and posterior curvatures and minimum thickness. The overall corneal stiffness as measured by the SSI within the central 8 mm-diameter area underwent slight but significant reductions from the first to the last examination (−0.02 ± 0.02, range: −0.09 to 0, p < 0.001). In all 29 cases, the reduction in stiffness was localised and concentred in the area inside the keratoconus cone. The SSI values inside the cone were significantly lower in the last examination (by 0.15 ± 0.09, range: −0.42 to −0.01, p < 0.001), while the SSI outside the cone presented minimal, non-significant variations (0 ± 0.01, range: −0.04 to 0.01, p = 0.999). Conclusion: It has been observed through the SSI maps that the regional deterioration in stiffness was concerted inside the area of pathology, while only mild non-significant alterations were observed outside the area of pathology.
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Affiliation(s)
- Bernardo T Lopes
- School of Engineering, University of Liverpool, Liverpool, United Kingdom.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Prema Padmanabhan
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, India
| | - Ashkan Eliasy
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Haixia Zhang
- School of Engineering, University of Liverpool, Liverpool, United Kingdom.,School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Ahmed Abass
- School of Engineering, University of Liverpool, Liverpool, United Kingdom.,Department of Production Engineering and Mechanical Design, Faculty of Engineering, Port Said University, Port Fuad, Egypt
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, United Kingdom.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China.,National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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15
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Crosslinking vs. Observation in Fellow Eyes of Keratoconus Patients. J Ophthalmol 2022; 2022:4661392. [PMID: 35692966 PMCID: PMC9177316 DOI: 10.1155/2022/4661392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate whether unilateral crosslinking (CXL) and conservative follow-up of the fellow eye is an acceptable management strategy in patients with keratoconus (KC). Methods Seventy-nine fellow eyes of KC subjects that initially underwent unilateral CXL were included. Thirty fellow eyes ultimately received CXL (group 1) whereas 49 fellow eyes were followed (group 2). Best spectacle corrected visual acuity (BSCVA) and corneal tomographic parameters were collected in all eyes preoperatively and at the last follow-up. Results Subjects who received CXL in the fellow eye (group 1) were younger than subjects who did not (group 2, p=0.026). Group 1 eyes had higher baseline K1 (p=0.026), K2 (p=0.006), Km (p=0.01), and Kmax (p=0.002) compared to group 2 eyes. Amongst the 49 naïve fellow eyes (group 2), 19 eyes showed evidence of progression. Progressing naïve eyes had higher baseline K1, K2, Km, and Kmax (p < 0.01); progressors also had thinner pachymetry at the pupil, apex, and thinnest point (p < 0.01). Baseline values of K1 ≥ 43.5 Diopter (D), K2 > 45.1D, Km > 44.3D, Kmax > 47.9D, astigmatism > 1.4D, pachymetry at the pupil <475 μm, and thinnest pachymetry <478 μm were tentative predictors of progression in the naïve fellow eye. Conclusions Unilateral CXL with vigilant follow up of the fellow eye may be an acceptable management strategy in a subset of KC eyes.
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16
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Zhao Y, Yang H, Li Y, Wang Y, Han X, Zhu Y, Zhang Y, Huang G. Quantitative Assessment of Biomechanical Properties of the Human Keratoconus Cornea Using Acoustic Radiation Force Optical Coherence Elastography. Transl Vis Sci Technol 2022; 11:4. [PMID: 35666497 PMCID: PMC9185997 DOI: 10.1167/tvst.11.6.4] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose Quantification of biomechanical properties of keratoconus (KC) corneas has great significance for early diagnosis and treatment of KC, but the corresponding clinical measurement remains challenging. Here, we developed an acoustic radiation force (ARF) optical coherence elastography technique and explored its potential for evaluating biomechanical properties of KC corneas. Methods An ARF system was used to induce the tissue deformation, which was detected by an optical coherence tomography system, and thus the localized point-by-point Young's modulus measurements were achieved. Then, two healthy rabbit eyes were imaged to test the system, after which the human keratoconus cornea was evaluated by using the same method. Three regions were selected for biomechanics analysis: the conical region, the transitional region, and the peripheral region. Results Young's moduli of transitional region ranged from 53.3 to 58.5 kPa. The corresponding values for the peripheral region were determined to be 58.6 kPa and 63.2 kPa, respectively. Young's moduli of the conical region were gradually increased by 18.3% from the center to the periphery, resulting in the minimum and maximum values of 44.9 kPa and 53.1 kPa, respectively. Furthermore, Young's moduli of the anterior and posterior of the center were determined to be 44.9 kPa and 50.7 kPa, respectively. Conclusions Differences in biomechanical properties between the three regions and slight variations within the conical region were clearly distinguished. Biomechanical weakening of the keratoconus cornea was mainly localized in the conical region, especially in the vertex position. Translational Relevance The system may provide a promising clinical tool for the noninvasive evaluation of local corneal biomechanics and thus may have potential applications in early keratoconus detection with further optimization.
