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Neuhann L, Vogel D, Hall J, Dreyhaupt J, Werner JU, Garip-Kuebler A, Enders C. Keratometry Changes Between Year One to Seven After Corneal Cross-Linking in Patients With Keratoconus. Cornea 2024; 43:1397-1402. [PMID: 38289746 DOI: 10.1097/ico.0000000000003478] [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: 09/18/2023] [Accepted: 12/10/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE We evaluated the timing at and extent to which midterm to long-term keratometric changes can occur in year 1 to 7 after corneal collagen cross-linking (CXL) in patients with keratoconus. METHODS We conducted a subgroup analysis of a retrospective cohort study of all consecutive patients who underwent CXL at our cornea center between 2007 and 2011. The inclusion criteria comprised CXL according to the Dresden protocol and a full set of keratometry parameters collected by Scheimpflug tomography preoperatively and at year 1, 3, 5, and 7 after CXL. In addition, best-corrected visual acuity was evaluated. RESULTS Sixty-three eyes of 47 patients were enrolled. Mean age was 25.46 years ±7.39 years (80.9% male patients). All relevant keratometric parameters showed significant improvement at year 1 after CXL (except for posterior astigmatism). According to mixed-effects model analysis, they all showed further significant change at different points in time between year 1, 3, 5, and 7 (except for K1). In addition, best-corrected visual acuity improved statistically significant between year 1, 3, 5, and 7. Suspected disease progression was noted in 22.2% of patients, mostly between year 1 and 3 after CXL. CONCLUSIONS After initial improvement 1 year after CXL, keratometric and functional parameters were stable until year 5 after CXL in most cases; further improvement can take place even after up to 7 years post-CXL. By contrast, in case of disease progression, changes seem to occur already between year 1 and 3 after CXL.
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Affiliation(s)
- Lukas Neuhann
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
- MVZ Prof. Neuhann, Munich, Germany
| | | | | | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany ; and
| | | | - Aylin Garip-Kuebler
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
- MVZ Prof. Neuhann, Munich, Germany
| | - Christian Enders
- MVZ Prof. Neuhann, Munich, Germany
- Department of Ophthalmology, Ulm University, Ulm, Germany
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Li Y, Qiao C, Wang H, Liu Y, Qi M, Ke L, Zhou Y, Shen D, Zeng Q. Prediction model for treatment outcomes 3 years after corneal cross-linking for keratoconus. Int Ophthalmol 2024; 44:382. [PMID: 39302502 DOI: 10.1007/s10792-024-03301-8] [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: 12/03/2023] [Accepted: 09/08/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE This study aimed to identify preoperative factors that predict visual acuity and Kmax 3 years after corneal cross-linking (CXL) in patients with keratoconus (KC), and to develop a prediction model. METHODS We enrolled 68 patients with KC and followed up on 100 eyes that received CXL for at least 3 years. Preoperative data, including age, UDVA, CDVA, cylinder, SE, and the parameters of tomography including Kmax were collected as predictors. The primary outcomes were changes in CDVA (Delta CDVA) and Kmax (Delta Kmax) postoperatively. Univariate and multivariate linear regression were used to identify the correlation between the primary outcomes and predictors and establish prediction models. RESULTS Both CDVA and Kmax remained stable from baseline to 3 years after CXL: from 0.25 ± 0.18 to 0.22 ± 0.20 (P = 0.308) and from 58.70 ± 9.52 D to 57.02 ± 8.83 D (P = 0.187), respectively. Multivariate analysis showed that worse preoperative CDVA (ß coefficient - 0.668, P < 0.001) and lower preoperative Kmean (ß coefficient 0.018,P < 0.001) were associated with greater improvement in CDVA after CXL. A smaller preoperative eccentricity (ß coefficient 8.896, P = 0.01) and a higher preoperative Kmean (ß coefficient - 1.264, P < 0.001) predicted a more flattening of postoperative Kmax. The prediction model for CDVA (R2 = 0.43) and Kmax (R2 = 0.37) could accurately estimate treatment outcomes. CONCLUSIONS CXL is highly effective in halting or preventing further progression of KC. The preoperative factors CDVA and Kmean were able to predict visual acuity changes 3 years after CXL. And preoperative eccentricity and Kmean could predict Kmax changes 3 years after CXL.
