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Sun L, Zhang X, Ding L, Zhao J, Shen Y, Tian M, Jian W, Zhou X. Long-term changes in crystalline lens transparency after accelerated transepithelial corneal cross-linking in patients with keratoconus. Eur J Ophthalmol 2023; 33:1850-1859. [PMID: 37077155 DOI: 10.1177/11206721231170036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE To investigate the long-term clinical outcomes and changes in crystalline lens transparency after accelerated (45 mW/cm2) transepithelial corneal cross-linking (ATE-CXL) using the Pentacam imaging system in patients with progressive keratoconus. METHODS The study prospectively included 44 keratoconus eyes of 40 patients (mean age: 24.39 ± 5.61 years) who underwent ATE-CXL. The examinations, including assessment of uncorrected distance visual acuity, corrected distance visual acuity, corneal topography, and corneal endothelial cell density count, were conducted preoperatively and 1 month, 3 months, 6 months, 1 year, and 5 years postoperatively. Measurement of crystalline lens density using Pentacam images was also performed pre- and postoperatively. RESULTS All surgeries were uneventful with no postoperative complications. All keratometry values and corneal thickness remained stable during the 5-year follow-up period (all p > 0.05). There were no significant differences in corneal endothelial cell density count, visual acuity, and anterior average lens density in the 0.5-, 1.0-, and 1.5-mm depth zones during the 5-year follow-up period compared with the preoperative values (all p > 0.05). CONCLUSION The results of this study suggest that ATE-CXL at 45 mW/cm2 is safe and effective for the treatment of progressive keratoconus in terms of both crystalline lens density and endothelial cell density.
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Affiliation(s)
- Ling Sun
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xiaoyu Zhang
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Lan Ding
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jing Zhao
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Yang Shen
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Mi Tian
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Weijun Jian
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
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Sun L, Zhao J, Zhang X, Shen Y, Tian M, Zhou X. Transepithelial accelerated corneal crosslinking for keratoconus eyes with maximum keratometry values larger than 58 diopters. J Cataract Refract Surg 2022; 48:208-214. [PMID: 34288636 PMCID: PMC8845528 DOI: 10.1097/j.jcrs.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of transepithelial accelerated corneal crosslinking (CXL) for advanced keratoconus eyes with maximum keratometry (Kmax) values >58 diopters (D). SETTING Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China. DESIGN Prospective parallel control study. METHODS 41 keratoconus eyes from 41 patients (mean age, 21.93 ± 5.48 years) who underwent transepithelial accelerated CXL were included prospectively. The enrolled eyes were divided into 2 groups according to their Kmax values (Group A, Kmax ≥58.0 D; Group B, Kmax <58.0 D). The examinations including assessment of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal topography, and corneal endothelial cell density count were conducted preoperatively, at 1 day, 1 month, 3 months, 6 months, and 1 year postoperatively. RESULTS All 41 eyes finished 1 year follow-up. No statistical difference was noted between the mean UDVA and CDVA in both groups throughout the follow-up duration. At 1-year postoperative follow-up, the CDVA increased by ≥2 lines in 45% (9/20) and 28.6% (6/21) eyes in Groups A and B, respectively. The mean preoperative Kmax in Groups A and B were 62.51 ± 3.34 D and 49.98 ± 4.32 D, respectively, and that at postoperative 1-year follow-up were 61.94 ± 4.11 D and 50.24 ± 4.72 D, respectively. The Kmax values of 30% (6/20) eyes in Group A and 4.8% (1/21) eyes in Group B decreased by more than 1 D. Deduction of flat K, steep K, mean K, and Kmax showed no significant difference between the 2 groups at 1-year postoperative follow-up. Moreover, 20% (4/20) and 23.8% (5/21) of eyes in Groups A and B, respectively, showed progress at postoperative 1-year follow-up. CONCLUSIONS Transepithelial accelerated CXL can safely treat advanced keratoconus eyes with Kmax values ≥58.0 D with some extent of efficacy and has similar progressive rate as Kmax values <58.0 D.
