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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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Saad S, Saad R, Jouve L, Kallel S, Trinh L, Goemaere I, Borderie V, Bouheraoua N. Corneal crosslinking in keratoconus management. J Fr Ophtalmol 2020; 43:1078-1095. [DOI: 10.1016/j.jfo.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/30/2020] [Indexed: 01/04/2023]
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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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Benoist d'Azy C, Pereira B, Chiambaretta F, Dutheil F. Efficacy of Different Procedures of Intra-Corneal Ring Segment Implantation in Keratoconus: a Systematic Review and Meta-Analysis. Transl Vis Sci Technol 2019; 8:38. [PMID: 31211003 PMCID: PMC6561134 DOI: 10.1167/tvst.8.3.38] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/27/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the efficacy of the functional, keratometric, and refractive postoperative parameters of intracorneal ring segment (ICRS) implantation in keratoconus and its association with collagen cross-linking (CXL), photorefractive keratectomy (PRK), and intraocular lenses (IOLs). Methods We conducted a systematic review and meta-analysis on case series published between 2007 and 2017. Results We included 95 case series with a total of 4560 patients. We included 64 studies of the ICRS procedure, 20 studies of ICRS+CXL, 9 studies of ICRS+CXL+PRK, and 5 studies of ICRS+IOL. We demonstrated an overall improvement of all parameters in all procedures. Cylinder was decreased with an overall effect size (ES) of −1.15 (−1.36 to −0.95; I2 = 93.7%). Corrected distance visual acuity was improved with an overall ES of 0.89 (0.78 to 1.00; I2 = 81.9%). Maximal keratometry was decreased with an overall ES of 0.98 (0.85 to 1.11; I2 = 78.9%). ICRS+IOL is the best procedure to improve spherical equivalent and uncorrected distance visual acuity (P < 0.05) compared with other procedures. ICRSs versus ICRS+CXL are similar in all parameters except for corrected distance visual acuity. ICRS+CXL+PRK is better than ICRS alone in all parameters except for the correction of spherical equivalent. Conclusions Although the quality and strength of the data are questionable, ICRS implantation is an effective strategy to preserve visual function in keratoconic patients. Particularly, ICRS+CXL+PRK could be a low invasive procedure to propose to young keratoconic patients. Translational Relevance To propose an overview of postoperative parameters on each ICRS procedure on keratoconus.
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Affiliation(s)
- Cédric Benoist d'Azy
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Ophthalmology, Preventive and Occupational Medicine, Clermont-Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont-Ferrand (CHU), Biostatistics Unit, Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Frédéric Chiambaretta
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Clermont Auvergne University, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont-Ferrand, France.,Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
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Al Zubi K, Albakar Y, Nasser R. Transepithelial versus Epithelium off Crosslinking for Treating Keratoconus among Jordanians. Open Ophthalmol J 2019. [DOI: 10.2174/1874364101913010008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The progression of keratoconus is stabilized with the help of corneal collagen cross-linking (CXL) supported through photosynthesized riboflavin.
Objective:
This study aims to compare the effectiveness of the transepithelial procedure and epithelium off procedure of corneal collagen crosslinking among keratoconus patients in Jordan.
Methods:
The study recruited 80 patients suffering from progressive keratoconus, from a tertiary care setting in Jordan. These participants were randomly divided into two groups; group 1 with 40 participants subjected to transepithelial (Corneal collagen cross-linking) CXL; and 40 participants in group 2 received conventional epithelium off CXL.
Results:
Improvement was observed in the mean contact lens, which corrected distance visual acuity (CDVA) from logMAR 0.332 ± 0.09 (group 1), 0.35 ± 0.09 (group 2) to 0.241 ± 0.07 (group 1), 0.21 ± 0.07 (group 2), respectively at the end of follow-up (12 months). The mean pachymetry improved from 429.81 ± 18.96 μm (group 1), 430.08 ± 17.05 μm (group 2) to 436.5 ± 15.49 μm (group 1), 436.44 ± 12.53 μm (group 2), respectively, after twelve months. Additionally, the mean Sim K astigmatism declined from 7.0 ± 2.0 (group 1), 6.73 ± 1.98 (group 2) to 5.97 ± 1.88 (group 1), 5.53 ± 0.08 (group 2) respectively at twelve months post-treatment. Majority of the patients in group 2 experienced more pain as compared to group 1 participants.
Conclusion:
The effectiveness of a cross-linking procedure related to keratometry readings and corneal thickness showed that conventional (epithelium off) CXL method is more effective than transepithelial CXL.