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Affiliation(s)
- Yuping Li
- Aier School of Ophthalmology, Central South University, Changsha, 410083, China
- Chongqing Aier Eye Hospital, Chongqing, 400025, China
| | - Chen Qiao
- Department of Ocular Surface, Hankou Aier Eye Hospital, Wuhan, 430024, China
| | - Haoyu Wang
- Department of Ocular Surface, Hankou Aier Eye Hospital, Wuhan, 430024, China
| | - Yu Liu
- Aier School of Ophthalmology, Central South University, Changsha, 410083, China
| | - MengYing Qi
- Department of Ocular Surface, Hankou Aier Eye Hospital, Wuhan, 430024, China
| | - Lan Ke
- Department of Ocular Surface, Hankou Aier Eye Hospital, Wuhan, 430024, China
| | - Yu Zhou
- Aier Eye Hospital of Wuhan University, Wuhan, 430024, China
| | - Dan Shen
- Department of Ocular Surface, Hankou Aier Eye Hospital, Wuhan, 430024, China
| | - Qingyan Zeng
- Aier School of Ophthalmology, Central South University, Changsha, 410083, China.
- Department of Ocular Surface, Hankou Aier Eye Hospital, Wuhan, 430024, China.
- Aier Eye Hospital of Wuhan University, Wuhan, 430024, China.
- School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University Science and Technology, Xianning, China.
- Department of Ocular Surface, Wuhan Aier Hankou Eye Hospital, No.328, Machang Rd, Jianghan District, Wuhan430024, R.P. China.
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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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Cehelyk EK, Syed ZA. Long-term outcomes of corneal crosslinking. Curr Opin Ophthalmol 2024; 35:315-321. [PMID: 38700950 DOI: 10.1097/icu.0000000000001054] [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: 05/05/2024]
Abstract
PURPOSE OF REVIEW This manuscript summarizes contemporary research from 2018 to 2023 evaluating long-term (≥2 years) outcomes of corneal crosslinking (CXL) for progressive keratoconus (KCN). RECENT FINDINGS The standard Dresden protocol (SDP) has been utilized clinically since the early 2000 s to treat ectatic disorders, primarily progressive KCN and postrefractive ectasia. Various modifications have since been introduced including accelerated and transepithelial protocols, which are aimed at improving outcomes or reducing complications. This review summarizes data demonstrating that the SDP halts disease progression and improves various visual and topographic indices (UDVA, CDVA, Kmax, K1, K2) up to 13 years postoperatively. Accelerated and transepithelial protocols have been found to be well tolerated alternatives to SDP with similar efficacy profiles. Studies focusing on pediatric populations identified overall higher progression rates after CXL. All protocols reviewed had excellent safety outcomes in adults and children. SUMMARY Recent studies revealed that SDP successfully stabilizes KCN long term, and a variety of newer protocols are also effective. Pediatric patients may exhibit higher progression rates after CXL. Further research is required to enhance the efficacy and ease of these protocols.
