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Moshirfar M, Rognon GT, Olson N, Kay W, Sperry RA, Ha S, Hoopes PC. Merging Photorefractive Keratectomy and Collagen Crosslinking: An Analysis of Literature and a Guide to Prevalent Protocols. Cornea 2024; 43:1184-1197. [PMID: 38759151 DOI: 10.1097/ico.0000000000003536] [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: 09/15/2023] [Accepted: 02/08/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The purpose of this review was to summarize the different surgical approaches combining photorefractive keratectomy (PRK) and corneal crosslinking (CXL), present each protocol template in a simple format, and provide an overview of the primary outcomes and adverse events. METHODS A literature review was conducted as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eight different databases were searched. Papers were included if PRK was immediately followed by CXL. RESULTS Thirty-seven papers met the inclusion criteria of a total yield of 823. The latest research into simultaneous PRK and CXL has been shown to not only stabilize the cornea and prevent keratoconus progression but also improve the visual acuity of the patient. Improvements in uncorrected distance visual acuity and (spectacle) corrected distance visual acuity were found to be significant when considering all protocols. There were also significant reductions in K1, K2, mean K, Kmax, sphere, cylinder, and spherical equivalent. Random-effects analysis confirmed these trends. Corrected distance visual acuity was found to improve by an average of 0.18 ± 1.49 logMAR (Cohen's D [CD] 0.12; P <0.02). There was also a significant reduction of 2.57 ± 0.45 D (CD 5.74; P <0.001) in Kmax. Cylinder and spherical equivalent were also reduced by 1.36 ± 0.26 D (CD 5.25; P <0.001) and 2.61 ± 0.38 D (CD 6.73; P <0.001), respectively. CONCLUSIONS Combining the 2 procedures appears to be of net benefit, showing stabilization and improvement of ectatic disease, while also providing modest gains in visual acuity. Since customized PRK and CXL approaches appear superior, a combination of these would likely be best for patients.
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Affiliation(s)
- Majid Moshirfar
- Corneal and Refractive Surgery, HDR Vision Research Center, Hoopes Vision, Draper, UT
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT
- Corneal Transplantation and Eye Banking, Utah Lions Eye Bank, Murray, UT
| | - Gregory T Rognon
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL
| | - Nate Olson
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT
| | | | | | - Seungyeon Ha
- Department of Statistics, Texas A&M University, Bryan, TX; and
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Niazi S, Doroodgar F, Hashemi Nazari S, Rahimi Y, Alió Del Barrio JL, Gatzioufas Z, Findl O, Vinciguerra P, Vinciguerra R, Moshirfar M, Ambrósio R, Alio JL. Refractive surgical approaches to keratoconus: A systematic review and network meta-analysis. Surv Ophthalmol 2024; 69:779-788. [PMID: 38710236 DOI: 10.1016/j.survophthal.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
Advancements in diagnostic methods and surgical techniques for keratoconus (KC) have increased non-invasive treatment options. Successful surgical planning for KC involves a combination of clinical science, empirical evidence, and surgical expertise. Assessment of disease progression is crucial, and halting the progression should be the focus if it is progressive. While surgeons used to rely on experience alone to decide the surgical method, comparing the network of primary factors, such as visual acuity, across studies can help them choose the most appropriate treatments for each patient and achieve optimal outcomes. Meticulous tabulation methods facilitate interpretation, highlighting the importance of selecting the correct surgical and rehabilitation approach based on each patient's condition and stage of the disease. We detail the outcomes of a comprehensive network meta-analysis comparing the effectiveness of various combined therapeutic refractive treatments for KC at identical stages of the disease, spanning 4 distinct follow-up intervals. Additionally, the comprehensive analysis suggests that for corneas with optimal best corrected visual acuity (BCVA) preoperatively (classified as regular), combining phakic intraocular lenses with intracorneal ring segments (ICRS) and corneal cross-linking (CXL) could offer the best therapeutic approach provided the disease stage does not exceed stage 3. For irregular corneas, although initial follow-ups show a significant difference in BCVA with surface ablation, longer-term follow-ups recommend combining surface ablation with ICRS and CXL, especially at higher stages.