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Affiliation(s)
- Yanzhi Zhao
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
| | - Hongwei Yang
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
| | - Yingjie Li
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
| | - Yongbo Wang
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
| | - Xiao Han
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Yirui Zhu
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Yubao Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Guofu Huang
- Nanchang University, Nanchang, P. R. China.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, P. R. China
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Wang L, Wang J, Sun H, Pang Z, Mu G. Corneal Collagen Cross-Linking Inhibits Corneal Blood and Lymphatic Vessels Temporarily in Alkali-Burned Rabbits. Curr Eye Res 2022; 47:1266-1271. [PMID: 35634710 DOI: 10.1080/02713683.2022.2079143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to explore whether corneal cross-linking (CXL) could regress corneal blood vessels (CBV) and corneal lymphatic vessels (CLV) in alkali-burned rabbits. METHODS A total of 80 rabbits 2-3 months old weighing 1.5-2.0 kg were randomly divided into four groups: CXL7 group; CTL7 group; CXL14 group; and CTL14 group. Then, 3% sodium pentobarbital 1 ml/kg and tetracaine eye drop 5 g/L were administered before surgery. NaOH 2 mol/L was topically applied to the central cornea to establish the alkali burning model. Then CXL was administered within 2 h in groups CXL7 and CXL14. Corneal opacity and edema, CBV and CLV volume, cluster differentiation 31 (CD31), and lymphatic vessel endothelial receptor 1 (LYVE-1) expression levels were analyzed on days 7 and 14. RESULTS CXL reduced cornea opacity, CNV, and CLV volumes on day 7 in alkali-burned rabbits. However, CNV and CLV volumes were increased on day 14. CXL also showed down- and upregulation of CD31 and LYVE-1 expression levels on days 7 and 14, respectively. CONCLUSIONS CXL effectively regulated CBV and CLV in alkali-burned rabbits. The transient angioregression and lymphangioregression induced by CXL may be potentially helpful in vascularized high-risk eyes.
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Affiliation(s)
- Lijun Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.,Department of Ophthalmology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Jia Wang
- Department of Ophthalmology, Aier Eye Hospital Group (J.W.), LiaochengAier Eye Hospital, Liaocheng, Shandong, China
| | - Hongkun Sun
- Department of Hematopathology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Zuoxiang Pang
- Department of Ophthalmology, Weifang Eye Hospital, Weifang, Shandong, China
| | - Guoying Mu
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Ishii H, Yoshida J, Toyono T, Yamagami S, Usui T, Miyai T. Three-year results of accelerated transepithelial cross-linking (30 mW/cm2 × 3 min) for keratoconus: a prospective study. BMJ Open Ophthalmol 2022; 7:e000827. [PMID: 35224204 PMCID: PMC8830257 DOI: 10.1136/bmjophth-2021-000827] [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: 09/10/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo assess the long-term efficacy and safety of accelerated transepithelial corneal cross-linking (ATE-CXL) with 30 mW/cm2 × 3 min.Methods and AnalysisThirty-four eyes of 23 patients with progressive keratoconus (KCN) recruited within a single centre were enrolled in this prospective interventional study. Exclusion criteria included: history of Descemet’s membrane rupture, glaucoma, uveitis, severe dry eye, concurrent corneal infections, and systemic disease that could affect corneal healing. ATE-CXL was performed with 3 min of ultraviolet-A continuous irradiation (30 mW/cm2). Follow-up examinations were scheduled on postoperative day 1; 1 and 2 weeks; 1, 3 and 6 months; and 1, 2 and 3 years. Main outcome measures were maximum corneal power (Kmax), average corneal power (AvgK), steepest corneal power (Ks), central corneal thickness, thinnest corneal thickness, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA) and endothelial cell density.ResultsMean Kmax, AvgK, Ks, UCVA, BCVA and endothelial cell density did not significantly change over 3 years. The speed of progression obtained by linear regression analysis on corneal parameters (Kmax, AvgK, Ks) improved after ATE-CXL. All baseline parameters correlated with the postoperative Kmax slope. Two eyes underwent ATE-CXL redo because of continued progression after the primary CXL.ConclusionThis is the first report of 3-year results of ATE-CXL with 30 mW/cm2 × 3 min. ATE-CXL (30 mW/cm2 × 3 min) was safe and effective for slowing down KCN progression.Trial registration numberThis study was registered with ID UMIN000009372 in UMIN-Clinical Trials Registry.
