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Preliminary Characterization of Predictive Factors of the Visual Change after Epi-On and Epi-Off Corneal Collagen Crosslinking Techniques. J Ophthalmol 2021; 2021:9680253. [PMID: 34917415 PMCID: PMC8670975 DOI: 10.1155/2021/9680253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the potential predictive factors of the visual change achieved with accelerated epi-on and epi-off corneal collagen crosslinking (CXL) in keratoconus. Methods This retrospective comparative study analyzed 67 eyes treated with an accelerated epithelium-on (epi-on group) and epithelium-off (epi-off group) CXL. The clinical outcomes were evaluated and compared during a 1-year follow-up. Likewise, the relationship of the change achieved with both CXL techniques in the corrected distance visual acuity (CDVA) with different preoperative data was investigated. Results The mean CDVA change at 3 months postoperatively was −0.04 ± 0.19 and −0.07 ± 0.25 in the epi-on and epi-off groups, respectively (p = 0.809). In the epi-on group, this change was significantly correlated with the preoperative apical (r = −0.375, p = 0.045) and central corneal thickness (r = −0.402, p = 0.031). In the epi-off group, the CDVA change was significantly correlated with not only the preoperative apical (r = 0.402, p = 0.028) and central corneal thickness (r = 0.367, p = 0.046) but also with some topometric and aberrometric indices (r ≤ −0.374, p ≤ 0.042). Furthermore, the change in CDVA in the epi-on group could be predicted from age, preoperative refractive astigmatism J45 component, anterior corneal asphericity, and posterior corneal high order aberration root mean square (p = 0.002, R2 = 0.503). In the epi-off group, the CDVA change could be predicted from the preoperative minimum corneal thickness and magnitude of the vertical anterior corneal primary coma component (p = 0.001, R2 = 0.446). Conclusions Clearly, different predictive factors of the visual change induced with the accelerated epi-on and epi-off CXL techniques are present, suggesting a different mechanism of action for stiffening the cornea and inducing changes in this structure.
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Zhang X, Sun L, Tian M, Shen Y, Li M, Zhao J, Zhou X. Accelerated (45 mW/cm 2) Transepithelial Corneal Cross-Linking for Progressive Keratoconus Patients: Long-Term Topographical and Clinical Outcomes. Front Med (Lausanne) 2020; 7:283. [PMID: 32637419 PMCID: PMC7318888 DOI: 10.3389/fmed.2020.00283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022] Open
Abstract
Aims: We characterized long-term clinical outcomes of accelerated (45 mW/cm2) transepithelial corneal cross-linking (ATE-CXL) for the treatment of progressive keratoconus. Methods: Forty-two eyes from 37 patients treated for keratoconus were observed. ATE-CXL was performed using riboflavin and pulsed-light ultraviolet treatment (45 mW/cm2, 7.2 J/cm2). Structural and functional measurements were made after 1 week and 1, 3, 6, 12, 24, 36, and 48 months subsequently. Corneal topographic parameters were observed using Scheimpflug topography (Pentacam software). Results: Surgery was uneventful in all subjects. Mean uncorrected (UDVA) and corrected distance visual acuity (CDVA) (logMAR) were 0.99 ± 0.58 and 0.44 ± 0.27 (P = 0.022), 0.24 ± 0.29 and 0.27 ± 0.35 (P = 0.601), at baseline and last follow-up, respectively. The pre-operative mean maximum keratometry (Kmax) value was 57.29 ± 9.13 diopters (D), and the thinnest corneal thickness (TCT) was 456.21 ± 44.66 μm. Mean Kmax was 56.67 ± 9.36 D, 4 years post-operatively (P = 0.781). TCT changed to 453.17 ± 46.76 μm at 4 years post-operatively (P = 0.780). Multiple linear regression indicated that patients with thinner pre-operative TCT (≤ 450 μm) showed decreasing post-operative average keratometry (Kavg) and increasing post-operative TCT. Patients with posterior central elevation (PCE) >80 μm showed decreasing post-operative Kavg as well as post-operative PCE. No complications were observed during follow-up. Conclusion: Stabilization after ATE-CXL was achieved for the treatment of keratoconus. The clinical efficacy of ATE-CXL in advanced keratoconus patients with thin corneal thickness and greater PCE will require further investigation.