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Affiliation(s)
- Sana Niazi
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Doroodgar
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yekta Rahimi
- Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge L Alió Del Barrio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | | | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria
| | - Paolo Vinciguerra
- Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Renato Ambrósio
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil; Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil; BrAIN: Brazilian Artificial Intelligence Networking in Medicine, Rio de Janeiro, Maceió, Brazil; Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil; Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jorge L Alio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Dai Z, Liu Z, Zhang Y, Yuan Y, Liu Y, Wang Y, Yu S, Chen Y. Topography-guided photorefractive keratectomy combined with accelerated corneal collagen cross-linking versus cross-linking alone for progressive keratoconus: a long-term prospective cohort study. Front Med (Lausanne) 2024; 11:1420264. [PMID: 39188874 PMCID: PMC11345261 DOI: 10.3389/fmed.2024.1420264] [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: 05/22/2024] [Accepted: 08/02/2024] [Indexed: 08/28/2024] Open
Abstract
Purpose To comprehensively compare the long-term outcome of the combined topography guided photorefractive keratectomy (TG-PRK) with accelerated corneal cross-linking (ACXL) and ACXL alone in eyes with progressive keratoconus. The analysis focused on the changes in the detailed corneal aberrometric values. Methods This single-center, prospective cohort study included 28 patients (30 eyes) of the TG-PRK plus ACXL group and 14 patients (15 eyes) of the ACXL alone group. The mean duration of the follow-up was 44 ± 10.18 months (ranged from 31 to 65 months). The preoperative data and the postoperative measurement data at the last follow-up visit, including demographic data, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, pachymetry, aberrometry and densitometry were analyzed. Results The CDVA significantly improved in the TG-PRK plus ACXL group at the last follow-up visit (p = 0.006), while no significant improvement was found in the ACXL alone group (p = 0.432). The maximal keratometry of the anterior corneal surface (Kmax) of both groups significantly decreased at the last follow-up visit (p < 0.05). Compared with the ACXL alone group, the Kmax of the TG-PRK plus ACXL group showed a greater decline (p = 0.008). The total corneal aberrations, the corneal lower-order aberrations (LOAs), the corneal higher order aberrations (HOAs), the vertical coma and the spherical aberration (SA) at the 4.0 mm and 6.0 mm zone of the TG-PRK plus ACXL group significantly decreased at the last follow-up visit (all p < 0.05). The declines of the total corneal aberrations, the corneal LOAs, the corneal HOAs and the vertical coma at the 4.0 mm and 6.0 mm zone of the TG-PRK plus ACXL group were significantly higher than those in the ACXL alone group (p < 0.001). Conclusion Compared with ACXL alone, combined TG-PRK with ACXL procedure had a significantly higher reduction in the corneal HOAs and better CDVA, while providing a similar long-term stability and safety. For progressive keratoconus patients with adequate corneal thickness, the combined procedure might be a recommended treatment option.
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Affiliation(s)
- Zhihao Dai
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yufei Yuan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yuexin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Shuo Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
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Iqbal M, Gad A, Kotb A, Abdelhalim M. Analysis of the outcomes of three different cross-linking protocols for treatment of paediatric keratoconus: A multicentre randomized controlled trial. Acta Ophthalmol 2024; 102:e105-e116. [PMID: 37140143 DOI: 10.1111/aos.15686] [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: 01/22/2023] [Revised: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To analyse long-term outcomes of standard cross-linking (SCXL), accelerated cross-linking (ACXL) and transepithelial cross-linking (TCXL) in the treatment of progressive paediatric keratoconus regarding stability, safety and efficacy. METHODS This prospective multicentre randomized controlled trial included 97 eyes of 97 paediatric patients with stages I-III ABCD keratoconus grading system, who were randomized into three groups; SCXL group (control group, n = 32; 3 mW/cm2 × 30 min/5.4 J/cm2 ), ACXL (n = 33; 18 mW/cm2 × 5 min/5.4 J/cm2 ) and TCXL (n = 32; 18 mW/cm2 × 5 min/5.4 J/cm2 ). Subjective refraction, uncorrected and corrected visual acuity, keratometry and pachymetry measurements using corneal topography were recorded preoperatively and 1, 2 and 3 years postoperatively. RESULTS SCXL group exhibited significant successive improvements in the mean visual, refractive and keratometric parameters throughout the entire postoperative 3 years while ACXL group exhibited significant improvements in visual and keratometric parameters in the first postoperative year that remained stable in second and third postoperative years. TCXL group exhibited significant progressive deterioration in all mean parameters compared to SCXL and ACXL (p < 0.0001). Both SCXL and ACXL revealed final 100% success rate with good stability while TCXL revealed final 22% failure rate with keratoconus progression (p < 0.0001). CONCLUSION SCXL and ACXL were comparable in halting keratoconus progression and achieved good stability and safety; however, SCXL was more efficient than ACXL as it yielded greater significant postoperative mean visual, refractive and keratometric improvements achieving smoother corneal remodelling. Both SCXL and ACXL were much superior to TCXL. SCXL is the best CXL treatment option for paediatric keratoconus while ACXL is a good and effective alternative.