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Affiliation(s)
- Hitoha Ishii
- The Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Junko Yoshida
- The Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Ophthalmology, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Tetsuya Toyono
- The Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Satoru Yamagami
- Division of Ophthalmology, Department of Visual Sciences, Nihon Daigaku, Chiyoda-ku, Tokyo, Japan
| | - Tomohiko Usui
- Department of Ophthalmology, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Takashi Miyai
- The Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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19
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Astigmatic Vectorial Analysis in Pediatric Keratoconus After Unilateral Cross-Linking Treatment. Cornea 2021; 41:272-279. [PMID: 34864798 DOI: 10.1097/ico.0000000000002924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to evaluate the treatment response of pediatric keratoconus (KC) patients to unilateral corneal collagen cross-linking (CXL) in treated eyes, disease progression in untreated eyes, and define the predictive value of astigmatic parameters by astigmatic vectorial analysis. METHODS Pediatric patients with KC with CXL-treated progressive eye and untreated fellow eye were included. Patients with other ocular conditions and a history of previous ocular surgery were excluded. Astigmatic changes in anterior and posterior corneal surfaces were evaluated with vectorial analysis. The receiver operating characteristic curves were analyzed to detect the best parameter that discriminates treated and untreated groups. RESULTS Thirty-two eyes of 16 patients with at least 2-year follow-up were analyzed. The maximum keratometry (K) in CXL-treated eyes remained stable (from 53.51 ± 2.86-53.41 ± 2.84 diopter (D), P = 0.84) while the steepest K increased in untreated eyes (from 47.82 ± 1.71-49.59 ± 3.32 D, P = 0.03). The oblique components of corneal astigmatism in CXL-treated eyes were higher than those of fellow eyes (all P < 0.05), which significantly decreased in the anterior 3-mm zone after treatment (P = 0.048). The mean differential astigmatism magnitudes were significantly higher in treated eyes (all P < 0.05). The refractive centroid remained unchanged in treated eyes (P = 0.553) and shifted in the oblique direction in untreated eyes (P = 0.04). The oblique differential astigmatism in the anterior 7-mm zone showed the highest area under the curve value in predicting treatment efficacy (0.813, 95% confidence interval: 0.646-0.981, P < 0.001). CONCLUSIONS Astigmatic vectorial analysis is an objective tool for longitudinal assessment of clinical outcomes in KC. Changes in the oblique components of corneal astigmatism might predict progression and treatment efficacy.
