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Manumuraleekrishna, Asif MI, Maharana PK, Nagpal R, Agarwal T, Sinha R, Titiyal JS, Sharma N. Comparative evaluation of biomechanical changes and aberration profile following accelerated collagen cross-linking using hypo-osmolar and iso-osmolar riboflavin: A prospective study. Indian J Ophthalmol 2024; 72:712-717. [PMID: 38648433 PMCID: PMC11168534 DOI: 10.4103/ijo.ijo_1387_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To compare the changes encountered in corneal biomechanics and aberration profile following accelerated corneal collagen cross-linking (CXL) using hypo-osmolar and iso-osmolar riboflavin in corneal thicknesses of <400 and >400 microns, respectively. METHODS This is a prospective, interventional, comparative study involving 100 eyes of 75 patients with progressive keratoconus. Eyes were divided into two groups based on corneal thickness: group 1 included eyes with a corneal thickness of <400 microns who underwent hypo-osmolar CXL, and group 2 included eyes with a corneal thickness of >400 microns who underwent iso-osmolar CXL. Corneal biomechanical and aberration profiles were evaluated and compared between groups. RESULTS In group 1, all higher-order aberrations (HOA) except secondary astigmatism significantly decreased from baseline; however, in group 2, only coma and trefoil decreased. The corneal resistance factor and corneal hysteresis significantly improved in both groups, which was significantly greater in group 2 than in group 1. The change in inverse radius, deformation amplitude, and tomographic biomechanical index was significantly improved in group 2 as compared to group 1. CONCLUSION Improvement in corrected distance visual acuity and decrease in HOA were significantly better in the hypo-osmolar CXL group; however, the improvement in biomechanical strength of the cornea was significantly better in the iso-osmolar group.
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Affiliation(s)
- Manumuraleekrishna
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nagpal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan Singh Titiyal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Erdinest N, Wajnsztajn D, London N, Solomon A. Ocular surface inflammation and ectatic corneal disorders. Curr Opin Allergy Clin Immunol 2023; 23:430-437. [PMID: 37490610 DOI: 10.1097/aci.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW Inflammatory mediators are a focus of recent corneal ectasia (CE) research and are a profound, modifiable contributor to CE in general and keratoconus (KC) in particular, opening a path to explore new methods of control. As advanced imaging technology and expanded population screening allow for earlier detection, the possibility of early intervention can profoundly change the prognosis of CE. RECENT FINDINGS Significant increases in the inflammatory mediators and immune components have been observed in the cornea, tear fluid, and blood of ectasia patients, while inflammation dampeners such as vitamin D and their receptors are reduced. Atopy and allergy have a strong association with KC, known to increase itch factors and stimulate eye rubbing, a risk factor in ectasia pathogenesis. Management of atopy or allergic conditions and topical anti-inflammatories has helped stabilize CE disease. SUMMARY Strategies such as monitoring inflammatory factors and using immune or inflammatory modulators, including managing subclinical inflammation, may be clinically beneficial in stabilizing the disease and improving outcomes. The detected factors are biomarkers, but as yet unproven to be sensitive or specific enough to be considered biomarkers for early detection of CE. The establishment of such biomarkers could improve the therapeutic outcome.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
| | - Denise Wajnsztajn
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
| | | | - Abraham Solomon
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
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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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Abe K, Miyai T, Toyono T, Aixinjueluo W, Inoue T, Asano S, Ishii H, Yoshida J, Shirakawa R, Usui T. Comparison of efficacy and safety of accelerated trans-epithelial crosslinking for keratoconus patients with corneas thicker and thinner than 380µm. Curr Eye Res 2021; 47:511-516. [PMID: 34898348 DOI: 10.1080/02713683.2021.2018466] [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: 10/19/2022]
Abstract
PURPOSE Accelerated trans-epithelial cross-linking (ATE-CXL), a therapy to halt keratoconus progression, has the merit of widening the indications for thinner corneas (<380 μm). Since a hypotonic solution affects the swollen cornea, corneas of <380 μm thickness at preoperative measurement can be an indication for ATE-CXL. The aim of this retrospective study was to compare the efficacy and safety of ATE-CXL for keratoconus between corneas with thicknesses <380 μm and ≥380 μm. MATERIALS AND METHODS Thirty-four eyes of 27 patients who underwent ATE-CXL (30 mW/cm2; 3 minutes) with completion of a 24-month follow-up, were enrolled and divided into two groups: Group 1, thinnest corneal thickness (TCT), <380 μm (n = 10) and Group 2, TCT, ≥380 μm (n = 24). A hypotonic solution was administered to Group 1 until the corneal thickness increased by >380 μm before UV-A irradiation. We measured uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), maximum and average keratometric values (Kmax and AveK), central corneal thickness (CCT), TCT by anterior segment optical coherence tomography, and corneal endothelial cell density (ECD) using specular microscopy. The changes from baseline to 24 months postoperatively between the two groups were compared accordingly. RESULTS The changes in Kmax and AveK from baseline to 24 months in Group 1 (ΔKmax: -7.8±7.7 D, ΔAveK: -4.3±6.1 D) showed significant decreases compared to those in Group 2 (ΔKmax: 0.2±3.0 D, ΔAveK: 0.6±2.7 D) (p = 0.004 and p = 0.001), and there were no significant changes from baseline to 24 months postoperatively in UCVA, BCVA, CCT, TCT, and ECD in both groups. CONCLUSION ATE-CXL is effective and safe for keratoconic corneas in both groups. The effect of reducing keratometric values was greater in the group with thinner corneas.