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Affiliation(s)
- Mohammed Iqbal
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed Gad
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed Kotb
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Abdelhalim
- Department of Ophthalmology, Faculty of Medicine, Aswan University, Aswan, Egypt
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Iqbal M, Hammour A, Elsayed A, Gad A. Outcomes of the Q value-based nomogram in managing pediatric versus adult keratoconus: a prospective interventional study. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2023; 12:78-89. [PMID: 38357612 PMCID: PMC10862023 DOI: 10.51329/mehdiophthal1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024]
Abstract
Background Keratoconus (KCN) is an ectatic disorder of the cornea characterized by stromal weakness and apical protrusion of the cornea, and is associated with a gradual and painless reduction in visual acuity. KCN in pediatric patients has certain important characteristics, such as a progressive and aggressive nature. We aimed to analyze the visual, refractive, and topographic outcomes of implanting a single 210° arc-length Keraring segment according to a novel, objective, Q value-based nomogram (Q-N) for the treatment of pediatric versus adult KCN. Methods This prospective, multicenter, non-randomized, open-label trial included 47 eyes of 47 patients who were allocated to one of two groups. The adult group included 33 eyes of patients ≥ 18 years of age, whereas the pediatric group included 14 eyes of patients aged 14 - 17 years. All patients underwent femtosecond laser-assisted implantation of a single 210° arc-length Keraring segment according to the Q-N and were followed up for 6 months. All eyes underwent visual acuity measurement, cycloplegic refraction, and corneal topography at baseline and 6 months after surgery. Results The study groups were comparable in terms of sex proportions and KCN grades (both P > 0.05). The adult group exhibited significant postoperative improvements in mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere, cylinder, spherical equivalent (SE), and Kmax (all P < 0.001) with a mean change of -0.56 logarithm of the minimal angle of resolution (logMAR), - 0.40 logMAR, 3.07 diopters (D), 0.70 D, 3.42 D, and - 5.26 D, respectively. The pediatric group exhibited significant postoperative improvements in mean UDVA, CDVA, sphere, SE, and Kmax (all P < 0.05) with a mean change of - 0.62 logMAR, - 0.34 logMAR, 3.18 D, 3.67 D, and - 5.37 D, respectively. There were no significant differences between the groups in terms of the mean change in visual, refractive, and topographic variables (all P > 0.05). No postoperative complications were observed in either group. Conclusions Use of the objective Q-N was efficient in the treatment of pediatric KCN, with postoperative improvements in the mean visual, refractive, and topographic parameters, comparable to outcomes in adult keratoconus. Q-N achieved good corneal remodeling with subsequent improvements in visual, refractive, and topographic outcomes in both adult and pediatric patients with keratoconus. To verify our preliminary findings, we recommend further multicenter randomized clinical trials using the Q-N nomogram in a larger sample of pediatric patients with KCN as an adjunct treatment before or after CXL.
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Affiliation(s)
- Mohammed Iqbal
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Abdallah Hammour
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elsayed
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Gad
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt
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Nabil KM, Elmassry AAK, Ntakarusho S, Said AA. Intraocular pressure after combined photorefractive keratectomy and corneal collagen cross-linking for keratoconus. Int Ophthalmol 2023; 43:4837-4849. [PMID: 37861937 PMCID: PMC10724307 DOI: 10.1007/s10792-023-02886-w] [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: 05/16/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE The purpose of this prospective study was to evaluate the effect of combined photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) on intraocular pressure (IOP) in patients with keratoconus (KC). METHODS We included 64 eyes of 34 patients (19 males and 15 females; age: 19-40y) with stages 1-2 keratoconus which had undergone combined wavefront-optimized photorefractive keratectomy and corneal collagen cross linking. Two other groups of patients were added as controls: the PRK group including 110 eyes of 57 patients (23 males and 34 females; age: 18-44y) which had undergone wavefront-optimized photorefractive keratectomy for myopic refractive errors, and the CXL group including 36 eyes of 23 patients (14 males and 9 females; age: 12-38y) with keratoconus, not filling the inclusion criteria for combined PRK and CXL, which had undergone corneal collagen cross-linking. IOP was recorded preoperatively and postoperatively at 3, 6 and 12 months follow-up visits. RESULTS Preoperative IOP in both CXL (12.1 ± 2.53 mmHg) and PRK + CXL (13.2 ± 2.50 mmHg) groups was significantly lower than PRK group (15.8 ± 3.10 mmHg) (F = 30.505, p < 0.001). At 3 months postoperatively, IOP showed no statistically significant difference between the three studied groups (F = 1.821, p = 0.164). At 6 months postoperatively, IOP in the CXL group (14.6 ± 2.64 mmHg) was significantly higher than both PRK (13.4 ± 2.27 mmHg) and PRK + CXL (13.3 ± 2.62 mmHg) groups (F = 3.721, p = 0.026). At 12 months postoperatively, IOP in the CXL group (14.3 ± 2.69 mmHg) was significantly higher than the PRK group (13.2 ± 2.23 mmHg) and was higher than PRK + CXL group (13.3 ± 2.59 mmHg) although not statistically significant (F = 3.393, p = 0.035). Regarding the percent of change from preoperative IOP, a statistically significant difference between the three studied groups was detected at 3, 6 and 12 months postoperatively (H = 117.459, 109.303, 122.694 respectively, p < 0.001). The median percent of change from preoperative IOP in the PRK group was -16.7%, -15%, and -16.7%, in the CXL group was + 14.3%, + 19.4%, and + 19.1%, while in PRK + CXL group was 0% at 3, 6 and 12 months postoperatively. (Post-hoc power analysis 75%). CONCLUSIONS Combined PRK and CXL in patients with KC shows no significant effect on IOP, in contrast to either procedure performed separately.