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20
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Jiménez-García M, Kreps EO, Ní Dhubhghaill S, Koppen C, Rozema JJ. Determining the Most Suitable Tomography-Based Parameters to Describe Progression in Keratoconus. The Retrospective Digital Computer Analysis of Keratoconus Evolution Project. Eye Contact Lens 2021; 47:486-493. [PMID: 34050086 DOI: 10.1097/icl.0000000000000800] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To identify the most suitable parameters to describe keratoconus progression. METHODS Longitudinal retrospective cohort study. Monotonicity and consistency of over 250 parameters extracted from the Pentacam tomographies (Oculus, Germany) of 743 patients was analyzed. Repeatability was calculated for 69 patients (published elsewhere). The parameters were scored based on their performance for each desired feature and a global ranking was created. RESULTS Overall, parameters that average a higher number of corneal points performed better than single-point parameters. Zonal keratometries on areas surrounding the maximum curvature point and the steepest front keratometry performed best, followed by front best-fit sphere and mean keratometry of both surfaces. Platform-dependent indices (e.g., Belin-Ambrósio Deviation- or index height decentration-) obtained good scores, but platform-independent LOGIK performed slightly better. Finally, although minimum radius in both surfaces worked competently, minimum pachymetry (PachyMin) performed considerably poorer. CONCLUSIONS We presented a list of parameters whose behavior was repeatable, monotonic and consistent, features desirable to describe change. The parameters normally used to follow keratoconus progression may not be the most adequate, as evidenced by the poor performance of PachyMin. Although calculated for a specific Scheimpflug device, most of the best-performing parameters are platform-independent variables, and results may be generalized, pending validation.
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Affiliation(s)
- Marta Jiménez-García
- Department of Ophthalmology (M.J.-G., S.N.D., C.K., J.J.R.), Antwerp University Hospital (UZA), Edegem, Belgium ; Department of Medicine and Health Sciences (M.J.-G., E.O.K., S.N.D., C.K., J.J.R.), University of Antwerp, Antwerp, Belgium ; Department of Ophthalmology (E.O.K.), Ghent University Hospital, Ghent, Belgium ; and Department of Medicine and Health Sciences (E.O.K.), University of Ghent, Ghent, Belgium
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21
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Comment on: "What are the costs, capacity, and clinical implications of "waiting for documented progression" in young West of Scotland patients prior to collagen cross linking?". Eye (Lond) 2021; 36:1512. [PMID: 34408317 DOI: 10.1038/s41433-021-01704-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
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22
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Murchison CE, Petroll WM, Robertson DM. Infectious keratitis after corneal crosslinking: systematic review. J Cataract Refract Surg 2021; 47:1075-1080. [PMID: 33769765 PMCID: PMC8298263 DOI: 10.1097/j.jcrs.0000000000000620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Abstract
Corneal crosslinking is a U.S. Food and Drug Administration--approved therapy to stiffen the cornea and prevent progression of corneal ectasia in patients with keratoconus. The standard procedure involves removal of the corneal epithelium (epithelial-off) prior to treatment. Variations to the standard procedure include accelerated crosslinking and transepithelial procedures. This study reviewed what is known regarding the risk for infection after epithelial-off crosslinking, the spectrum of pathogens, and clinical outcomes. 26 publications were identified. All eyes were fit with a bandage contact lens postoperatively. Available data indicate that the overall frequency of infectious keratitis after epithelium-off crosslinking is low. Bacterial infections are the most common, with a mean time of presentation of 4.8 days postoperatively. The use of steroids and bandage contact lenses in the immediate postoperative period and/or a history of atopic or herpetic disease were associated with infection. These patients require intense postoperative care with prophylactic antiviral therapy when appropriate.
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Affiliation(s)
- Caroline E Murchison
- From the Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas
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23
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Wu D, Lim DKA, Lim BXH, Wong N, Hafezi F, Manotosh R, Lim CHL. Corneal Cross-Linking: The Evolution of Treatment for Corneal Diseases. Front Pharmacol 2021; 12:686630. [PMID: 34349648 PMCID: PMC8326410 DOI: 10.3389/fphar.2021.686630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/05/2021] [Indexed: 01/31/2023] Open
Abstract
Corneal cross-linking (CXL) using riboflavin and ultraviolet A (UVA) light has become a useful treatment option for not only corneal ectasias, such as keratoconus, but also a number of other corneal diseases. Riboflavin is a photoactivated chromophore that plays an integral role in facilitating collagen crosslinking. Modifications to its formulation and administration have been proposed to overcome shortcomings of the original epithelium-off Dresden CXL protocol and increase its applicability across various clinical scenarios. Hypoosmolar riboflavin formulations have been used to artificially thicken thin corneas prior to cross-linking to mitigate safety concerns regarding the corneal endothelium, whereas hyperosmolar formulations have been used to reduce corneal oedema when treating bullous keratopathy. Transepithelial protocols incorporate supplementary topical medications such as tetracaine, benzalkonium chloride, ethylenediaminetetraacetic acid and trometamol to disrupt the corneal epithelium and improve corneal penetration of riboflavin. Further assistive techniques include use of iontophoresis and other wearable adjuncts to facilitate epithelium-on riboflavin administration. Recent advances include, Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) for treatment of infectious keratitis, customised protocols (CurV) utilising riboflavin coupled with customised UVA shapes to induce targeted stiffening have further induced interest in the field. This review aims to examine the latest advances in riboflavin and UVA administration, and their efficacy and safety in treating a range of corneal diseases. With such diverse riboflavin delivery options, CXL is well primed to complement the armamentarium of therapeutic options available for the treatment of a variety of corneal diseases.