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Affiliation(s)
- Kentaro Abe
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan
| | - Takashi Miyai
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan
| | - Tetsuya Toyono
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan
| | - Wei Aixinjueluo
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan.,Department of Ophthalmology, Tokyo Teishin Hospital, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan
| | - Shotaro Asano
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan
| | - Hitoha Ishii
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan.,Department of Ophthalmology, Saitama Red Cross Hospital, Japan
| | - Junko Yoshida
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan
| | - Rika Shirakawa
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan
| | - Tomohiko Usui
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Japan
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Ocak SY, Mangan MS, Elçioğlu MN. The intra-operative corneal pachymetry changes during accelerated corneal cross-linking in progressive keratoconus patients with thin corneas. ACTA ACUST UNITED AC 2021; 35:438-442. [PMID: 34488256 PMCID: PMC8666252 DOI: 10.3341/kjo.2021.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022]
Abstract
Purpose To report the intra-operative corneal pachymetry changes during accelerated corneal cross-linking (A-CXL) in progressive keratoconus patients with thin corneas. Methods Thirty-six eyes (mean age: 22.26 ± 4.02 years) with progressive keratoconic thin corneas (< 400 µm without epithelium) who underwent A- CXL with ultraviolet A (9 mW/cm2) using isotonic RF-HPMC (riboflavin5-phosphate 0.1% with 1.1% hydroxypropyl methycellulose/Mediocross M®) were included in this retrospective study. Intra-operative corneal pachymetric changes were noted before the procedure, after removal of epithelium, after RF-HPMC instillation, before and after UV irradiation. The mean of corneal pachymetric values were compared statistically. Results The mean corneal pachymetry reduced from 415.72±29.66 µm to 369.50±23.45 µm after removal of the epithelium (p<0.05). After the application of RF-HPMC solution the mean TCP increased to 412.89±26.94 µm. Statistically significant increase was observed in TCP after saturation with RF-HPMC (p=0.001). The mean corneal pachymetry was before and after UV-A irradiation respectively 419.86±10.41 µm, 417.47±8.25 µm (p>0.05). Conclusion Isotonic RF-HPMC lead to a significant increase in intra-operative mean TCP. RF-HPMC seems to be a favorable riboflavin option in keratoconus patients with thin corneas.
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Affiliation(s)
- Serap Yurttaşer Ocak
- University of Health Sciences, Okmeydanı Prof.Dr.Cemil Tascioglu Education and Research Hospital, Department of Ophtalmology , Istanbul, Turkey
| | - Mehmet Serhat Mangan
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Institute ,Department of Ophtalmology, Istanbul, Turkey
| | - Mustafa Nuri Elçioğlu
- University of Health Sciences, Okmeydanı Prof.Dr.Cemil Tascioglu Education and Research Hospital, Department of Ophtalmology , Istanbul, Turkey
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Akkaya S, Ulusoy DM, Duru Z, Demirtaş AA. Long-term Outcomes of Accelerated Corneal Cross-linking in the Treatment of Keratoconus: Comparison of Hypotonic Riboflavin Solution With Standard Riboflavin Solution. J Refract Surg 2020; 36:110-117. [DOI: 10.3928/1081597x-20191218-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/17/2019] [Indexed: 11/20/2022]
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Deshmukh R, Hafezi F, Kymionis GD, Kling S, Shah R, Padmanabhan P, Sachdev MS. Current concepts in crosslinking thin corneas. Indian J Ophthalmol 2019; 67:8-15. [PMID: 30574883 PMCID: PMC6324097 DOI: 10.4103/ijo.ijo_1403_18] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas.