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Affiliation(s)
- Karim Mahmoud Nabil
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Postal Code 21523, 19 Amin Fekry Street, Raml Station, Alexandria, Egypt.
| | - Ahmed Abdel Karim Elmassry
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Postal Code 21523, 19 Amin Fekry Street, Raml Station, Alexandria, Egypt
| | - Silas Ntakarusho
- Department of Ophthalmology, University of Ngozi, Ngozi, Burundi
| | - Amr Ahmed Said
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Postal Code 21523, 19 Amin Fekry Street, Raml Station, Alexandria, Egypt
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Yousif MO, Elkitkat RS, Edrees ES, Alaarag NA. Introducing a Revised Tissue Saving Protocol for Combined Topography-Guided Photorefractive Keratectomy and Cross-Linking in Keratoconic Corneas. Cornea 2023; 42:755-765. [PMID: 36728310 DOI: 10.1097/ico.0000000000003225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/26/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to introduce a revised tissue-saving technique for combined topography-guided photorefractive keratectomy (PRK) and cross-linking for keratoconus (KC) treatment and to evaluate its efficacy, safety, and stability. METHODS This retrospective, noncontrolled study was performed at Maadi Eye Subspecialty Center and Eye Care Center, Cairo, Egypt. The technique was performed on virgin keratoconic corneas with 3 different morphological patterns of ectasia. It involves performing topography-guided PRK before epithelial removal, followed by customized phototherapeutic keratectomy (PTK) that is tailored to each cornea after studying the treatment profile on the laser treatment screen. The electronic medical records were explored for preoperative and postoperative data, including subjective refraction and topographic data (using Sirius topographer). RESULTS The study was conducted on 123 eyes of 93 patients with a mean age of 27.98 years ±6.06. The follow-up ranged from 6 to 36 months (mean ± SD of 16.2 months ±10.4). The results showed statistically nonsignificant differences among the 3 ectasia subgroups in treatment spherical equivalent, treatment maximum depth, thickness of removed epithelium, and thinnest residual stromal bed. There were statistically significant differences in almost all values between the preoperative and postoperative data, with significant postoperative patients' improvement ( P value <0.001). The subgroups' results were almost the same as the whole cohort's results. The safety and efficacy indices of the performed procedure showed remarkably high values (1.48 ± 0.21 and 0.87 ± 0.40, respectively). CONCLUSIONS This revised protocol for KC management maximally preserves stromal tissue with proven efficacy, safety, and stability.
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Affiliation(s)
- Mohamed Omar Yousif
- Assistant Professor of Ophthalmology, Faculty of Medicine, Ain Shams University
- Cornea and Refractive Surgery Consultant, Maadi Eye Subspecialty Center
| | - Rania Serag Elkitkat
- Assistant Professor of Ophthalmology, Faculty of Medicine, Ain Shams University
- Watany Eye Hospital
- Watany Research and Development Center
- Head of Ophthalmology Department, Faculty of Medicine, MTI University
| | - Eman Samir Edrees
- Lecturer of Ophthalmology, Faculty of Medicine, Ain Shams University; and
- Maadi Eye Subspecialty Center, Cairo, Egypt
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Ang MJ, Darbinian JA, Hoskins EN, Holsclaw DS, Sudesh S, Chandra NS. The Safety Profile of FDA-Approved Epithelium-Off Corneal Cross-Linking in a US Community-Based Healthcare System. Clin Ophthalmol 2022; 16:1117-1125. [PMID: 35431539 PMCID: PMC9012302 DOI: 10.2147/opth.s359224] [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: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the occurrence of early post-operative complications following FDA-approved epithelium-off corneal cross-linking in the United States. Materials and Methods This multicenter, retrospective cohort study identified patients who underwent epithelium-off (epi-off) corneal cross-linking (CXL) for keratoconus and post-refractive keratectasia within the Kaiser Permanente Northern California healthcare system between 2016 and 2018. Post-operative complications including delayed epithelial healing, infection, and loss of visual acuity were recorded. Results The study included 878 eyes of 654 patients. The mean age was 27±9.4 years (range 7–71). Five hundred ninety-nine patients (91.6%) had keratoconus while 55 had post-refractive corneal ectasia (8.4%). Forty-seven eyes had prolonged follow-up because of the occurrence of complications in the early post-operative period. The respective rates of delayed epithelial healing, and keratitis were 3.9% (95% CI 2.7–5.3%), and 1.5% (95% CI 0.8–2.5%). Four approaches for management of delayed epithelial healing were compared; epithelium healing duration was the longest in the repeat bandage contact lens (BCL) group (23.8 days) and the shortest in the antibiotic ointment group (14.3 days), with statistically significant differences (p < 0.05) in the healing time between these 2 groups. Conclusion The concern for early clinical complications after epi-off CXL often leads to delayed CXL intervention and further keratoconus progression with increased economic burdens. A large retrospective review of 878 eyes found that FDA-approved epi-off CXL protocol appears to be safe with low occurrence rates of early post-operative complications. The recommended management for delayed epithelial healing is using antibiotic ophthalmic ointment.