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Affiliation(s)
| | - Zeba A Syed
- Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Cortina MS, Greiner MA, Kuo AN, Li JY, Miller DD, Shtein RM, Veldman PB, Yin J, Kim SJ, Shen JF. Safety and Efficacy of Epithelium-Off Corneal Collagen Cross-Linking for the Treatment of Corneal Ectasia: A Report by the American Academy of Ophthalmology. Ophthalmology 2024:S0161-6420(24)00282-3. [PMID: 38935041 DOI: 10.1016/j.ophtha.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To review the evidence on the safety and effectiveness of epithelium-off corneal collagen cross-linking (CXL) for the treatment of progressive corneal ectasia. METHODS A literature search of the PubMed database was most recently conducted in March 2024 with no date restrictions and limited to studies published in English. The search identified 359 citations that were reviewed in abstract form, and 43 of these were reviewed in full text. High-quality randomized clinical trials comparing epithelium-off CXL with conservative treatment in patients who have keratoconus (KCN) and post-refractive surgery ectasia were included. The panel deemed 6 articles to be of sufficient relevance for inclusion, and these were assessed for quality by the panel methodologist; 5 were rated level I, and 1 was rated level II. There were no level III studies. RESULTS This analysis includes 6 prospective, randomized controlled trials that evaluated the use of epithelium-off CXL to treat progressive KCN (5 studies) and post-laser refractive surgery ectasia (1 study), with a mean postoperative follow-up of 2.4 years (range, 1-5 years). All studies showed a decreased progression rate in treated patients compared with controls. Improvement in the maximum keratometry (Kmax) value, corrected distance visual acuity (CDVA), and uncorrected distance visual acuity (UDVA) was observed in the treatment groups compared with control groups. A decrease in corneal thickness was observed in both groups but was greater in the CXL group. Complications were rare. CONCLUSIONS Epithelium-off CXL is effective in reducing the progression of KCN and post-laser refractive surgery ectasia in most treated patients with an acceptable safety profile. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maria S Cortina
- Department of Ophthalmology and Visual Science, University of Illinois College of Medicine, Chicago, Illinois
| | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Anthony N Kuo
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer Y Li
- UC Davis Eye Center, University of California, Davis, California
| | - Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| | - Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Peter B Veldman
- Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois
| | - Jia Yin
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joanne F Shen
- Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
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Hagem AM, Thorsrud A, Sæthre M, Sandvik G, Kristianslund O, Drolsum L. Dramatic Reduction in Corneal Transplants for Keratoconus 15 Years After the Introduction of Corneal Collagen Crosslinking. Cornea 2024; 43:437-442. [PMID: 37851565 DOI: 10.1097/ico.0000000000003401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/28/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The aim of this study was to investigate the effect of the implementation of corneal collagen crosslinking (CXL) on the frequency of corneal transplants among patients with keratoconus (KC) in the same region. METHODS Before the introduction of CXL in 2007, 55 primary corneal transplants had been conducted in patients with KC (2005 and 2006) at the Department of Ophthalmology, Oslo University Hospital, Norway. We collected data from our corneal transplant registry for 2021 and 2022. The primary outcome was the number of corneal transplants performed in patients with KC. Age, sex, visual acuity (logarithm of the minimal angle of resolution), KC stage according to the Amsler-Krumeich classification system, and steepest keratometry reading (maximum keratometry, Pentacam, HR) were recorded. Furthermore, we registered the annual number of CXL treatments conducted from 2007 to 2022. RESULTS A total of 352 corneal transplants were performed in 2021 and 2022. Among them, 11 (3.1%) were transplants for patients with KC. All included patients were male; further, 90.1% and 9.1% of the patients were graded stages 4 and 3, respectively. The mean maximum keratometry was 79.0 diopter (range 61.0-109). The mean best-corrected visual acuity (logarithm of the minimal angle of resolution) was 1.3 (range 0.2-3.0). In 2021 to 2022, 431 CXL treatments were performed. CONCLUSIONS There was a significant decrease in the number of corneal transplants performed in patients with KC 15 years after the introduction of CXL. This indicates that the availability of CXL treatment over many years may considerably reduce the need for keratoplasties in this group of patients.