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Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus. J Clin Med 2020; 9:jcm9103222. [PMID: 33049990 PMCID: PMC7600308 DOI: 10.3390/jcm9103222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 02/02/2023] Open
Abstract
Customized cross-linking has been proposed as an alternative to conventional cross-linking in patients with progressive keratoconus, targeting greater flattening of the cone region and improved visual function. Epithelium-on cross-linking aims to reduce complications associated with epithelial removal, while the addition of oxygen aims to maintain treatment effect. Our study evaluates the combination of these novel treatment strategies to achieve a minimally invasive treatment targeting maximal functional outcomes. This prospective study included 42 eyes undergoing epithelium-on, accelerated, oxygen-supplemented, customized corneal cross-linking for progressive keratoconus. Outcome measures, including refraction, visual acuity, and corneal tomography were obtained at baseline and at 1, 3, and 6 months, and 1 year postoperatively. Logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity was significantly improved, from 0.87 ± 0.53 preoperatively, to 0.78 ± 0.56 1 year postoperatively (Wilcoxon rank sum test, p = 0.016). LogMAR best spectacle-corrected visual acuity was also significantly improved, from 0.19 ± 0.36 preoperatively, to 0.11 ± 0.33 postoperatively (p = 0.004). Manifest refractive cylinder was significantly decreased, from 4.50 ± 2.96 D preoperatively, to 3.27 ± 2.61 D postoperatively (p = 0.004). The baseline maximum keratometry (Kmax) was 53.04 ± 7.91 D, significantly flattening to 52.25 ± 7.31 D by 1 month, and remaining relatively stable at 1 year postoperatively (52.31 ± 7.50 D) (p < 0.001). No significant adverse events occurred in any eye. Epithelium-on, accelerated, oxygen-supplemented, customized corneal cross-linking is a promising new treatment approach, with reduced maximum keratometry, reduced astigmatism, and improved visual acuity at 1 year, with a favorable safety and patient comfort profile.
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Belviranli S, Oltulu R. Efficacy of pulsed-light accelerated crosslinking in the treatment of progressive keratoconus: Two-year results. Eur J Ophthalmol 2019; 30:1256-1260. [PMID: 31505958 DOI: 10.1177/1120672119872375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate the 2-year results of epithelium-off pulsed-light accelerated corneal collagen crosslinking treatment in progressive keratoconus using 30 mW/cm2 ultraviolet A light for 6 min with a total dose of 5.4 J/cm2. METHODS A total of 30 eyes of 22 patients with documented progressive keratoconus and treated with epithelium-off pulsed-light accelerated corneal collagen crosslinking using the KXL® crosslinking device (Avedro Inc, Waltham, MA, USA) were included in this retrospective study. Corneal tomographic measurements and best spectacle-corrected visual acuity were compared using analysis of variance with repeated measurements between the baseline visit (before the corneal collagen crosslinking treatment), and the sixth month, first, and second year visits. RESULTS Flat keratometry (K1), steep keratometry (K2), and mean keratometry (Km) decreased significantly at sixth month, first, and second years (p < 0.001, p = 0.001, and p < 0.001, respectively). Maximum keratometry (Kmax) decreased from 55.40 ± 4.90 D at baseline to 54.82 ± 4.68 D, 54.80 ± 5.12 D, and 54.65 ± 5.36 D at sixth month, first year, and second year, respectively (p = 0.007). The best spectacle-corrected visual acuity improved from 0.34 ± 0.24 logMAR at baseline to 0.25 ± 0.16 logMAR, 0.22 ± 0.15 logMAR, and 0.17 ± 0.13 logMAR at sixth month, first year, and second year, respectively (p < 0.001). At the second year visit, best spectacle-corrected visual acuity remained stable (no lines lost) with respect to the baseline in 8 eyes and increased 1 or more lines in 22 eyes. CONCLUSION Pulsed-light accelerated corneal collagen crosslinking using 30 mW/cm2 ultraviolet A light for 6 min with a total dose of 5.4 J/cm2 is an effective treatment modality in cases with progressive keratoconus-it stops progression at 2 years also regresses some of the cases.