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Affiliation(s)
- Rashmi Deshmukh
- Cornea, Cataract and Refractive Services, Centre for Sight Hospital, New Delhi, India
| | - Farhad Hafezi
- ELZA Institute, Dietikon/Zurich; Laboratory for Ocular Cell Biology, University of Zurich, Zurich, Switzerland; University of Southern California, Roski Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, University of Wenzhou, Wenzhou, China
| | - George D Kymionis
- Athens Medical School, University of Athens, Athens, Greece; Jules Gonin Eye Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sabine Kling
- Ophthalmic Personalized treatment and imaging cluster (OPTIC), Department of Information Technology and Electrical Engineering Swiss Federal Institute of Technology Zurich (ETHZ), Switzerland
| | - Rupal Shah
- Centre for Sight Hospital, Vadodara, India
| | - Prema Padmanabhan
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, India
| | - Mahipal S Sachdev
- Cornea, Cataract and Refractive Services, Centre for Sight Hospital, New Delhi, India
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Wollensak G, Spörl E. Biomechanical efficacy of corneal cross-linking using hypoosmolar riboflavin solution. Eur J Ophthalmol 2018; 29:474-481. [DOI: 10.1177/1120672118801130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: The use of hypoosmolar riboflavin solution has been suggested for cross-linking thin corneas. The aim of this study was to compare the biomechanical efficacy of corneal cross-linking using hypoosmolar dextran-free riboflavin solution (HCXL) versus isoosmolar standard corneal cross-linking treatment (CXL). Methods: A total of 24 postmortem porcine eyes with debrided corneas were subdivided into three treatment groups: Controls, the isoosmolar group with isoosmolar 0.1% riboflavin-20% dextran solution and the hypoosmolar group with dextran-free, 0.1% riboflavin solution. The samples were irradiated with UVA light of 365 nm wavelength and an irradiance of 3 mW/cm² for 30 min (dose 5.4 J/cm²). For the biomechanical measurements, 400-µm-deep anterior corneal flaps were created using a lamellar rotating microkeratome. Uniaxial stress–strain measurements were performed. Results: In the isoosmolar treatment group, stress and Young’s modulus at 8% strain were significantly increased by 67.97%, respectively, 62.62% versus the controls. In the hypoosmolar treatment group, stress and Young’s modulus at 8% strain were significantly increased by 81.21%, respectively, 51.40% versus the controls. There was no significant difference between the iso- and hypoosmolar groups in biomechanical efficacy. On histology, there was no edema in the anterior 200 µm of the corneas after stromal swelling by the hypoosmolar riboflavin solution. Conclusion: Corneal cross-linking using isoosmolar or hypoosmolar riboflavin solution induces a comparable biomechanical effect. This is explained by the localization of the maximum cross-linking effect in the anterior 200 µm of the cornea which are not affected by the swelling effect of hypoosmolar riboflavin solution.