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Comparison of Intrastromal Corneal Ring Segment Implantation only and in Combination with Collagen Crosslinking for Keratoconus. Eur J Ophthalmol 2018; 23:629-34. [DOI: 10.5301/ejo.5000250] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 11/20/2022]
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Hosny M, Nour M, Azzam S, Salem M, El-Mayah E. Simultaneous intratunnel cross-linking with intrastromal corneal ring segment implantation versus simultaneous epithelium-off cross-linking with intrastromal corneal ring segment implantation for keratoconus management. Clin Ophthalmol 2018; 12:147-152. [PMID: 29398901 PMCID: PMC5775736 DOI: 10.2147/opth.s151313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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 is to compare the efficacy of intratunnel cross-linking combined with intrastromal corneal ring segment (ICRS) implantation versus combined epithelium-off (epi-off) cross-linking and ICRS implantation for the management of keratoconus. Methods Our study included 20 eyes of 12 patients with moderate-to-severe keratoconus. Group A included 10 eyes that underwent simultaneous ICRS implantation with intratunnel cross-linking. Group B included 10 eyes that underwent simultaneous ICRS implantation with epi-off cross-linking. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest sphere and cylinder, mean and maximum keratometric readings, corneal thickness at pachy apex and thinnest location, as well as corneal hysteresis (CH) and corneal resistance factor (CRF) were compared preoperatively and at 6 months postoperatively. Results The mean UDVA and CDVA improved significantly in both groups with a statistically nonsignificant difference between the groups (P=0.798 and 0.126, respectively). The manifest cylinder decreased significantly in both groups, while the manifest sphere decreased significantly in Group A but nonsignificantly in Group B with a statistically nonsignificant difference between the groups (P=0.773 and 0.111, respectively). Both techniques led to significant flattening of the cornea and a significant decrease of Km and Kmax with a statistically nonsignificant difference between the groups (P=0.312 and 0.857, respectively). There was a statistically significant decrease in CH in both groups postoperatively; however, there was a statistically nonsignificant increase in CRF after both techniques with a statistically nonsignificant difference between the groups in the mean change of CH and CRF (P=0.633 and 0.313, respectively). No intraoperative or postoperative complications were observed in both groups. Conclusion Both techniques improved the visual and refractive outcomes in cases of moderate and severe keratoconus with no statistically significant difference between the groups; however, simultaneous intratunnel cross-linking and ICRS implantation showed early visual rehabilitation due to the absence of epithelial defect.
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Affiliation(s)
- Mohamed Hosny
- Department of Ophthalmology, Cairo University, Giza, Egypt
| | - Moustafa Nour
- Department of Ophthalmology, Cairo University, Giza, Egypt
| | - Sarah Azzam
- Department of Ophthalmology, Cairo University, Giza, Egypt
| | - Mohsen Salem
- Department of Ophthalmology, Cairo University, Giza, Egypt
| | - Esraa El-Mayah
- Department of Ophthalmology, Cairo University, Giza, Egypt
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Andreanos KD, Hashemi K, Petrelli M, Droutsas K, Georgalas I, Kymionis GD. Keratoconus Treatment Algorithm. Ophthalmol Ther 2017; 6:245-262. [PMID: 28755306 PMCID: PMC5693837 DOI: 10.1007/s40123-017-0099-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Indexed: 11/25/2022] Open
Abstract
Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.
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Affiliation(s)
- Konstantinos D Andreanos
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece.
| | - Kate Hashemi
- Faculty of Biology and Medicine, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Myrsini Petrelli
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Droutsas
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Georgalas
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - George D Kymionis
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
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Giacomin NT, Mello GR, Medeiros CS, Kiliç A, Serpe CC, Almeida HG, Kara-Junior N, Santhiago MR. Intracorneal Ring Segments Implantation for Corneal Ectasia. J Refract Surg 2016; 32:829-839. [DOI: 10.3928/1081597x-20160822-01] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/05/2016] [Indexed: 12/20/2022]
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Comparison of the Early Clinical Outcomes between Combined Small-Incision Lenticule Extraction and Collagen Cross-Linking versus SMILE for Myopia. J Ophthalmol 2016; 2016:2672980. [PMID: 27239334 PMCID: PMC4863112 DOI: 10.1155/2016/2672980] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/30/2016] [Accepted: 04/07/2016] [Indexed: 12/04/2022] Open
Abstract
Background. To compare the early outcome of combined SMILE and collagen crosslinking (SMILE Xtra) with SMILE. Method. Prospective, comparative interventional study of 21 eyes receiving SMILE Xtra using a low energy protocol and 32 control eyes receiving SMILE only. The outcomes were compared at 1, 3, and 6 months postoperatively. Results. Both groups had myopia with spherical equivalent refraction (SEQ) > 4.00 D. The SMILE Xtra group had thinner preoperative central corneal thickness and residual stromal bed thickness (p < 0.021). At 6 months, no eyes lost more than 1 line in corrected distance visual acuity. The safety index was 0.96 ± 0.06 and 1.00 ± 0.00 in SMILE Xtra and control, respectively (p < 0.001). 89% and 94% of eyes were within ±0.50 D of target refraction, respectively, with the mean error in SEQ correction being −0.17 ± 0.26 D for SMILE Xtra and +0.03 ± 0.25 D for control (p = 0.021). The efficacy index was 0.88 ± 0.13 and 0.97 ± 0.06, respectively (p = 0.005). Conclusion. SMILE Xtra had good overall safety profile and predictability at 6 months. However, when compared with control, the safety index and efficacy index were statistically significantly lower in the early postoperative period.