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Affiliation(s)
- Duoduo Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dawn Ka-Ann Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Blanche Xiao Hong Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Nathan Wong
- Royal Victorian Eye Hospital, Melbourne, VIC, Australia
| | - Farhad Hafezi
- Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland.,ELZA Institute, Dietikon, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Ophthalmology, USC Roski Eye Institute, Los Angeles, CA, United States.,Ophthalmology, Wenzhou Medical University, Wenzhou, China
| | - Ray Manotosh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Chris Hong Long Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Ophthalmology, National University Health System, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
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Simantov I, Or L, Gazit I, Dubinsky-Pertzov B, Zadok D, Pras E, Hartstein M, Einan Lifshitz A. Seven years follow-up of corneal cross-linking (CXL) in pediatric patients: Evaluation of treated and untreated eye. Eur J Ophthalmol 2021; 32:1482-1490. [PMID: 34058903 DOI: 10.1177/11206721211020632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes. METHODS Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography. RESULTS Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years; p = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years; p = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D); p < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm (p = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D (p = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL. CONCLUSION CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.
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Affiliation(s)
- Iliya Simantov
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Gazit
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zadok
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morris Hartstein
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan Lifshitz
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Safety and efficacy of repeated crosslinking assisted by transepithelial double-cycle iontophoresis in keratoconus progression after primary corneal crosslinking. Eye (Lond) 2021; 35:3020-3027. [PMID: 33414527 PMCID: PMC8526808 DOI: 10.1038/s41433-020-01365-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of repeated corneal collagen crosslinking assisted by transepithelial double-cycle iontophoresis (DI-CXL) in the management of keratoconus progression after primary CXL. METHODS A retrospective analysis was conducted in the patients who underwent repeated CXL between 2016 and 2018. These patients were treated with DI-CXL if keratoconus progression was confirmed after primary CXL. Scoring of ocular pain and corneal epithelial damage, visual acuity, corneal tomography, in vivo corneal confocal microscopy (IVCM) was performed before and at 3, 6, 12, and 24 months after DI-CXL. RESULTS Overall, 21 eyes of 12 patients (mean age 17.3 ± 1.9 years) were included in this study. Before DI-CXL, an average increase of 4.26 D in Kmax was detected in these patients with a mean follow-up interval of (23.0 ± 13.7) months. After DI-CXL, corneal epithelial damage rapidly recovered within days. Visual acuity remained unchanged with follow-up of 24 months. When compared to baseline, significant decreases were observed in Kmax (at 3 months) and K2 (at 3 and 6 months) after DI-CXL. Corneal thickness of thinnest point significantly decreased at 3 months postoperatively. When compared to baseline, no significant differences were found in any of the refractive or tomographic parameters at 12 and 24 months. IVCM revealed trabecular patterned hyperdense tissues after DI-CXL in the anterior stroma at the depth of 200 μm or more. No corneal infiltration or persistent epithelial defect was recorded after DI-CXL. CONCLUSION DI-CXL is safe and effective as a good alternative in stabilizing keratoconus progression after primary CXL.