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Affiliation(s)
- Michael J Ang
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Jeanne A Darbinian
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Eliza N Hoskins
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Douglas S Holsclaw
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Sudha Sudesh
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
| | - Naveen S Chandra
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA, USA
- Correspondence: Naveen S Chandra, The Permanente Medical Group, 320 Lennon Lane, Walnut Creek, CA, 94598, 94598, Tel +1 925-906-2550, Fax +1 925-906-2332, Email
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Maharramov PM, Aghayeva FA. Evaluation of the effectiveness of combined staged surgical treatment in patients with keratoconus. PLoS One 2022; 17:e0264030. [PMID: 35255102 PMCID: PMC8901062 DOI: 10.1371/journal.pone.0264030] [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: 10/05/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This study performs comparative assessment of the results of different types of two-stage surgical treatment in patients with keratoconus, including combination of corneal collagen cross-linking with intrastromal corneal ring segments followed by topography-guided photorefractive keratectomy. Materials and methods Prospective review of 101 patients (101 eyes) with keratoconus was performed. Patients underwent corneal collagen cross-linking (32 patients), intrastromal corneal ring segments (48 patients), and a combination of these two procedures (21 patients). Transepithelial topography-guided photorefractive keratectomy was performed as the second stage of treatment in all patients with obtained stable refractive results at 8 months after first stage. Main outcome measures were visual acuity (uncorrected distance and corrected distance) and corneal topographic indices. Results Comparison of the studied parameters after first stage surgical treatment between non-combined CXL and combined groups demonstrated a statistically significant difference for uncorrected distance visual acuity, corrected distance visual acuity, and cylindrical refraction values (p<0.05). We observed significant improvement of visual acuity and key corneal topographic indices after topography-guided photorefractive keratectomy in all study groups (p<0.05). In 50 (49.5%) patients customized excimer laser ablation gave the possibility of full spherical and cylindrical corrections. Ten eyes (10%) had delayed epithelial healing, no corneal stromal opacities developed. Conclusions This study shows that combined two-stage surgical treatment of keratoconus, consisting of intrastromal corneal ring segment implantation with corneal collagen cross-linking followed by topography-guided photorefractive keratectomy, is clinically more effective to prevent keratectasia progression and increase visual acuity than the use of non-combined two-stage techniques.
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Affiliation(s)
- Polad M. Maharramov
- National Centre of Ophthalmology named after academician Zarifa Aliyeva, Baku, Azerbaijan
- * E-mail:
| | - Fidan A. Aghayeva
- National Centre of Ophthalmology named after academician Zarifa Aliyeva, Baku, Azerbaijan
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De Rosa G, Rossi S, Santamaria C, Boccia R, De Rosa L, D'Alterio FM, Simonelli F. Combined photorefractive keratectomy and corneal collagen cross-linking for treatment of keratoconus: a 2-year follow-up study. Ther Adv Ophthalmol 2022; 14:25158414221083362. [PMID: 35340750 PMCID: PMC8949731 DOI: 10.1177/25158414221083362] [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: 09/14/2021] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Corneal collagen cross-linking (CXL) is considered an effective procedure for slowing down or eliminating the progression of keratoconus. New techniques, in combination with CXL, have been proposed to stop the evolution of keratoconus and improve the visual function. Objective: To evaluate the effectiveness of combined photorefractive keratectomy (PRK) with mitomycin-C (MMC) application and CXL in the management of grade 1–2 keratoconus over a 2-year follow-up. Methods: Fifteen eyes underwent topography-guided PRK with 0.02% MMC application immediately followed by standard CXL. Results: Best corrected visual acuity improved from 0.15 ± 0.11 logMAR to 0.08 ± 0.09 logMAR at 24 months (p < 0.0001) in treated eyes. Mean steepest meridian keratometry reduced from 48.79 ± 3.22 D at baseline to 46.16 ± 3.11 D at 24 months (p < 0.0001). Mean flattest meridian keratometry reduced from 45.18 ± 2.17 D preoperatively to 44.35 ± 2.19 D at 24 months (p < 0.0001). Conclusion: Simultaneous topography-guided PRK with MMC 0.02% application and standard CXL is a safe, promising and effective procedure in the treatment of mild and moderate keratoconus.
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Affiliation(s)
- Giuseppe De Rosa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Settimio Rossi
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Carmine Santamaria
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Rosa Boccia
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Luigi De Rosa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Francesco Maria D'Alterio
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Via Sergio Pansini 5, 80131 Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
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11
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El-Massry A, Rashid K, Saad S, Osman I. One-Year Outcomes of Intracorneal Ring-Segment Insertion Assisted by Femtosecond Laser Simultaneously Performed with Corneal Collagen Cross-Linking for Treatment of Keratoconus. Clin Ophthalmol 2021; 15:4447-4453. [PMID: 34815661 PMCID: PMC8604634 DOI: 10.2147/opth.s333832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the results of simultaneously performed femtosecond laser–assisted Keraring intrastromal corneal ring–segment insertion and corneal collagen cross-linking for the treatment of keratoconus. Patients and Methods In this retrospective, noncomparative, interventional study, 30 eyes of 24 progressive-keratoconus patients of both sexes aged 18–36 years old with poor best-corrected visual acuity (BCVA) and intolerance to contact lenses were included. All patients had been subjected to complete preoperative and postoperative ophthalmological examinations — unaided VA, BCVA, refraction, Pentacam, and contrast sensitivity examinations at 3-month, 6-month, and 1-year follow-ups. Results Mean unaided VA had changed significantly from 0.649±0.239 logMAR preoperatively to 0.514±0.222 (P=0.014), 0.419±0.162 (P<0.001), and 0.379±0.142 (P<0.001) logMAR at the three follow-up visits, respectively. Mean BCVA had changed significantly from 0.326±0.144 logMAR preoperatively to 0.231±0.140 (P=0.006) at 1-year follow-up. Mean spherical equivalent refraction had decreased significantly at 6-month (P=0.0298) and 1-year follow-up (P=0.0081). Mean steep keratometry (K2) had also significantly reduced from 51.89±3.81 D to 49.87±4.57 D (P=0.034) at 6 months and 49.40±4.39 D (P=0.011) at 1 year. Mean refractive and keratometric astigmatism had significantly decreased at all follow-up visits. Conclusion At 1-year follow-up, keraring intrastromal corneal ring–segment insertion assisted by femtosecond laser performed simultaneously with corneal collagen cross-linking resulted in an improvement in visual, refractive, and topographic outcomes, which may suggest it is an effective treatment of keratoconus.