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Gallhoefer NS, Spiess BM, Guscetti F, Hilbe M, Hartnack S, Hafezi F, Pot SA. Penetration depth of corneal cross‐linking with riboflavin and
UV
‐A (
CXL
) in horses and rabbits. Vet Ophthalmol 2015. [DOI: 10.1111/vop.12301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nicolin S. Gallhoefer
- Augen Vet Lindenthalguertel 83 50935 Cologne Germany
- Division of Ophthalmology Equine Department Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
- Center for Clinical Studies Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
| | - Bernhard M. Spiess
- Division of Ophthalmology Equine Department Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
| | - Franco Guscetti
- Institute of Veterinary Pathology Vetsuisse Faculty University of Zurich Winterthurerstrasse 268, 8057 Zurich Switzerland
| | - Monika Hilbe
- Institute of Veterinary Pathology Vetsuisse Faculty University of Zurich Winterthurerstrasse 268, 8057 Zurich Switzerland
| | - Sonja Hartnack
- Division of Veterinary Epidemiology Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
| | - Farhad Hafezi
- Laboratory for Ocular Cell Biology University of Geneva Rue Alcide‐Jentzer 22 CH‐1211 Geneva 14 Switzerland
- Department of Ophthalmology University of Southern California 1450 San Pablo St. Los Angeles CA 90033 USA
- The ELZA Institute AG Webereistrasse 2 8953 Dietikon Zurich Switzerland
| | - Simon A. Pot
- Division of Ophthalmology Equine Department Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
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Late Stage of Corneal Decompensation Caused by Progressive Keratoconus: Can We Treat It and Save the Cornea? Case Rep Ophthalmol Med 2015; 2015:795826. [PMID: 26064737 PMCID: PMC4430651 DOI: 10.1155/2015/795826] [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: 12/26/2014] [Revised: 03/29/2015] [Accepted: 04/13/2015] [Indexed: 11/17/2022] Open
Abstract
Aim. To report a case of 40-year-old male with progressive bilateral keratoconus who had undergone transepithelial phototherapeutic keratectomy (TE-PTK) and corneal collagen cross-linking (CXL) using hypoosmolar riboflavin solution in a same day procedure. Methods. Eye examination showed that UCDVA on both eyes was 0,01 according to Snellen charts, and slit lamp biomicroscopy showed paracentral diffuse intrastromal corneal haze. Anterior OCT marked stromal hyperreflective zones and localized paracentral thinning of the cornea. Scheimpflug tomography noted keratoconus stages III-IV on both eyes. After 40/35 microns TE-PTK, a CXL was performed for 30 minutes using hypoosmolar riboflavin solution. The left eye was treated first and the right eye 1 month after. Follow-up period was 10 months. Results. One month after the treatment both eyes showed improvement in corneal topography and the UCDVA was better. Eight months after the treatment BSCVA improved to 0,6 in both eyes using Rose K2 contact lenses and remained stable. Conclusion. TE-PTK and CXL using hypotonic riboflavin solution as a same day procedure have been shown to be a safe and promising method in this case of progressive keratoconus. It was necessary to consider certain parameters that could influence the safety and the final outcome of this combined protocol.