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Affiliation(s)
| | - Eberhard Spörl
- Department of Ophthalmology, Technical University of Dresden, Dresden, Germany
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Doroodgar F, Niazi F, Sanginabadi A, Niazi S, Baradaran-Rafii A, Alinia C, Azargashb E, Ghoreishi M. Comparative analysis of the visual performance after implantation of the toric implantable collamer lens in stable keratoconus: a 4-year follow-up after sequential procedure (CXL+TICL implantation). BMJ Open Ophthalmol 2017; 2:e000090. [PMID: 29354720 PMCID: PMC5721648 DOI: 10.1136/bmjophth-2017-000090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/28/2017] [Accepted: 08/24/2017] [Indexed: 11/23/2022] Open
Abstract
Aims To report on 4-year postoperative visual performance with the toric implantable collamer lens (TICL) for stable keratoconus after sequential procedure (corneal collagen crosslinking plus TICL implantation). Methods Forty eyes of 24 patients with stable keratoconus with myopia between 0.00 and −18.00 dioptres (D) and astigmatism between 1.25 and 8.00 D were evaluated in this prospective interventional study (https://clinicaltrials.gov/ct2/show/NCT02833649). We evaluated refraction, visual outcomes, astigmatic changes analysed by Alpins vector, contrast sensitivity, aberrometry, modulation transfer functions (MTFs), defocus curve, and operative and postoperative complications. Results At 4-year follow-up, 45% had 20/20 vision or better and 100% had 20/40 or better uncorrected visual acuity (UCVA). Vector analysis of refractive astigmatism shows that the surgically induced astigmatism (SIA) (3.20±1.46 D) was not significantly different from the target induced astigmatism (TIA) (3.14±1.42 D) (p=0.620). At 4 years postoperatively, none of the eyes showed a decrease in UCVA, in contrast to 24 eyes in which UCVA was increased by ≥1 lines, with contrast sensitivity and improvement in total aberrations and MTF value at 5 per degree (*p=0.004) after TICL implantation. The cumulative 4-year corneal endothelial cell loss was ≤5%. No patients reported dissatisfaction. At the end of follow-up, the vault was 658±54.33m (range, 500–711) and the intraocular pressure was 11.7±2.08 mm Hg. Occurrences of glare and night-driving troubles diminished after TICL surgery. Conclusion The results from this standardised clinical investigation support TICL implantation from clinical and optical viewpoints in patients with stable keratoconus. Trial registration number NCT02833649, Pre-results
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Affiliation(s)
- Farideh Doroodgar
- Ophthalmology Department, Eye Research Center Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Feazollah Niazi
- Shahid Beheshti University of Medical Sciences and Health Services , Chamran Highway, Daneshjoo Street, Tehran, Iran, Thran, Tehran, Iran
| | - Azad Sanginabadi
- Ophthalmology Department, Eye Research Center Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Sana Niazi
- Shahid Beheshti University of Medical Sciences and Health Services , Chamran Highway, Daneshjoo Street, Tehran, Iran, Tehran, Tehran, Iran
| | - Alireza Baradaran-Rafii
- Shahid Beheshti University of Medical Sciences and Health Services , Chamran Highway, Daneshjoo Street, Tehran, Iran, Tehran, Tehran, Iran
| | - Cyrus Alinia
- Department of Public Health, Urmia University of Medical Sciences, Urmia, West Azerbaijan, Iran
| | - Eznollah Azargashb
- Shahid Beheshti University of Medical Sciences and Health Services , Chamran Highway, Daneshjoo Street, Tehran, Iran, Tehran, Tehran, Iran
| | - Mohammad Ghoreishi
- Ophthalmology Department, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran
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Thinner Corneas Appear to Have More Striking Effects of Corneal Collagen Crosslinking in Patients with Progressive Keratoconus. J Ophthalmol 2017; 2017:6490915. [PMID: 28392939 PMCID: PMC5368419 DOI: 10.1155/2017/6490915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/16/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose. To analyze the outcomes and difference after UVA/riboflavin corneal collagen crosslinking (CXL) in four different corneal thickness groups of patients with progressive keratoconus. Methods. Retrospective study. Eyes with progressive keratoconus after CXL were divided into 4 subgroups as follows: group 1, thinnest corneal thickness (TCT) ≤ 400 µm; group 2, 400 µm < TCT ≤ 450 µm; group 3, 450 µm < TCT ≤ 500 µm; group 4, TCT ≥ 500 µm. Baseline, 6-month, and 12-month visual acuity, corneal topography, TCT, and endothelial cell density were evaluated. Results. The analysis included 123 eyes of 101 patients. At 6 and 12 months after CXL, there was a mean improvement about visual acuity and keratometry values in all patients. There was a reduction in the change of maximum keratometry (Kmax) with the increase of TCT. After 1 year of treatment, it was 3.04 ± 0.75 D in group 1, 2.38 ± 0.51 D in group 2, 1.57 ± 0.35 D in group 3, and 0.31 ± 0.20 D in group 4. Conclusion. CXL is successful in halting the progression of keratoconus and there was a negative linear correlation between TCT and Kmax. Advanced cases of progressive keratoconus seemed to obtain more benefits from the flatting effects of CXL.
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Koc M, Uzel MM, Tekin K, Kosekahya P, Ozulken K, Yilmazbas P. Effect of preoperative factors on visual acuity, corneal flattening, and corneal haze after accelerated corneal crosslinking. J Cataract Refract Surg 2016; 42:1483-1489. [PMID: 27839604 DOI: 10.1016/j.jcrs.2016.08.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/26/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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