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Affiliation(s)
- Ahmed El-Massry
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Khalid Rashid
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Seham Saad
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ihab Osman
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
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12
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Iqbal M, Mounir A, Abd-Elaziz K, Said OM. Long-Term Visual, Refractive and Topographic Outcomes of KeraRings Combined with Accelerated Transepithelial Crosslinking for Management of Different Grades of Progressive Keratoconus: A Retrospective Cohort Study. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
To evaluate long-term visual, refractive, and topographic outcomes of KeraRings intrastromal implantation combined with accelerated transepithelial cross-linking for management of different stages of progressive keratoconus.
Materials and Methods:
This retrospective cohort study included 70 eyes of 70 patients with Amsler-Krumeich grades 1 to 4 keratoconus. They were divided into two groups: group-A included 37 eyes with grades 1-2 keratoconus, and group-B included 33 eyes with grades 3-4 keratoconus. Both groups underwent combined Keraring implantation with TCXL treatment. The main outcome measures included the preoperative and postoperative visual acuity, refraction, keratometry readings, and pachymetry.
Results:
At postoperative month 60, group-B exhibited significantly higher values of all mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere/cylinder/spherical equivalent/defocus equivalent (DEQ), and K1/K2/Kaverages/Kmax parameters compared to that of group A. However, group-A exhibited better stability of postoperative improvements. Keratoconus progression (KCP) was greater in group-B (45.5%) than group-A (10.8%). Two eyes revealed segments' migration while one eye showed tunnel vascularization and opacification with segments' migration.
Conclusion:
The diagnostic criteria of preoperative-KCP are not adequate for the diagnosis of postoperative-KCP following ICRS implantation. UDVA and K average posterior seemed to be more sensitive parameters than K max in documenting early postoperative-KCP. We suggest that deterioration of UDVA≥0.10 log MAR and/or K average posterior ≥0.25 D are highly suspicious of post-ring implantation keratoconus progression (PR-KCP). The occurrence of two of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, K average posterior ≥0.25 D, or pachymetry≥1.5% thinning, is diagnostic of PR-KCP. The occurrence of two or more of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, Kaverageposterior ≥0.25 D, pachymetry≥ 1.5% thinning or UDVA≥0.10 logMAR, is diagnostic of PR-KCP. We also suggest that Kmax≥0.75 D alone is diagnostic of PR-KCP.
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13
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Kankariya VP, Dube AB, Grentzelos MA, Kontadakis GA, Diakonis VF, Petrelli M, Kymionis GD. Corneal cross-linking (CXL) combined with refractive surgery for the comprehensive management of keratoconus: CXL plus. Indian J Ophthalmol 2020; 68:2757-2772. [PMID: 33229651 PMCID: PMC7856931 DOI: 10.4103/ijo.ijo_1841_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The past two decades have witnessed an unprecedented evolution in the management of keratoconus that demands a holistic approach comprising of inhibiting the ectatic progression as well as visual rehabilitation. The advent of corneal cross-linking (CXL) in the late 1990s resulted in long-term stabilization of the ectatic cornea along with limited reduction in corneal steepening and regularization of corneal curvature. However, CXL as a standalone procedure does not suffice in rehabilitating the functional vision especially in patients who are unwilling or intolerant towards contact lenses. The concept of “CXL plus” was proposed which incorporates adjunctive use of refractive procedures with CXL in order to overcome the optical inefficiency due to corneal irregularity, decrease the irregular astigmatism, correct the residual refractive error and improve functional visual outcome in keratoconus. Several refractive procedures such as conductive keratoplasty (CK), photorefractive keratectomy (PRK), transepithelial phototherapeutic keratectomy (t-PTK), intrastromal corneal ring segments (ICRS) implantation, phakic intraocular lens (PIOL) implantation and multiple other techniques have been combined with CXL to optimize and enhance the CXL outcome. This review aimed to summarize the different protocols of CXL plus, provide guidelines for selection of the optimum CXL plus technique and aid in decision-making for the comprehensive management of cases with primary keratoconus in addition to discussing the future and scope for innovations in the existing treatment protocols.