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Randleman JB, Khandelwal SS, Hafezi F. Corneal cross-linking. Surv Ophthalmol 2015; 60:509-23. [PMID: 25980780 DOI: 10.1016/j.survophthal.2015.04.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 12/26/2022]
Abstract
Since its inception in the late 1990s, corneal cross-linking has grown from an interesting concept to a primary treatment for corneal ectatic disease worldwide. Using a combination of ultraviolet-A light and a chromophore (vitamin B2, riboflavin), the cornea can be stiffened, usually with a single application, and progressive thinning diseases such as keratoconus arrested. Despite being in clinical use for many years, some of the underlying processes, such as the role of oxygen and the optimal treatment times, are still being worked out. More than a treatment technique, corneal cross-links represent a physiological principle of connective tissue, which may explain the enormous versatility of the method. We highlight the history of corneal cross-linking, the scientific underpinnings of current techniques, evolving clinical treatment parameters, and the use of cross-linking in combination with refractive surgery and for the treatment of infectious keratitis.
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Affiliation(s)
- J Bradley Randleman
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA; Emory Vision, Emory Eye Center, Atlanta, Georgia, USA.
| | | | - Farhad Hafezi
- ELZA Institute, Zurich, Switzerland; Laboratory for Ocular Cell Biology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
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Neue Behandlungsprotokolle der Hornhautvernetzung (Corneal Crosslinking). SPEKTRUM DER AUGENHEILKUNDE 2015. [DOI: 10.1007/s00717-015-0257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nawaz S, Gupta S, Gogia V, Sasikala NK, Panda A. Trans-epithelial versus conventional corneal collagen crosslinking: A randomized trial in keratoconus. Oman J Ophthalmol 2015; 8:9-13. [PMID: 25709267 PMCID: PMC4333560 DOI: 10.4103/0974-620x.149855] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: The purpose was to compare transepithelial versus epithelium off technique of corneal collagen crosslinking (CXL) in patients of keratoconus. Materials and Method: Totally, 40 eyes (40 patients) with progressive keratoconus were subjected to transepithelial CXL (20 eyes; Group I), and conventional CXL (20 eyes; Group II). Patients were evaluated for uncorrected distance visual acuity, best corrected visual acuity (BCVA), slit lamp-biomicroscopy, keratometry, 9-point pachymentry, orbscan II, and endothelial cell count at baseline and post CXL at 1, 3, and 6 months. Results: The two groups were similar with respect to the evaluated parameters both at baseline and at the end of 6 months. There was an improvement in mean BCVA from Log Mar 0.327 ± 0.1 (Group 1), 0.36 ± 0.08 (Group 2) to 0.23 ± 0.08 (Group 1; P < 0.001), 0.22 ± 0.06 (Group 2; P < 0.001), respectively, at 6 months. Mean Sim K astigmatism decreased from 6.6 ± 1.93 D (Group 1), 6.64 ± 1.93 D (Group 2) to 5.14 ± 1.86 D (Group 1; P = 0.001), and 4.77 ± 0.06 (Group 2; P = 0.001), respectively, at 6 months. The mean pachymetry increased from 432.05 ± 19.36 μm (Group 1), 429.91 ± 16.66 μm (Group 2) to 447.8 ± 16.09 μm (Group 1; P < 0.001), 440.25 ± 11.18 um (Group 2; P = 0.002), respectively, at 6 months. All cases showed stabilization of keratoconus two eyes in epithelium off group developed persistent stromal haze. Most of the patients in Group II experienced pain and photophobia during first 2 days, but not of Group I. Conclusion: Trans-epithelial technique offers visual and topographic outcomes similar to the conventional method with superior patient comfort postintervention.
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Affiliation(s)
- Shah Nawaz
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Gogia
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - N K Sasikala
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Panda
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kanellopoulos AJ, Asimellis G. Hyperopic correction: clinical validation with epithelium-on and epithelium-off protocols, using variable fluence and topographically customized collagen corneal crosslinking. Clin Ophthalmol 2014; 8:2425-33. [PMID: 25506204 PMCID: PMC4259508 DOI: 10.2147/opth.s68222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To report novel application of topographically-customized collagen crosslinking aiming to achieve hyperopic refractive changes. Two approaches were evaluated, one based on epithelium-off and one based on epithelium-on (transepithelial). Methods A peripheral annular-shaped topographically customizable design was employed for high-fluence ultraviolet (UV)-A irradiation aiming to achieve hyperopic refractive changes. A total of ten eyes were involved in this study. In group-A (five eyes), a customizable ring pattern was employed to debride the epithelium by excimer laser ablation, while in group-B (also five eyes), the epithelium remained intact. In both groups, specially formulated riboflavin solutions were applied. Visual acuity, cornea clarity, keratometry, topography, and pachymetry with a multitude of modalities, as well as endothelial cell counts were evaluated. Results One year postoperatively, the following changes have been noted: in group-A, average uncorrected distance visual acuity changed from 20/63 to 20/40. A mean hyperopic refractive increase of +0.75 D was achieved. There was some mild reduction in the epithelial thickness. In group-B, average uncorrected distance visual acuity changed from 20/70 to 20/50. A mean hyperopic refractive increase of +0.85 D was achieved. Epithelial thickness returned to slightly reduced levels (compared to baseline) in group-A, whereas to slightly increased levels in group-B. Conclusion We introduce herein the novel application of a topographically-customizable collagen crosslinking to achieve a hyperopic refractive effect. This novel technique may be applied either with epithelial removal, offering a more stable result or with a non-ablative and non-incisional approach, offering a minimally invasive alternative.