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Affiliation(s)
- Selman Belviranli
- Department of Ophthalmology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Refik Oltulu
- Department of Ophthalmology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Combined wavefront-guided transepithelial photorefractive keratectomy and corneal crosslinking for visual rehabilitation in moderate keratoconus. J Cataract Refract Surg 2018; 44:571-580. [DOI: 10.1016/j.jcrs.2018.03.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 11/24/2022]
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Sun L, Li M, Zhang X, Tian M, Han T, Zhao J, Zhou X. Transepithelial accelerated corneal collagen cross-linking with higher oxygen availability for keratoconus: 1-year results. Int Ophthalmol 2017; 38:2509-2517. [DOI: 10.1007/s10792-017-0762-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022]
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Corneal Stiffening by a Bacteriochlorophyll Derivative With Dextran and Near-Infrared Light: Effect of Shortening Irradiation Time up to 1 Minute. Cornea 2017. [PMID: 28644240 DOI: 10.1097/ico.0000000000001272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study is to determine the effect of variation of the exposure time of near-infrared irradiation on corneal stiffening after a bacteriochlorophyll derivative (WST11) with dextran (WST-D) application. METHODS One hundred four paired eyes of 3-month-old New Zealand White rabbits were included in this study. Fifty-two eyes (ex vivo n = 34, in vivo n = 18) were mechanically deepithelialized, treated topically with WST-D, and irradiated at 10 mW/cm using a diode laser at 755 nm for 1, 5, or 30 minutes. Untreated fellow eyes served as controls. Corneoscleral rings were removed immediately after treatment (ex vivo), or 1 month after treatment (in vivo). Corneal strips were cut and underwent biomechanical stress-strain measurements. RESULTS Ex vivo, the mean tangent elastic modulus was significantly higher in the treatment groups than in the control groups for 1, 5, and 30 minutes of irradiation, respectively, 6.06 MPa, 95% confidence interval (CI, 4.5-7.6) versus 14.02 MPa, 95% CI (10.2-17.8), n = 11, 4.8 MPa, 95% CI (3.9-5.7) versus 15.03 MPa, 95% CI (12-18.1), n = 11, and 7.8 MPa, 95% CI (5.6-10.02) versus 16.2 MPa, 95% CI (13.6-18.9), n = 11; P < 0.001 for all comparisons. In vivo, the mean elastic moduli in the treatment groups were significantly higher for 5 and 30 minutes of irradiation but not for 1 minute of irradiation, respectively, 11.4 MPa, 95% CI (8.5-14.2), versus 17.1 MPa, 95% CI (14.5-19.7), n = 5; P < 0.001, and 9.4 MPa, 95% CI (5.1-13.8) versus 16 MPa, 95% CI (13.1-19), n = 5; P < 0.01, and 11.3 MPa, 95% CI (6-16.6) versus 12.2 MPa, 95% CI (7.5-16.8), n = 5; P = 0.7. CONCLUSIONS WST-D/near-infrared treatment using shortened irradiation time (1 minute ex vivo and 5 minutes in vivo) results in significant corneal stiffening, and this might provide an alternative to the currently applied riboflavin/ultraviolet A cross-linking.
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Rajpal RK, Wisecarver CB, Williams D, Rajpal SD, Kerzner R, Nianiaris N, Lytle G, Hoang K. Lasik Xtra ® Provides Corneal Stability and Improved Outcomes. Ophthalmol Ther 2015; 4:10.1007/s40123-015-0039-x. [PMID: 26499330 PMCID: PMC4675731 DOI: 10.1007/s40123-015-0039-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 11/28/2022] Open
Abstract
A new procedure which combines LASIK and corneal cross-linking (Lasik Xtra®) has been proposed as an alternative to traditional LASIK. It is aimed at restoring strength to the cornea, increasing stability in visual outcomes, increasing the accuracy of the refractive correction, and potentially lowering enhancement rates. This article reviews the current clinical evidence which has been published on the topic and reviews both the safety and efficacy argument for the procedure.
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Affiliation(s)
- Rajesh K Rajpal
- See Clearly Vision Group, 8138 Watson Street, Mclean, VA, USA.
| | | | - Dawn Williams
- See Clearly Vision Group, 8138 Watson Street, Mclean, VA, USA
| | - Sachin D Rajpal
- See Clearly Vision Group, 8138 Watson Street, Mclean, VA, USA
| | | | | | | | - Khoa Hoang
- See Clearly Vision Group, 8138 Watson Street, Mclean, VA, USA
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Current concepts and future developments of corneal cross-linking. J Ophthalmol 2015; 2015:302983. [PMID: 25878894 PMCID: PMC4387952 DOI: 10.1155/2015/302983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/14/2014] [Indexed: 11/29/2022] Open
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