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Affiliation(s)
| | - Ankita B Dube
- Asian Eye Hospital and Laser Institute, Pune, Maharashtra, India
| | - Michael A Grentzelos
- Asian Eye Hospital and Laser Institute, Pune, Maharashtra, India; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - George A Kontadakis
- Laboratory of Vision and Optics, Medical School, University of Crete, Heraklion, Greece
| | | | - Myrsini Petrelli
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - George D Kymionis
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
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14
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Tamayo GE, Castell C, Vargas P, Polania E, Tamayo J. High-Resolution Wavefront-Guided Photorefractive Keratectomy and Accelerated Corneal Crosslinking for Stabilization and Visual Rehabilitation of Keratoconus Eyes. Clin Ophthalmol 2020; 14:1297-1305. [PMID: 32494120 PMCID: PMC7229783 DOI: 10.2147/opth.s248787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the visual and refractive outcomes after high-resolution wavefront-guided (HRWG) surface ablation with corneal crosslinking (CXL) in keratoconus eyes. PATIENTS AND METHODS In this prospective, interventional case series, 47 eyes of 28 progressive keratoconus patients older than age 18 were enrolled. All patients underwent HRWG photorefractive keratectomy (PRK) with simultaneous accelerated CXL. The study parameters were manifest refraction spherical equivalent (MRSE), keratometric outcomes, uncorrected (UDVA) and corrected distance visual acuity (CDVA) at postoperative 6 and 12 months. RESULTS There was improvement in mean MRSE from -2.39±1.89 D preoperatively to -0.13 ± 0.68 D at 12 months, with corresponding improvement in UDVA from 0.77 ± 0.35 logMAR to 0.08 ± 0.12 logMAR and CDVA from 0.10 ± 0.11 logMAR to 0.02 ± 0.04 logMAR. Preoperative flat and steep keratometry (K) were 4wct 32.49 ± 1.67 D and 45.94 ± 2.10 D, respectively, and at postoperative 12 months were 41.36 ± 2.08 D and 42.65 ± 2.78 D, respectively. At postoperative 12 months, visual and refractive outcomes were maintained. Comparisons between preoperative and postoperative 12 month timepoints were statistically significant for all parameters. CONCLUSION Simultaneous wavefront-guided PRK followed by CXL is a promising treatment for the visual rehabilitation of keratoconus patients.
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Affiliation(s)
| | | | - Pilar Vargas
- Bogota Laser Ocular Surgery Center, Bogota, Colombia
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15
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Iqbal M, Elmassry A, Badawi AE, Gharieb HM, Said OM. Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management. Clin Ophthalmol 2019; 13:2477-2488. [PMID: 31849445 PMCID: PMC6913285 DOI: 10.2147/opth.s232954] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/04/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose To analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management. Patients and methods This study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively. Results Forty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by <1 D, 23 eyes (46.9%) improved from 1 D to <2 D and 7 eyes (14.3%) improved by ≥2 D. Both uncorrected distant visual acuity (UDVA) and corrected distant visual acuity (CDVA) showed statistically significant improvement from preoperative 1.34±0.29 (mean±SD) and 0.74±0.23 LogMAR to postoperative 0.99±0.32 and 0.50±0.22 LogMAR (P<0.0001) respectively. Both Kmax and SE refraction showed statistically significant and stable improvement from preoperative 51.95±1.90 and −7.90±3.14 D to postoperative 50.19±1.96 and −6.35±2.49 D (P<0.0001) respectively. Two eyes (4%) showed KC progression at the end of 5th follow-up year. Conclusion SCXL had good effectiveness and stability that halted KC progression over 5-year follow-up period. It had also unexpected improvement in the KC refractive components mainly the spherical and SE components.
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Affiliation(s)
- Mohammed Iqbal
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed Elmassry
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amani E Badawi
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hesham M Gharieb
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Omar M Said
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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16
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Koh IH, Seo KY, Park SB, Yang H, Kim I, Kim JS, Hwang DG, Nam SM. One-Year Efficacy and Safety of Combined Photorefractive Keratectomy and Accelerated Corneal Collagen Cross-Linking after Intacs SK Intracorneal Ring Segment Implantation in Moderate Keratoconus. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7850216. [PMID: 31360724 PMCID: PMC6644267 DOI: 10.1155/2019/7850216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/24/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To report one-year outcomes of a modified version of two-stage multimodal surgical protocol for moderate keratoconus which has been suggesting promising preliminary results. MATERIALS AND METHODS 30 eyes of 25 patients with moderate keratoconus who exhibited visual complaints and/or disease progression were included for this retrospective case study. Approximately 3 months after implantation of intracorneal ring segment (Intacs SK™), a combination of corneal wavefront-guided transepithelial photorefractive keratectomy (CWG-transPRK, Schwind Amaris® 1050, and Schwind Sirius) and accelerated collagen cross-linking (accCXL, Avedro KXL™) was performed. Patients were examined for uncorrected and corrected distance visual acuity (UDVA; CDVA), keratometric power (K), corneal thickness, and corneal higher-order aberrations (HOAs) preoperatively and at postoperative 1, 3, 6, and 12 months. RESULTS The median UDVA and mean CDVA were enhanced from 6/38 to 6/12 and from 6/19 to 6/7.5, respectively, through 12 months after CWG-transPRK/accCXL. The 12-month CDVA of all patients was better than 6/12 Snellen, and no subject lost one or more lines of CDVA. The magnitudes of both myopia and corneal steepness were decreased in turn by Intacs SK implantation and also by CWG-transPRK/accCXL, but the reduction in HOA was largely the result of CWG-transPRK/accCXL. The magnitude of corneal thinning stabilized within 3 months after CWG-transPRK/accCXL. CONCLUSION This approach may allow patients with moderate keratoconus to obtain satisfactory vision without the need for contact lens wear. This surgery appeared to be effective and safe through 1 year of follow-up.