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Affiliation(s)
- Anastasios John Kanellopoulos
- LaserViison.gr Clinical and Research Eye Institute, Athens, Greece ; Department of Ophthalmology, New York University Medical School, New York, NY, USA
| | - George Asimellis
- LaserViison.gr Clinical and Research Eye Institute, Athens, Greece
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Clinical outcomes after complete intracorneal ring implantation and corneal collagen cross-linking in an intrastromal pocket in one session for keratoconus. J Ophthalmol 2014; 2014:568128. [PMID: 25276417 PMCID: PMC4172981 DOI: 10.1155/2014/568128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/23/2014] [Accepted: 08/24/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of this work was to evaluate the results after combined surgery implantation of full rings and CXL in one session in a group of patients with keratoconus during a 12-month follow-up. Material and Methods. The study included 22 eyes of 20 keratoconic patients, mean age of 28.41 (from 18 to 50) years. A full ring was inserted and afterwards 0.1% riboflavin solution was injected into the corneal pocket through the incision tunnel. The cornea was irradiated with UV-A light for 30 minutes. Postoperative visits were scheduled for the first week and months 1, 3, 6, 12, and 24 after surgery. Minimal follow-up time was 12 months. Results. The mean UDVA improved by 6 lines from before the operation to 1 year after the operation, the mean CDVA improved by approximately 2.5 lines, and the mean K improved by 3.94 D. Statistically significant reductions of sphere (P < 0.001), cylinder (P = 0.004), and spherical (P < 0.001) equivalents were found 1 month after surgery. Conclusion. The combined surgery MyoRing implantation and CXL seems to be a safe method in the treatment of keratoconus. We noticed an improvement of the refractive error in all of our patients.
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Biomechanical efficacy of collagen crosslinking in porcine cornea using a femtosecond laser pocket. Cornea 2014; 33:300-5. [PMID: 24457453 DOI: 10.1097/ico.0000000000000059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to assess the biomechanical efficacy of transepithelial collagen crosslinking using the femtosecond laser pocket technique compared with that using the standard crosslinking (CXL) technique. METHODS Forty ex vivo porcine eyes were divided into 4 groups with 10 samples each. Group 1 comprised the untreated controls. Group 2 was the standard CXL group with debridement, instillation of 0.1% riboflavin-dextran solution for 15 minutes before and every 5 minutes during the 30 minutes of irradiation with ultraviolet A (UVA) light of 370 nm and an irradiance of 3 mW/cm². Group 3 pertained to the femtolaser pocket control with an intrastromal pocket but without riboflavin/UVA. Group 4 was the femtolaser pocket CXL group with an intrastromal pocket of an 8-mm diameter at a 180-μm depth, riboflavin/dextran application for 15 minutes and subsequent exposure to UVA light for 30 minutes. Postoperatively, biomechanical stress-strain measurements were performed. RESULTS In the standard CXL group, the stress at 10% strain was 207.8 ± 64.1 × 10 Pa (+79.45% vs. controls; P = 0.021) compared with 115.8 ± 20.8 × 10 Pa in the untreated control group; in the crosslinked femtolaser pocket group, it was 159.5 ± 30.4 × 10 Pa (+37.74%; P = 0.049), in the non-cross-linked femtolaser pocket group, it was 103.5 ± 17.3 × 10 Pa (-10.62%; P = 0.103). The Young modulus was 5.4 MPa (+100% vs. controls) in the standard CXL group, 3.7 MPa (+37.04%) in the crosslinked femtolaser pocket group, and 2.4 MPa (-11.12%) in the non-cross-linked femtolaser pocket group compared with 2.7 MPa in the untreated control group. CONCLUSIONS The biomechanical effect of CXL using the femtolaser pocket technique is about 50% less pronounced than that after standard CXL. Future studies will show whether the efficacy of the technique can still be improved and whether the clinical effect is sufficient for stabilizing ectatic corneas.
