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Akgöz H, Fındık H, Aslan MG. Evaluation of tear parameters and meibomian gland morphology in keratoconus patients after epithelial-on corneal cross-linking. Eur J Ophthalmol 2022; 33:11206721221118740. [PMID: 35929885 DOI: 10.1177/11206721221118740] [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: 11/17/2022]
Abstract
PURPOSE To evaluate the variations in tear parameters and meibomian gland morphology after epithelial-on (epi-on) corneal collagen cross-linking (CXL) in keratoconus (KC) patients. METHODS This prospective observational study included 38 KC eyes that underwent epithelium-on CXL. Thirty-three eyes of 33 stable KC patients with no prior CXL treatment formed the KC group and 35 eyes of 35 healthy volunteers were recruited as the control group. All participants were evaluated by Schirmer I test, first and average noninvasive tear break-up time (NITBUT), ocular surface disease index (OSDI) questionnaire, and meibography scores. The CXL patients were evaluated preoperatively and at the 1st, 3rd, and 6th months, and participants without any intervention (KC and control groups) were evaluated initially, at 1st, 3rd, and 6th months. RESULTS The KC patients had significantly lower average NITBUT, higher OSDI scores, and impaired meibomian gland morphology than healthy individuals (NITBUT(seconds): KC, 12.8(2.4-17.6), healthy group (HG), 17.1(6.8-17.6); p = 0.012, OSDI: KC, 27.5(0.0-87.5), HG, 7.5(0.0-55.0); p < 0.001, p < 0.001, respectively). A significant difference was found in Schirmer values of the CXL group at 0-1st months, first NITBUT values at 1-6 months, and average NITBUT values at 1-3 and 1-6 months (p = 0.003, p = 0.001, p = 0.003, p = 0.001, respectively). All meibography parameters remained unchanged after CXL over a 6-month follow-up compared to initial measurements. CONCLUSIONS Even though the KC patients had lower NITBUT, higher OSDI scores, and increased meibomian gland disfunction, the CXL treatment did not significantly affect tear quantity, dry eye symptoms, and meibomian gland morphology.
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Affiliation(s)
- Hasan Akgöz
- 175650Recep Tayyip Erdoğan University, Merkez/Rize, Turkey
| | - Hüseyin Fındık
- 175650Recep Tayyip Erdoğan University, Merkez/Rize, Turkey
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Analysis of Tear Function Outcomes following Collagen Cross-Linking Treatment in Ectatic Corneas. J Ophthalmol 2022; 2022:1910607. [PMID: 35321348 PMCID: PMC8938138 DOI: 10.1155/2022/1910607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To analyze tear function outcomes following collagen cross-linking (CXL) treatment in ectatic corneas. Methods Fifty-seven eyes of 34 patients were included, and patients with keratoconus who underwent epithelium-on (epi-on) or epithelium-off (epi-off) CXL were evaluated. The following tests were performed preoperatively and at 1, 3, 6, and 12 months postoperatively: best-corrected visual acuity (BCVA), maximum keratometry value (Kmax), ocular surface disease index (OSDI) questionnaire, slit-lamp examination, tear meniscus height, first noninvasive Keratograph breakup time (1st NIKBUT), average NIKBUT, and bulbar redness. Results BCVA improved in both epi-on and epi-off groups at most follow-up points, but was not significantly different between groups. At 12-month follow-up, Kmax in the epi-on and epi-off groups improved after CXL, but there was no significant difference between the groups. The OSDI in both groups decreased after operation compared with before surgery, and there was no significant difference between the two groups. Comparing the two groups, only the change in the tear meniscus height at 6 months postoperatively was statistically significant, and the pre- and postoperative values of the two groups were within the normal range (>0.20 mm). The change was small and had no clinical significance. There was no change in the 1st NIKBUT and average NIKBUT between the epi-on and epi-off groups. A change in bulbar redness was significantly better in the epi-off group than in the epi-on group at 3 months postoperatively. Comparing the effects at 1 year postoperatively, both groups had positive results in OSDI, NIKBUT, tear meniscus height, and bulbar redness. Conclusion Both epi-on and epi-off CXL can control the progression of keratoconus, although epi-off CXL is more effective. Both methods have a positive effect on dry eye, which can improve the condition of the tear film and reduce dry eye symptoms in patients with keratoconus.
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Bubnova IA, Sarkisova KG. [Changes in precorneal tear film and ocular surface in keratoconic patients after corneal collagen cross-linking]. Vestn Oftalmol 2022; 138:118-123. [PMID: 35801890 DOI: 10.17116/oftalma2022138031118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article reviews the current available data on the signs and symptoms of dry eye syndrome (DES) in patients with keratoconus (KC), describes the clinical features of DES in KC patients and the morphological features of this type of keratectasia that lead to manifestations of the «dry eye», and highlights the risk factors, consequences of therapeutic measures, concomitant ophthalmological and general somatic diseases that contribute to the development of DES in KC.