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Affiliation(s)
- Anne Marie Hagem
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Thorsrud
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Marit Sæthre
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Gunhild Sandvik
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Liu Y, He Y, Deng Y, Wang L. Lenticule addition keratoplasty for the treatment of keratoconus: A systematic review and critical considerations. Indian J Ophthalmol 2024; 72:S167-S175. [PMID: 38271413 DOI: 10.4103/ijo.ijo_695_23] [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: 03/11/2023] [Accepted: 09/09/2023] [Indexed: 01/27/2024] Open
Abstract
Keratoconus is a corneal disorder characterized by the progressive thinning and bulging of the cornea. Currently, the major goal of management is to halt its progression, restore normal corneal strength, prevent acute complications, and save vision. Penetrating keratoplasty and deep anterior lamellar keratoplasty as conventional surgical methods for advanced keratoconus are limited by relatively high rates of immune intolerance, slow post-operational recovery, high costs, and shortage of donor corneas. Recently, the development of lenticule addition keratoplasty enables the restoration of corneal thickness simply by implanting a lenticule into the stromal pocket created with the femtosecond laser, which can originate from cadaver corneas or more appealing, be extracted from patients via a small-incision lenticule extraction (SMILE) surgery. As the first systematic review in this field, we critically review publications on lenticule addition keratoplasty and provide our perspectives on its clinical application and the focus of future research.
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Affiliation(s)
- Yanling Liu
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yan He
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Meyer JJ, Gokul A, Vellara HR, McGhee CNJ. Progression of keratoconus in children and adolescents. Br J Ophthalmol 2023; 107:176-180. [PMID: 34479856 DOI: 10.1136/bjophthalmol-2020-316481] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/23/2021] [Indexed: 01/25/2023]
Abstract
AIMS To evaluate the rates of keratoconus progression and associated factors in eyes of children and adolescents. METHODS Retrospective, cohort study of individuals ≤18 years old at the time of keratoconus diagnosis and with at least 6 months of follow-up. Corneal tomography was performed using an Orbscan tomographer (Bausch & Lomb, Rochester, New York, USA) to determine whether progression occurred. Tomographic progression of keratoconus was defined as a change in any of the investigated parameters (keratometry values, KMAX, maximum anterior or posterior elevation, central pachymetry, thinnest pachymetry) beyond the limits of repeatability. RESULTS 148 eyes of 106 patients with a mean age of 15.2±2.5 years were studied over a mean follow-up period of 2.9±2.2 years. The overall rate of tomographic progression was 77.0% (114/148 eyes). Eyes that progressed had more advanced disease at presentation with higher anterior curvature (KMAX55.4±6.3 vs 52.2±5.4 dioptres; p<0.01), posterior elevation (108.2±40.9 vs 86.3±35.6 µm; p<0.01) and lower central pachymetry measurements (442.1±56.7 vs 454.4±47.5 µm; p=0.01). Age at presentation, gender, atopy, documented eye rubbing, ethnicity and duration of follow-up were not significantly associated with progression in the multivariate analyses. There was a higher rate of bilateral progression if at least one eye had severe keratoconus (73.9%) compared with no severe keratoconus in either eye (36.8%; p=0.03). CONCLUSIONS A high rate of progression was identified in keratoconic eyes of children and adolescents. More advanced disease at initial presentation may increase the risk of further keratoconus progression.