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Affiliation(s)
- Xiaoyu Zhang
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ling Sun
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Mi Tian
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yang Shen
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhao
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Study of Demarcation Line Depth in Transepithelial versus Epithelium-Off Accelerated Cross-Linking (AXL) in Keratoconus. J Ophthalmol 2019; 2019:3904565. [PMID: 31662893 PMCID: PMC6791224 DOI: 10.1155/2019/3904565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/03/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
Aim This is a prospective interventional clinical trial to assess the depth of the demarcation line in transepithelial versus epithelium-off accelerated corneal cross-linking (AXL) in keratoconus patients. Methods This prospective clinical trial was conducted on 40 eyes of 20 patients. Each patient had transepithelial AXL in one eye and epithelium-off AXL in the contralateral eye applying UVA light with an irradiance of 45 mW/cm2 for 2.4 minutes and 30 mW/cm2 for 4 minutes. The depth of the demarcation line was measured using anterior segment OCT (Topcon 3D OCT-2000) one month postoperative for both eyes. Results The demarcation line was patchy in 50% of the transepithelial AXL eyes, the other half showing a demarcation line at a mean depth of 183 ± 41.6 μm. In the epithelium-off AXL technique, the demarcation line was well defined in all cases with a mean depth of 219 ± 27.3 μm. There was a statistically significant difference in corneal demarcation line depth between transepithelial and epithelium-off techniques (P = 0.008 and P < 0.05). The shallower demarcation line in the transepithelial group suggests that it is less effective. Conclusion Based on the depth of the demarcation line, the cross-linking effect of epi-off AXL seems more efficacious than after transepithelial AXL. The future will show if the biomechanical effect will be sufficient to stop progression of keratoconus similarly after standard CXL. This trial is registered with NCT04045626.
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Madeira C, Vasques A, Beato J, Godinho G, Torrão L, Falcão M, Falcão-Reis F, Pinheiro-Costa J. Transepithelial accelerated versus conventional corneal collagen crosslinking in patients with keratoconus: a comparative study. Clin Ophthalmol 2019; 13:445-452. [PMID: 30880905 PMCID: PMC6402612 DOI: 10.2147/opth.s189183] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose To systematically compare the efficacy of transepithelial accelerated corneal collagen crosslinking (TE-ACXL) with conventional corneal collagen crosslinking (C-CXL) in patients with progressive keratoconus. Methods Eyes of patients with progressive keratoconus who were treated with C-CXL (3 mW/cm2 for 30 minutes) were compared with those who underwent TE-ACXL (6 mW/cm2 for 15 minutes). Best-corrected visual acuity (BCVA), keratometry values, corneal thickness, and topometric indexes were compared before CXL, and at 2 months, 6 months, and 12 months postoperatively. Results The study enrolled 26 eyes of which 16 had TE-ACXL and 10 had C-CXL. Both groups were comparable at baseline and 12 months in terms of BCVA (P=0.16 and P=0.57), Kmax (maximum keratometry) (P=0.31 and P=0.73), pachymetry (P=0.75 and P=0.37), index of surface variance (ISV) (P=0.45 and P=0.86), index of vertical asymmetry (IVA) (P=0.26 and P=0.61), and index of height decentration (IHD) (P=0.27 and P=0.86, respectively). We did not observe significant differences between preoperative and 12-month postoperative readings in within-group analysis: ΔKmax (TE-ACXL, −2.13±5.41, P=0.25 vs C-CXL, 0.78±1.65, P=0.17), Δpachymetry (TE-ACXL, 4.10±14.83, P=0.41 vs C-CXL, −8.90±22.09, P=0.24), ΔISV (TE-ACXL, −8.50±21.26, P=0.24 vs C-CXL, 3.80±12.43, P=0.36), ΔIVA (TE-ACXL, −0.12±0.31, P=0.26 vs C-CXL, 0.03±0.18, P=0.61), and ΔIHD (TE-ACXL, −0.03±0.07, P=0.18 vs C-CXL, −0.01±0.03, P=0.88). Conclusion Both TE-ACXL and C-CXL were similarly effective. Further follow-up is required to determine whether these techniques are comparable in the long-term.
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Affiliation(s)
- Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal,
| | - Ana Vasques
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal,
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal,
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal,
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal, .,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal, .,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal, .,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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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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Abozaid MA. Sequential Keraring implantation and corneal cross-linking for the treatment of keratoconus in children with vernal keratoconjunctivitis. Clin Ophthalmol 2017; 11:1891-1895. [PMID: 29123375 PMCID: PMC5661448 DOI: 10.2147/opth.s150022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to assess the safety and efficacy of femtosecond laser-assisted Keraring implantation followed by transepithelial accelerated corneal collagen cross-linking (CXL) for the treatment of keratoconus in children with vernal keratoconjunctivitis (VKC). Study design This is a prospective interventional non-comparative case series. Patients and methods Eighteen eyes of 11 children with keratoconus and VKC were included in this study. All the cases were treated with femtosecond laser-assisted Keraring implantation followed after 2 weeks by transepithelial accelerated CXL, and the patients were followed up for 1 year. Results The preoperative mean uncorrected visual acuity (UCVA) was 1.01±0.2 (logMAR), whereas the postoperative mean UCVA was 0.6±0.2. The preoperative mean best-corrected visual acuity (BCVA) was 0.6±0.1, whereas the postoperative mean BCVA was 0.40±0.2. The preoperative average keratometry was 50.3±2.7 D, whereas the postoperative average keratometry was 45.8±3.1 D. Conclusion The results of this study suggest that femtosecond laser-assisted Keraring implantation followed by CXL is safe and effective in the management of keratoconus in children with VKC. However, studies with a longer follow-up period are needed.
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Affiliation(s)
- Mortada A Abozaid
- Ophthalmology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
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