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Affiliation(s)
- I A Bubnova
- Research Institute of Eye Diseases, Moscow, Russia
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Voronin GV, Bubnova IA, Averich VV, Sarkisova KG. [Precorneal tear film after corneal collagen cross-linking in keratoconus (preliminary report)]. Vestn Oftalmol 2021; 137:224-230. [PMID: 34669331 DOI: 10.17116/oftalma2021137052224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To study the condition of precorneal tear film in keratoconus patients after corneal collagen cross-linking (CXL). MATERIAL AND METHODS The study enrolled 24 patients (30 eyes) with stages I-III progressive keratoconus. All study patients underwent standard (Dresden) protocol CXL. Patients were examined before the surgery and 1 week, 1 month, and 3 months postoperatively. The condition of precorneal tear film was evaluated based on the results of Norn test (the tear film break-up time), Schirmer test, Jones test, optical coherence tomography based lacrimal meniscometry, and improved tearscopy. RESULTS One month after CXL, patients with keratoconus experienced transient changes in the precorneal tear film condition - the tear film break-up time was reduced, the tear secretion was elevated, the lacrimal meniscus biometry parameters were increased, and the thickness of the tear film lipid layer was decreased. CONCLUSION Corneal changes resulting from CXL lead to transient disorders of the mucin and lipid layers of the precorneal tear film, which requires adequate tear substitute therapy in the postoperative period.
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Affiliation(s)
- G V Voronin
- Research Institute of Eye Diseases, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I A Bubnova
- Research Institute of Eye Diseases, Moscow, Russia
| | - V V Averich
- Research Institute of Eye Diseases, Moscow, Russia
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Vastardis I, Gatzioufas Z, McLintock C, Kohlhaas M, Hamada S, Lake D, Elalfy M. Tear film parameters before and after intracorneal ring segment implantation in keratoconic eyes. Eur J Ophthalmol 2020; 31:2213-2218. [PMID: 32951440 DOI: 10.1177/1120672120958301] [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: 11/17/2022]
Abstract
PURPOSE To assess signs of dry eye syndrome in keratoconic eyes following intracorneal ring segment (ICRS) implantation. PATIENT AND METHODS Twenty eyes of 20 consecutive patients with keratoconus were assessed for tear film changes following ICRS implantation at 6 months postoperatively. Evaluated parameters included tear osmolarity, non-invasive tear breakup time test (NI-BUT test) and Schirmer test I and II before and after treatment. RESULTS No significant changes were found with respect to osmolarity, Schirmer I and II (p = 0.9, p < 0.64, and p < 0.91, respectively). The NITUBT was significantly lower after surgery (p = 0.04). CONCLUSION Our results suggest that implantation of ICRS does not result in a significant change in tear film osmolarity, or tear film volume nor improves the tear film stability.
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Affiliation(s)
| | - Zisis Gatzioufas
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Department of Ophthalmology, University Hospital Basel, Switzerland
| | - Cameron McLintock
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Princess Alexandra Hospital, Brisbane, Australia
| | | | - Samer Hamada
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Damian Lake
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Mohamed Elalfy
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,The Research Institute of Ophthalmology, Cairo, Egypt
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Tear function and ocular surface changes following corneal collagen cross-linking treatment in keratoconus patients: 18-month results. Int Ophthalmol 2019; 40:169-177. [PMID: 31440935 DOI: 10.1007/s10792-019-01161-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the long-term effects that CXL has on the tear function and ocular surface in keratoconus. METHODS Twenty-one consecutive patients (24 eyes) with progressive keratoconus scheduled for CXL were included. All patients underwent the following procedures: conjunctival impression cytology analysis, ocular surface disease index (OSDI) score, tear osmolarity test, Schirmer test, tear film breakup time (TBUT), ophthalmic surface fluorescein (Fl) staining, and topographical corneal evaluation before as well as 3 and 18 months after accelerated CXL. RESULTS There was no change in the median OSDI score, tear osmolarity test, Schirmer test, and the Fl staining score after CXL. The median TBUT increased from 9.00 s at baseline to 12.00 s at 18 months postoperative (P < 0.001). The cytological features of the temporal and superior bulbar conjunctiva deteriorated at 3 months post-CXL (P < 0.001). An improvement in impression cytology analysis of the temporal conjunctiva was noted at 18-month follow-up (P < 0.001). Significant improvements in the median maximum keratometry and mean keratometry (K-mean) readings were also noted 18 months after CXL (P < 0.001). The changes in the K-mean correlated significantly with the changes in TBUT levels at 18-month follow-up as compared to baseline (r = - 0.688, P < 0.001). CONCLUSIONS The improvement in TBUT, conjunctival squamous metaplasia, and the goblet cell density indicates a favorable effect of CXL on the ocular surface and tear film in keratoconus, presumably due to the reduced corneal irregularity after CXL.