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Sideroudi H, Labiris G, Soto-Beobide A, Voyiatzis G, Chrissanthopoulos A, Kozobolis V. The effect of collagen cross-linking procedure on the material of intracorneal ring segments. Curr Eye Res 2014; 40:592-7. [PMID: 25025990 DOI: 10.3109/02713683.2014.941071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the potential impact of corneal crosslinking treatment (365 nm ultraviolet (UV)A irradiation with riboflavin) on the material properties of Intracorneal Rings Segments (ICRS). MATERIALS AND METHODS Material properties were studied using FT-IR spectroscopy and UV-Vis spectroscopy. Rings were examined: (1) after installation of riboflavin solution, (2) after irradiation with UV-A light and (3) after instillation of riboflavin solution followed by instillation and coeval irradiation. The experiments followed the standard corneal cross-linking (CXL) protocol of corneal crosslinking treatment. RESULTS After instillation of riboflavin solution, a permanent intense yellow staining of the samples was observed. UV-Vis spectroscopy confirmed that a certain amount of riboflavin solution was absorbed into the samples after CXL procedure. FT-IR spectroscopic analysis showed alterations in the spectra of ICRS mainly at the 2800-3200 cm(-1) spectral region [modification in band intensities of CH(2) (2925 cm(-1)) and CH(3) (2950 cm(-1))]. CONCLUSIONS Our results suggest crosslinking reaction in ICRS material. This should be taken into consideration prior to any CXL treatment of post ICRS-implanted cornea.
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Affiliation(s)
- Haris Sideroudi
- Eye Institute of Thrace, Democritus University , Alexandroupolis , Greece and
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Kymionis GD, Grentzelos MA, Portaliou DM, Kankariya VP, Randleman JB. Corneal Collagen Cross-linking (CXL) Combined With Refractive Procedures for the Treatment of Corneal Ectatic Disorders: CXL Plus. J Refract Surg 2014; 30:566-76. [DOI: 10.3928/1081597x-20140711-10] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/02/2014] [Indexed: 12/17/2022]
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Kanellopoulos AJ, Dupps WJ, Seven I, Asimellis G. Toric topographically customized transepithelial, pulsed, very high-fluence, higher energy and higher riboflavin concentration collagen cross-linking in keratoconus. Case Rep Ophthalmol 2014; 5:172-80. [PMID: 25076897 PMCID: PMC4105951 DOI: 10.1159/000363371] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a novel application of toric topographically customized transepithelial collagen cross-linking (CXL) aiming to achieve refractive astigmatic changes in a keratoconic cornea. Methods Specially formulated riboflavin transepithelial administration and delivery of high-fluence UVA in a topographically customized pattern was applied in an eye with progressive keratoconus. Visual acuity, cornea clarity, keratometry, topography, and pachymetry with a multitude of modalities, as well as endothelial cell counts were evaluated for >6 months. Results Uncorrected distance visual acuity changed from preoperative 20/40 to 20/25 at 6 months. A mean astigmatic reduction of 0.8 D, and significant cornea surface normalization was achieved 6 months postoperatively. There was some mild change in the epithelial distribution, with the treated area having a slight normalization in the average epithelial thickness. Conclusions We introduce herein the novel application of a topographically customizable transepithelial CXL in progressive keratoconus in order to achieve an astigmatic refractive effect and ectasia stabilization. This novel technique offers a nonablative and nonincisional approach to treat irregular astigmatism in ectatic cornea with rapid visual rehabilitation.