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Affiliation(s)
- Jay J Meyer
- Ophthalmology, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Akilesh Gokul
- Ophthalmology, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Hans R Vellara
- Ophthalmology, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Charles N J McGhee
- Ophthalmology, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
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Smith JR. Randomised controlled trials in ophthalmology. Clin Exp Ophthalmol 2022; 50:988-990. [DOI: 10.1111/ceo.14179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 11/10/2022]
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10
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Enders C, Vogel D, Dreyhaupt J, Wolf W, Garip-Kuebler A, Hall J, Neuhann L, Werner JU. Corneal cross-linking in patients with keratoconus: up to 13 years of follow-up. Graefes Arch Clin Exp Ophthalmol 2022; 261:1037-1043. [PMID: 36197498 DOI: 10.1007/s00417-022-05844-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/20/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION To evaluate long-term safety and efficacy of corneal collagen cross-linking (CXL) in patients with keratoconus up to 13 years. MATERIALS AND METHODS In this mono-centre exploratory study, we included all consecutive patients who underwent CXL in our cornea centre from 01/01/2007 to 12/30/2011 and met the inclusion criteria. CXL was performed in all patients according to the Dresden protocol. Evaluation included best-corrected visual acuity (BCVA), topographic keratometry by Scheimpflug corneal tomography and endothelial cell count (ECC). Follow-up measurements were taken up to 13 years after treatment were compared with baseline values. RESULTS The study enrolled 168 eyes. The mean age of our patients was 26.3 years ± 7.8 years. A complete topographic dataset was available 1 year postoperatively for 142 eyes, 5 years postoperatively for 105 eyes, 10 years postoperatively for 61 eyes and 13 years postoperatively for 9 eyes. BCVA increased statistically significant after 1 year, 5 years and 10 years and non-significantly after 13 years. All keratometric parameters with exception of posterior astigmatism showed a statistically significant decrease after 1 year, 5 years and 10 years. After 13 years, the decrease was statistically significant only in Kmax, K2 and thinnest cornea. No significant changes in ECC were detected. Three eyes received Re-CXL, none of the eyes received penetrating keratoplasty and no infections occurred in this cohort. CONCLUSIONS CXL can slow down or even stop the progression of keratoconus in the majority of cases. The effect is long-lasting with excellent safety.
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Affiliation(s)
- Christian Enders
- MVZ Prof. Neuhann GmbH, Helene-Weber-Allee 19, 80637, Munich, Germany.
| | - Diana Vogel
- MVZ Prof. Neuhann GmbH, Helene-Weber-Allee 19, 80637, Munich, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Waltraud Wolf
- MVZ Prof. Neuhann GmbH, Helene-Weber-Allee 19, 80637, Munich, Germany.,MVZ Smileeyes Alte Boerse, Munich, Germany
| | | | - Jonathan Hall
- MVZ Prof. Neuhann GmbH, Helene-Weber-Allee 19, 80637, Munich, Germany
| | - Lukas Neuhann
- MVZ Prof. Neuhann GmbH, Helene-Weber-Allee 19, 80637, Munich, Germany
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Angelo L, Gokul Boptom A, McGhee C, Ziaei M. Corneal Crosslinking: Present and Future. Asia Pac J Ophthalmol (Phila) 2022; 11:441-452. [PMID: 36094381 DOI: 10.1097/apo.0000000000000557] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/08/2022] [Indexed: 11/25/2022] Open
Abstract
Keratoconus is a progressive corneal thinning disorder that can lead to vision loss. In the last 2 decades, corneal crosslinking (CXL) has emerged as an effective method to halt the progression of keratoconus and reduce the number of patients requiring keratoplasty. The procedure has been adopted globally and has evolved to become a part of combination treatments to regularize the cornea and improve visual outcomes. CXL has even been extrapolated in managing other ocular pathologies such as progressive myopia, infectious keratitis, and bullous keratopathy. This review aims to summarize the current role of CXL in keratoconus and its alternative uses, and provide insights into future developments in this fast-developing field.