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Gomes JÁP, Milhomens Filho JAP. Iatrogenic corneal diseases or conditions. Exp Eye Res 2020; 203:108376. [PMID: 33279524 DOI: 10.1016/j.exer.2020.108376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
Any prescribed or self-administered therapy carries inherent risks of secondary adverse events. While the volume of treatments being administered through healthcare systems has been increasing, scientific advancements in our understanding of the mechanisms of pharmaceutical side effects and complications from procedures now allow us to reduce the risk of non-intentional damage to ocular health. This review summarizes the most common and leading causes of iatrogenic visual impairment, corneal diseases, and conditions that present in a general ophthalmologic practice, including a comprehensive analysis of their pathophysiology and recommendations for management and prophylaxis.Iatrogenic corneal diseases and conditions can arise from topical drugs, contact lens use, eye surgeries and procedures, systemic drugs, non-ophthalmological events, and cosmetic procedures. Topical and systemic drugs may disturb tear film homeostasis or result in ocular surface deposits. The use of ill-fitted contact lenses can trigger eye discomfort and poor hygiene conditions that can predispose to severe infections. Procedures to the eye may result in a variety of anatomical and functional complications that ophthalmologists should be aware of how to avoid or at least be prepared to manage if they occur. Even non-ophthalmological events such as non-invasive ventilation, radiation therapies and, immune-based conditions, or cosmetic procedures such as eyelash growth and fillers, can result in unwanted damage to the ocular surface.
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Affiliation(s)
- José Álvaro Pereira Gomes
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine / Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - José Arthur Pinto Milhomens Filho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine / Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Transepithelial corneal cross-linking assisted by two continuous cycles of iontophoresis for progressive keratoconus in adults: retrospective 5-year analysis. Graefes Arch Clin Exp Ophthalmol 2020; 259:239-246. [PMID: 32725404 PMCID: PMC7790794 DOI: 10.1007/s00417-020-04861-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The aim of this study is to compare the long-term effects of transepithelial corneal crosslinking with two continuous cycles of iontophoresis (EI-CXL) and conventional corneal crosslinking (C-CXL) in adults with progressive keratoconus. METHODS A retrospective analysis was conducted in adults who underwent C-CXL or EI-CXL between 2013 and 2015. Visual acuity, corneal tomography, anterior segment optical coherence tomography, in vivo corneal confocal microscopy (IVCM), and endothelial cell count (ECC) were performed preoperatively and 5 years postoperatively. RESULTS Sixty-eight patients with a mean age of (24.3 ± 3.8) years were included, 34 for each group. After CXL, UCVA or BCVA remained stable, while the spherical diopter, cylinder diopter, spherical equivalent, and Kmax significantly decreased at 1, 2, and 3 years in both groups than baseline (P < 0.05). No significant differences were found in any refractive or tomographic parameters as well as the minimal corneal thickness between groups during follow-up. At 5 years, Kmax was slightly higher in EI-CXL group (58.16 ± 6.28) than that of C-CXL group (57.46 ± 4.98). At 3 and 5 years, the minimal corneal thickness in C-CXL group was still significantly lower than baseline (P < 0.05). IVCM demonstrated the demarcation zone at a mean depth of (302.0 ± 41.7) μm after C-CXL, and at (251.2 ± 28.1) μm after EI-CXL (P < 0.001). Keratocyte repopulation was detectable at all follow-up timepoint in both groups. Postoperative complications including progression were recorded in 6 patients (11.7%) after C-CXL and 3 patients (8.8%) after EI-CXL. ECC remained stable in both groups. CONCLUSION EI-CXL showed approximate efficacy with C-CXL in stabilizing progressive keratoconus in adults. EI-CXL has the potential to be a preferable transepithelial protocol.
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Complications of accelerated corneal collagen cross-linking: review of 2025 eyes. Int Ophthalmol 2020; 40:3269-3277. [PMID: 32715365 DOI: 10.1007/s10792-020-01512-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the early- and late-stage complications of accelerated cross-linking (A-CXL) in a large case series and investigate the relationship of A-CXL complications with ocular and systemic conditions accompanying keratoconus. METHODS Retrospectively, records of 2025 eyes of 1184 patients diagnosed with keratoconus between March 2013 and 2020 who underwent A-CXL (18 mW/cm2 for 5 min) treatment were reviewed. Comorbid ocular and systemic diseases other than keratoconus were recorded. In the postoperative follow-up, early and late complications and their association with accompanying diseases were examined. RESULTS The mean age of patients was 26.16 ± 6.05 (range 18-42), and the mean follow-up time was 3.40 ± 1.63 years (range 1-8 years). Vernal keratoconjunctivitis (3.7%) was the most common disease accompanying keratoconus. Less frequently, systemic allergic diseases (2.9%) and Down syndrome (2.3%) were observed. The most common complication in the early postoperative period was haze formation (9.1%), while failure of the treatment (4.2%) occurred in the late period. Other common complications were loss of two or more Snellen lines (2.4%) and delayed epithelial healing (1.8%). There was a significant relationship between vernal keratoconjunctivitis and delayed epithelial healing (p = 0.011). Statistically significant relationships were found between Down syndrome and haze formation (p < 0.001) and sterile infiltrate formation (p = 0.041). CONCLUSION Although A-CXL complication rates are low, vernal keratoconjunctivitis following A-CXL might increase the risk of delayed epithelial healing, and similarly corneal haze and sterile infiltrates might be observed more frequently in patients with Down syndrome.