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Affiliation(s)
| | - William J Dupps
- Department of Ophthalmology, Cleveland State University, Cleveland, Ohio, USA ; Department of Biomedical Engineering, Cleveland Clinic, Cleveland State University, Cleveland, Ohio, USA
| | - Ibrahim Seven
- Department of Cole Eye Institute, Cleveland Clinic, Cleveland State University, Cleveland, Ohio, USA ; Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, Ohio, USA
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Kanellopoulos AJ. Novel myopic refractive correction with transepithelial very high-fluence collagen cross-linking applied in a customized pattern: early clinical results of a feasibility study. Clin Ophthalmol 2014; 8:697-702. [PMID: 24741289 PMCID: PMC3984063 DOI: 10.2147/opth.s59934] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study is to report the safety and efficacy of a new application of collagen cross-linking using a novel device to achieve predictable refractive myopic changes in virgin corneas. Methods Four cases were treated with a novel device employing very high-fluence collagen cross-linking applied in a myopic pattern. Prior to treatment, riboflavin solution was applied to the intact epithelium. The collagen cross-linking device was then engaged for a total of 12 J/cm2, to be applied transepithelially in a predetermined pattern. Cornea clarity, corneal keratometry, and corneal topography were evaluated by both Placido disc and Scheimpflug imaging, along with cornea anterior segment optical coherence tomography and endothelial cell counts. Results An average of 2.3 diopters was achieved in the first week in all four cases treated with the very high-fluence myopic collagen cross-linking intervention. There was a slight regression to 1.44 diopters at 1 month, which remained stable at 6-month follow-up. The mean keratometry change was from 44.90 diopters to 43.46 diopters. There was no significant change in endothelial cell counts or corneal clarity. There was some mild change in epithelial thickness distribution, with the treated area showing a slight but homogeneous reduction in mean thickness from 52 μm to 44 μm. Conclusion This report describes the novel application of very high-fluence collagen cross-linking with a predictable well defined myopic refractive (flattening) corneal effect. This technique has the advantages of essentially no postoperative morbidity, immediate visual rehabilitation, and the potential for tapering until the desired result is achieved.
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Rocha KM, Perez-Straziota CE, Perez-Straziota E, Stulting RD, Randleman JB. SD-OCT analysis of regional epithelial thickness profiles in keratoconus, postoperative corneal ectasia, and normal eyes. J Refract Surg 2013; 29:173-9. [PMID: 23446013 DOI: 10.3928/1081597x-20130129-08] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 01/09/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess corneal microarchitecture and regional epithelial thickness profile in eyes with keratoconus, postoperative corneal ectasia (ectasia), and normal unoperated eyes (controls) using spectral-domain optical coherence tomography (SD-OCT). METHODS Regional corneal epithelial thickness profiles were measured with anterior segment SD-OCT (Optovue RTVue-100, Optovue Inc., Fremont, CA). Epithelial thickness was assessed at 21 points, 0.5 mm apart, across the central 6-mm of the corneal apex in the horizontal and vertical meridians. RESULTS One hundred twenty eyes were evaluated, including 49 eyes from 29 patients with keratoconus, 32 eyes from 16 patients with ectasia, and 39 eyes from 21 control patients. Average epithelial thickness at the corneal apex was 41.18 ± 6.47 μm (range: 30 to 51 μm) for keratoconus, 46.5 ± 6.72 μm for ectasia (range: 34 to 60 μm), and 50.45 ± 3.92 μm for controls (range: 42 to 55 μm). Apical epithelial thickness was significantly thinner in eyes with keratoconus (P < .0001) and ectasia (P = .0007) than in controls. Epithelial thickness ranges in all other areas varied widely for keratoconus (range: 21 to 101 μm) and ectasia (range: 30 to 82 μm) compared to controls (range: 43 to 64) (P = .0063). CONCLUSION SD-OCT demonstrated significant central and regional epithelial thickness profile differences between keratoconus, ectasia, and control eyes, with significant variability and unpredictability in ectatic eyes. This regional irregularity may necessitate direct epithelial thickness measurement for treatments where underlying stromal variations may be clinically relevant, including corneal collagen cross-linking or topography-guided ablations.
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Raiskup F, Spoerl E. Corneal crosslinking with riboflavin and ultraviolet A. Part II. Clinical indications and results. Ocul Surf 2013; 11:93-108. [PMID: 23583044 DOI: 10.1016/j.jtos.2013.01.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 11/29/2022]
Abstract
Changes in the biomechanical properties of the human cornea play an important role in the pathogenesis of corneal ectatic diseases. A variety of conditions in primary acquired (keratoconus and pellucid marginal degeneration) or secondary induced (iatrogenic keratectasia after excimer refractive laser surgery) corneal ectatic disorders lead to reduced biomechanical resistance. Corneal collagen crosslinking (CXL) has emerged as a promising technique to slow or even to stop the progression of these corneal ectatic pathologies. In this procedure, riboflavin (vitamin B2) is administered in conjunction with ultraviolet A light (UVA, 365 nm). This interaction causes the formation of reactive oxygen species, leading to the formation of additional covalent bonds between collagen molecules, with consequent biomechanical stiffening of the cornea. Although this method is not yet accepted as an evidence-based medicine modality for the treatment of corneal primary or secondary ectasias, the results of prospective, randomized studies of CXL used in the treatment of these pathologic entities show significant changes in the properties of corneal tissue. This procedure is currently the only etiopathogenetic approach in ectatic eyes that can delay or stop the process of cornea destabilization, reducing the necessity for keratoplasty. Despite promising results, CXL is associated with issues that include long-term safety and duration of the stabilizing effect. Combination of CXL with vision-improving procedures, such as topography-guided custom ablation and implantation of intracorneal ring segments of phakic intraocular lenses, may expand the indications for this procedure.