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Affiliation(s)
- Lize Angelo
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Crosslinking vs. Observation in Fellow Eyes of Keratoconus Patients. J Ophthalmol 2022; 2022:4661392. [PMID: 35692966 PMCID: PMC9177316 DOI: 10.1155/2022/4661392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate whether unilateral crosslinking (CXL) and conservative follow-up of the fellow eye is an acceptable management strategy in patients with keratoconus (KC). Methods Seventy-nine fellow eyes of KC subjects that initially underwent unilateral CXL were included. Thirty fellow eyes ultimately received CXL (group 1) whereas 49 fellow eyes were followed (group 2). Best spectacle corrected visual acuity (BSCVA) and corneal tomographic parameters were collected in all eyes preoperatively and at the last follow-up. Results Subjects who received CXL in the fellow eye (group 1) were younger than subjects who did not (group 2, p=0.026). Group 1 eyes had higher baseline K1 (p=0.026), K2 (p=0.006), Km (p=0.01), and Kmax (p=0.002) compared to group 2 eyes. Amongst the 49 naïve fellow eyes (group 2), 19 eyes showed evidence of progression. Progressing naïve eyes had higher baseline K1, K2, Km, and Kmax (p < 0.01); progressors also had thinner pachymetry at the pupil, apex, and thinnest point (p < 0.01). Baseline values of K1 ≥ 43.5 Diopter (D), K2 > 45.1D, Km > 44.3D, Kmax > 47.9D, astigmatism > 1.4D, pachymetry at the pupil <475 μm, and thinnest pachymetry <478 μm were tentative predictors of progression in the naïve fellow eye. Conclusions Unilateral CXL with vigilant follow up of the fellow eye may be an acceptable management strategy in a subset of KC eyes.
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Bhattacharyya A, Sarma P, Kaur H, Hafezi F, Bhattacharyya J, Kirubakaran R, Prajapat M, Medhi B, Das K, Prakash A, Singh A, Kumar S, Singh R, Reddy D, Kaur G, Sharma S. Short- and long-term safety and efficacy of corneal collagen cross-linking in progressive keratoconus: A systematic review and meta-analysis of randomized controlled trials. Taiwan J Ophthalmol 2022. [PMID: 37484615 PMCID: PMC10361434 DOI: 10.4103/2211-5056.361974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of the study is to evaluate the safety and outcomes of corneal collagen cross-linking (CXL) and different CXL protocols in progressive keratoconus (PK) population at short and long-term. MATERIALS AND METHODS A systematic review and meta-analysis was conducted. A total of eight literature databases were searched (up to February 15, 2022). Randomized controlled trials (RCTs) comparing CXL versus placebo/control or comparing different CXL protocols in the PK population were included. The primary objective was assessment of outcomes of CXL versus placebo and comparison of different CXL protocols in terms of maximum keratometry (Kmax) or Kmax change from baseline (Δ), spherical equivalent, best corrected visual acuity (BCVA), and central corneal thickness (CCT) in both at short term (6 months) and long term (1st, 2nd, and 3rd year or more). The secondary objective was comparative evaluation of safety. For the meta-analysis, the RevMan5.3 software was used. RESULTS A total of 48 RCTs were included. Compared to control, CXL was associated with improvement in Δ Kmax at 1 year (4 RCTs, mean difference [MD], -1.78 [-2.71, -0.86], P = 0.0002) and 2 and 3 years (1 RCT); ΔBCVA at 1 year (7 RCTs, -0.10 [-0.14, -0.06], P < 0.00001); and Δ CCT at 1 year (2 RCTs) and 3 years (1 RCT). Compared to conventional CXL (C-CXL), deterioration in Δ Kmax, ΔBCVA and endothelial cell density was seen at long term in the transepithelial CXL (TE-CXL, chemical enhancer). Up to 2 years, there was no difference between TE-CXL using iontophoresis (T-ionto) and C-CXL. At 2 and 4 years, C-CXL performed better compared to accelerated CXL (A-CXL) in terms of improving Kmax. Although CCT was higher in the A-CXL arm at 2 years, there was no difference at 4 years. While exploring heterogeneity among studies, selection of control eye (fellow eye of the same patient vs. eye of different patient) and baseline difference in Kmax were important sources of heterogeneity. CONCLUSION CXL outperforms placebo/control in terms of enhancing Kmax and CCT, as well as slowing disease progression over time (till 3 years). T-ionto protocol, on the other hand, performed similarly to C-CXL protocol up to 2 years.
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