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Kim S, Jalilian I, Thomasy SM, Bowman MAW, Raghunathan VK, Song Y, Reinhart-King CA, Murphy CJ. Intrastromal Injection of Hyaluronidase Alters the Structural and Biomechanical Properties of the Corneal Stroma. Transl Vis Sci Technol 2020; 9:21. [PMID: 32821518 PMCID: PMC7409307 DOI: 10.1167/tvst.9.6.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/05/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Glycosaminoglycans (GAGs) are important components of the corneal stroma, and their spatiotemporal arrangement regulates the organization of collagen fibrils and maintains corneal transparency. This study was undertaken to determine the consequences of hyaluronidase (HAse) injected into the corneal stroma on stromal stiffness and ultrastructure. Methods Equal volumes of HAse or balanced salt solution (vehicle) were injected intrastromally into the corneas of New Zealand white rabbits. Ophthalmic examination and multimodal imaging techniques, including Fourier-domain optical coherence tomography and in vivo confocal microscopy (IVCM), were performed at multiple time points to evaluate the impact of HAse treatment in vivo. Atomic force microscopy and transmission electron microscopy (TEM) were used to measure corneal stiffness and collagen's interfibrillar spacing, respectively. Results Central corneal thickness progressively decreased after HAse injection, reaching its lowest value at day 7, and then returned to normal by day 42. The HAse did not impact the corneal endothelium but transiently altered keratocyte morphology at days 1 and 7, as measured by IVCM. HAse-injected corneas became stiffer by day 1 postinjection, were stiffest at day 7, and returned to preinjection values by day 90. Changes in stromal stiffness correlated with decreased interfibrillar spacing as measured by TEM. Conclusions Degradation of GAGs by HAse decreases the corneal thickness and increases stromal stiffness through increased packing of the collagen fibrils in a time-dependent manner. Translational Relevance Intrastromal HAse injection appears relatively safe in the normal cornea, but its impact on corneal biomechanics and structure under pathologic conditions requires further study.
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Affiliation(s)
- Soohyun Kim
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Iman Jalilian
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA.,Department of Ophthalmology & Vision Science, School of Medicine, University of California Davis, Davis, CA, USA
| | - Morgan A W Bowman
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Vijay Krishna Raghunathan
- Department of Basic Science, College of Optometry, University of Houston, Houston, TX, USA.,Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Yeonju Song
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Cynthia A Reinhart-King
- Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, TN, USA
| | - Christopher J Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA.,Department of Ophthalmology & Vision Science, School of Medicine, University of California Davis, Davis, CA, USA
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Yong JJ, Hatch KM. Corneal Cross-Linking: An Effective Treatment Option for Pellucid Marginal Degeneration. Semin Ophthalmol 2019; 34:512-517. [DOI: 10.1080/08820538.2019.1659832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- JJ. Yong
- Department of Ophthalmology, Harvard Medical School,Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - KM. Hatch
- Department of Ophthalmology, Harvard Medical School,Massachusetts Eye and Ear Infirmary, Waltham, MA, USA
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Lalgudi VG, Nischal KK. Pediatric corneal collagen cross-linking for keratoconus: not an experimental procedure. J AAPOS 2019; 23:63-65. [PMID: 30599204 DOI: 10.1016/j.jaapos.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Vaitheeswaran G Lalgudi
- UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Narayana Nethralaya, Bangalore, India
| | - Ken K Nischal
- UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh, School of Medicine.
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