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Affiliation(s)
- Frederik Raiskup
- Department of Ophthalmology, Carl Gustav Carus University Hospital, Dresden, Germany.
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Current world literature. Curr Opin Ophthalmol 2012; 23:330-5. [PMID: 22673820 DOI: 10.1097/icu.0b013e32835584e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tuwairqi WS, Sinjab MM. Safety and efficacy of simultaneous corneal collagen cross-linking with topography-guided PRK in managing low-grade keratoconus: 1-year follow-up. J Refract Surg 2012; 28:341-5. [PMID: 22443804 DOI: 10.3928/1081597x-20120316-01] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/21/2012] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate 1-year visual and topographic outcomes and safety and efficacy of corneal collagen cross-linking (CXL) combined with topography-guided photorefractive keratectomy (TG-PRK) to achieve near emmetropia in eyes with low-grade keratoconus. METHODS Twenty-two eyes from 15 patients (11 women, 4 men) were included in a prospective, nonrandomized, noncontrolled clinical study. Mean patient age was 26.6±6.07 years (range: 19 to 40 years). Inclusion criteria were low-grade keratoconus with evidence of progression, transparent cornea, corrected distance visual acuity (CDVA) 0.8 (decimal) or better, corneal thickness >440 μm, and maximum keratometry readings (K-max) <51.00 diopters (D). All patients underwent simultaneous TG-PRK with CXL. Study parameters were uncorrected distance visual acuity, CDVA, manifest refractive error, manifest and topographic (corneal) astigmatism, patient satisfaction, and efficacy and safety of the treatment. Follow-up was 1 year. RESULTS After 1 year, statistically significant improvement was noted in all study parameters (P<.01). The safety and efficacy indices were 1.6 and 0.4, respectively. Patient satisfaction questionnaire showed that 91% were satisfied, 9% were not completely satisfied but believed they improved, and none were dissatisfied. Corneal topography demonstrated significant improvement in 55%, improvement in 36%, and minor improvement in 9% of cases. No cases progressed as evidenced by keratometry readings. CONCLUSIONS Simultaneous TG-PRK with CXL is an effective and safe treatment with remarkable visual and topographic outcomes in patients with low-grade keratoconus who meet the recommended inclusion criteria.
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Kılıç A, Kamburoglu G, Akıncı A. Riboflavin injection into the corneal channel for combined collagen crosslinking and intrastromal corneal ring segment implantation. J Cataract Refract Surg 2012; 38:878-83. [PMID: 22425362 DOI: 10.1016/j.jcrs.2011.11.041] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 10/28/2011] [Accepted: 11/20/2011] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the effectiveness of intracorneal riboflavin injection for combined collagen crosslinking (CXL) and intrastromal corneal ring segment (ICRS) implantation. SETTING Kudret Eye Hospital, Ankara, Turkey. DESIGN Noncomparative case series. METHODS Keratoconic eyes had combined ICRS (Intacs) implantation and transepithelial CXL with 20% alcohol application and riboflavin injection into the corneal channel. Outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, sphere, cylinder, and keratotomy (K) readings. RESULTS The study enrolled 131 eyes (105 patients) with a mean follow-up of 7.07 months ± 4.66 (SD). The mean improvement was 0.26 ± 0.16 logMAR in UDVA and 0.24 ± 0.16 logMAR in CDVA (both P<.05). The mean manifest spherical refraction decreased from -3.87 ± 4.55 diopters (D) to -1.25 ± 2.31 D, the mean manifest cylinder improved from -3.89 ± 1.97 D to -2.27 ± 2.18 D, and the mean K reading improved from 50.50 ± 5.26 D to 46.03 ± 4.51 D (all P<.05). There were no intraoperative or postoperative complications. CONCLUSIONS Combined ICRS and CXL treatment with intracorneal riboflavin injection was effective in keratoconic eyes. Intracorneal riboflavin injection into the tunnel was safe and may provide more penetration without epithelial removal. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Aylin Kılıç
- Dünya Eye Hospital (Kılıç), Istanbul, Turkey.
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Randleman JB. The expanding spectrum of refractive surgery. J Refract Surg 2011; 27:707. [PMID: 21986001 DOI: 10.3928/1081597x-20110920-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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