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Affiliation(s)
- Il Hwan Koh
- SU Yonsei Eye Clinic, Seoul, Republic of Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Institute of Vision Research, Eye and Ear Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Hun Yang
- SU Yonsei Eye Clinic, Seoul, Republic of Korea
| | - InSik Kim
- SU Yonsei Eye Clinic, Seoul, Republic of Korea
| | - Jin Sun Kim
- SU Yonsei Eye Clinic, Seoul, Republic of Korea
| | - David G. Hwang
- Cornea Service and Refractive Surgery Service, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Sang Min Nam
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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17
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Mercatelli R, Mattana S, Capozzoli L, Ratto F, Rossi F, Pini R, Fioretto D, Pavone FS, Caponi S, Cicchi R. Morpho-mechanics of human collagen superstructures revealed by all-optical correlative micro-spectroscopies. Commun Biol 2019; 2:117. [PMID: 30937399 PMCID: PMC6435656 DOI: 10.1038/s42003-019-0357-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 02/05/2019] [Indexed: 12/18/2022] Open
Abstract
In every biological tissue, morphological and topological properties strongly affect its mechanical features and behaviour, so that ultrastructure, composition and mechanical parameters are intimately connected. Overall, it is their correct interplay that guarantees the tissue functionality. The development of experimental methods able to correlate these properties would open new opportunities both in the biological and the biomedical fields. Here, we report a correlative study intended to map supramolecular morphology, biochemical composition and viscoelastic parameters of collagen by all-optical microscopies. In particular, using human corneal tissue as a benchmark, we correlate Second-Harmonic Generation maps with mechanical and biochemical imaging obtained by Brillouin and Raman micro-spectroscopy. The study highlights how subtle variations in supramolecular organization originate the peculiar mechanical behavior of different subtypes of corneal lamellae. The presented methodology paves the way to the non-invasive assessment of tissue morpho-mechanics in biological as well as synthetic materials.
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Affiliation(s)
- Raffaella Mercatelli
- National Institute of Optics, National Research Council (CNR-INO), Via Nello Carrara 1, I-50019 Sesto Fiorentino, Italy
| | - Sara Mattana
- National Institute of Optics, National Research Council (CNR-INO), Via Nello Carrara 1, I-50019 Sesto Fiorentino, Italy
- Department of Physics and Geology, University of Perugia, Via Alessandro Pascoli, I-06123 Perugia, Italy
| | - Laura Capozzoli
- Institute of Applied Physics “Nello Carrara”, National Research Council (CNR-IFAC), Via Madonna del Piano 10, I-50019 Sesto Fiorentino, Italy
- Center of Electron Microscopy “Laura Bonzi” (Ce.M.E), Institute of Chemistry of Organometallic Compounds, National Research Council (CNR-ICCOM), Via Madonna del Piano 10, I-50019 Sesto Fiorentino, Italy
| | - Fulvio Ratto
- Institute of Applied Physics “Nello Carrara”, National Research Council (CNR-IFAC), Via Madonna del Piano 10, I-50019 Sesto Fiorentino, Italy
| | - Francesca Rossi
- Institute of Applied Physics “Nello Carrara”, National Research Council (CNR-IFAC), Via Madonna del Piano 10, I-50019 Sesto Fiorentino, Italy
| | - Roberto Pini
- Institute of Applied Physics “Nello Carrara”, National Research Council (CNR-IFAC), Via Madonna del Piano 10, I-50019 Sesto Fiorentino, Italy
| | - Daniele Fioretto
- Department of Physics and Geology, University of Perugia, Via Alessandro Pascoli, I-06123 Perugia, Italy
- CEMIN-Center of Excellence for Innovative Nanostructured Material, Via Alessandro Pascoli, I-06123 Perugia, Italy
| | - Francesco Saverio Pavone
- National Institute of Optics, National Research Council (CNR-INO), Via Nello Carrara 1, I-50019 Sesto Fiorentino, Italy
- European Laboratory for Non-linear Spectroscopy (LENS), Via Nello Carrara 1, I-50019 Sesto Fiorentino, Italy
- Department of Physics, University of Florence, Via Giovanni Sansone 1, I-50019 Sesto Fiorentino, Italy
| | - Silvia Caponi
- Institute of Materials, National Research Council (CNR-IOM), Unit of Perugia, c/o Department of Physics and Geology, University of Perugia, Via A. Pascoli, I-06123 Perugia, Italy
| | - Riccardo Cicchi
- National Institute of Optics, National Research Council (CNR-INO), Via Nello Carrara 1, I-50019 Sesto Fiorentino, Italy
- European Laboratory for Non-linear Spectroscopy (LENS), Via Nello Carrara 1, I-50019 Sesto Fiorentino, Italy
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