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Cagini C, Di Lascio G, Messina M, Riccitelli F, Dua HS. Correlation of central and peripheral keratometric parameters after corneal collagen cross-linking in keratoconus patients. Int Ophthalmol 2018; 39:2041-2048. [PMID: 30421316 DOI: 10.1007/s10792-018-1041-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the difference in the central and peripheral keratometric parameters in patients with keratoconus after corneal collagen cross-linking (CXL). METHODS Forty-eight eyes of 32 patients (18 males, 16-28 years) affected by progressive keratoconus in different stages of evolution underwent CXL using the standard epithelium-off protocol. Corneal thickness and corneal curvature before CXL and after 6 and 12 months using the Sirius tomographer were analyzed. The values of the mean corneal thickness at the corneal apex (CAT), center of the pupil (PCT), thinnest point (CTTL) and along concentric circles of 2, 4, 6, 8, 8.5, 9, 9.5 and 10 mm diameter were evaluated; the values of the mean curvature at the corneal apex and at the points in which the inferior, superior, nasal and temporal meridians crossed the above-mentioned concentric circles were also evaluated. RESULTS The mean preoperative values for CAT, PCT and CTTL were 461.4 ± 30.3, 475.3 ± 30.5 and 441 ± 32.0, respectively. The values after 12 months of CXL were 444.6 ± 36.2, 451.6 ± 36.7 and 418.2 ± 41.4. The peripheral corneal thickness at the eight points ranged from 479 to 733 preoperatively. At 12-month post-CXL, the values ranged from 444.6 to 734.1. The mean posterior curvature from apex to periphery ranged from - 4.5 to - 9.1 days preoperatively and from - 4.5 to - 9.2 days at 12 months. These were not statistically significant (ANOVA and unpaired T test). CONCLUSIONS Our data suggest that CXL over an 8-mm zone can stabilize the peripheral cornea. Longer-term follow-up studies on the peripheral cornea after CXL will provide useful information.
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Affiliation(s)
- C Cagini
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - G Di Lascio
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - M Messina
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - F Riccitelli
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - H S Dua
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Subasinghe SK, Ogbuehi KC, Dias GJ. Current perspectives on corneal collagen crosslinking (CXL). Graefes Arch Clin Exp Ophthalmol 2018; 256:1363-1384. [PMID: 29623463 DOI: 10.1007/s00417-018-3966-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 12/13/2022] Open
Abstract
Corneal collagen crosslinking has revolutionized the treatment of keratoconus and post-refractive corneal ectasia in the past decade. Corneal crosslinking with riboflavin and ultraviolet A is proposed to halt the progression of keratectasia. In the original "Conventional Dresden Protocol" (C-CXL), the epithelium is removed prior to the crosslinking process to facilitate better absorption of riboflavin into the corneal stroma. Studies analyzing its short- and long-term outcomes revealed that although there are inconsistencies as to the effectiveness of this technique, the advantages prevail over the disadvantages. Therefore, corneal crosslinking (CXL) is widely used in current practice to treat keratoconus. In an attempt to improve the visual and topographical outcomes of C-CXL and to minimize time-related discomfort and endothelial-related side effects, various modifications such as accelerated crosslinking and transepithelial crosslinking methods have been introduced. The comparison of outcomes of these modified techniques with C-CXL has also returned contradictory results. Hence, it is difficult to clearly identify an optimal procedure that can overcome issues associated with the CXL. This review provides an up-to-date analysis on clinical and laboratory findings of these popular crosslinking protocols used in the treatment of keratoconus. It is evident from this review that in general, these modified techniques have succeeded in minimizing the immediate complications of the C-CXL technique. However, there were contradictory viewpoints regarding their effectiveness when compared with the conventional technique. Therefore, these modified techniques need to be further investigated to arrive at an optimal treatment option for keratoconus.
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Affiliation(s)
- Sandeepani K Subasinghe
- Department of Anatomy, University of Otago, P.O. Box 913, 270 Great King Street, Dunedin, 9054, New Zealand.
| | - Kelechi C Ogbuehi
- Ophthalmology Section, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - George J Dias
- Department of Anatomy, University of Otago, P.O. Box 913, 270 Great King Street, Dunedin, 9054, New Zealand
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