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Sachdev GS, Thulasidas M, Sachdev MS. Long-term outcomes of tailored stromal expansion with refractive lenticule for crosslinking thin corneas. Indian J Ophthalmol 2024; 72:94-97. [PMID: 38131577 PMCID: PMC10841800 DOI: 10.4103/ijo.ijo_762_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/19/2023] [Accepted: 10/07/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To assess the long-term safety and stability of visual outcomes following the modified technique of collagen crosslinking (CXL) using refractive lenticule in eyes with thin corneas (<400 µm) and progressive keratoconus. SETTING A tertiary eye care hospital in India. DESIGN Prospective, interventional case series. METHODS Eyes with progressive keratoconus and thin corneas (<400 µm) underwent CXL with intraoperative stromal augmentation using a refractive lenticule obtained from small-incision lenticule extraction (SMILE). Preoperative and postoperative evaluation (3 months, and then yearly thereafter) included corneal tomography (Oculus Pentacam), uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively), manifest refraction, and endothelial cell count (specular microscopy), and adverse events, if any, were noted. The patients were followed up for a period of 5 years. RESULTS Seven eyes were included in the analysis. Mean corneal flattening of -4.29 D was noted from preoperative maximum keratometry (P = 0.018). An improvement in UDVA and CDVA of 0.38 logarithm of minimum angle of resolution (logMAR) and 0.36 logMAR, respectively, was noted at 5 years postoperative visit. Four eyes demonstrated a gain of two lines in CDVA. Mean spherical equivalent improved from -6.85 D preoperatively to -6.05 D at 5 years postoperatively. Clear demarcation line was noted between 230 to 270 µm on anterior segment optical coherence topography. No significant endothelial cell loss was noted postoperatively. CONCLUSION Long-term outcomes demonstrated safety and disease stability following lenticule-assisted CXL.
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Affiliation(s)
- Gitansha S Sachdev
- Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
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Blaser F, Zweifel S, Wiest MRJ, Bajka A, Said S, Barthelmes D, Muth DR. Severe Complications after Corneal Collagen Cross-Linking (CXL). Klin Monbl Augenheilkd 2023; 240:369-378. [PMID: 37164391 PMCID: PMC10129411 DOI: 10.1055/a-2040-4290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/22/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To present a case series of rare and severe complications after corneal collagen cross-linking (CXL) of keratoconus patients. METHODS Single-center descriptive case series covering the period of 2012 to 2022 at the Department of Ophthalmology at the University Hospital, Zurich, Switzerland. RESULTS We present four eyes of four patients that showed severe unusual complications within the first month after CXL. Three patients had been treated with the classical epithelium-off "Dresden" protocol. One patient had been treated with the accelerated epithelium-off protocol. One patient presented with extensive corneal edema due to rubbing the eye after treatment. Two patients showed a bacterial infectious keratitis: one due to Streptococcus pneumoniae and the other due to Staphylococcus hominis, Micrococcus luteus, and Streptococcus epidermidis. The latter of the two patients exhibited extensive infectious crystalline keratopathy. The fourth patient showed a severe ulcerative lesion where no infectious cause could be found. Therefore, an autoimmune keratolytic process had to be suspected. Apart from the corneal edema, which resolved ad integrum, the other complications resulted in permanent corneal scarring and thinning. One patient needed an emergency amniotic transplant. CONCLUSION Severe complications after CXL remain rare. Most common causes are complications that are not directly associated with the treatment as such. Those indirect complications occur after the treatment during the healing course of the epithelium. Associations with bandage contact lenses, topical steroids, atopic disease, and inappropriate patient behavior are often suspected. Correctly performed corneal scrapings with repeated microbiological analysis and a detailed patient history are essential for establishing the correct diagnosis, especially in complicated cases that do not respond to a standard therapeutic regimen. This case series supports the efforts that are currently taken to improve the CXL technique in a way that postoperative complications are further reduced. A more efficient epithelium-on technique might be a step in that direction.
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Affiliation(s)
- Frank Blaser
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandrine Zweifel
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Anahita Bajka
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sadiq Said
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Barthelmes
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Rudolf Muth
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Yang K, Xu L, Wang S, Zhu M, Fan Q, Gu Y, Wang Y, Wang Q, Zhao D, Pang C, Ren S. A Bibliometric Analysis of 100 Most-Cited Articles on Corneal Cross-Linking. Front Med (Lausanne) 2022; 9:904077. [PMID: 35721090 PMCID: PMC9199002 DOI: 10.3389/fmed.2022.904077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Highly cited papers are expected to have high-quality data that significantly contribute to the body of knowledge. The study aimed to evaluate the characters of the 100 most-cited articles on corneal cross-linking (CXL) through a bibliometric analysis. Materials and Methods The Web of Science database was searched to identify papers published from 1950 to 2020. A bibliometric analysis of the top 100-cited articles was conducted in the current study. The citation differences between basic research, clinical research, and reviews were compared by Kruskal-Wallis test. The association between citations and publication year was evaluated by Spearman correlation analysis. The VOSviewer software was used to create networks of co-authorship and keywords map. Results The median values of the number of citations, citations/year since publication, and citations since 2013 were 101, 9.5, and 11.92, respectively. A total of 61% of articles were clinical research. The citations since 2013 of clinical research were lower than basic research and the reviews (all p < 0.001). The publication year was positively correlated with the number of publications (r = 0.665, p = 0.013), and the total number of citations decreased for basic research (r = -0.447, p = 0.017), and clinical research (r = -0.433, p < 0.001). The J REFRACT SURG publishes the highest number of articles. The corresponding authors were predominantly from the Italy (N = 17), Germany (N = 16), and United States (N = 15). Spoerl Eberhard has the highest number of citations and total link strength with 15 articles. Extensive collaboration existed among the main core nodes containing "cross-linking (N = 45)," "riboflavin (N = 44)," and "ultraviolet A (UVA) (N = 42)." Conclusion The present study focused on the comprehensive analysis of the top 100-cited articles on the CXL research, providing insight into research developments over the past decades.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaopei Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Zhu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yawen Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongqing Zhao
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
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Benca Kapitánová K, Javorka M. EVALUATION OF THE CORNEAL STROMAL DEMARCATION LINE AFTER THE ACCELERATED CORNEAL CROSS-LINKING USING ANTERIOR SEGMENT OCT. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2022; 78:122-127. [PMID: 35760583 DOI: 10.31348/2022/14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Evaluation of the visibility and depth of the demarcation line in the corneal stroma in eyes with keratoconus 1 month and 3 months after epi-off accelerated corneal cross-linking (ACXL) using anterior segment optical coherence tomography (AS OCT). MATERIAL AND METHODS This study analyses a group of 34 eyes with keratoconus 1 month and 3 months after ACXL (9 mW/cm2 for 10 min). The group was classified based on the ABCD clinical classification of keratoconus according to Belin and Duncan. AS OCT (ZeissCirrus 500, Anterior Segment Premier module) was used to assess the visibility and exact depth of the demarcation line in the corneal stroma. RESULTS The demarcation line was visible 1 month after ACXL in 76.5% of eyes with a mean depth of 238.13 ±20.36 μm and 3 months after ACXL in 100% of eyes with a mean depth of 263.43 ±12.59 μm. Statistical analysis of the group did not show a significant relationship between the disease stage and the demarcation line visibility; however, there was a trend towards higher age (>30 years) in the group in those eyes where the demarcation line was visible vs. partially visible 3 months after ACXL. We found no difference in the mean and maximum line depth when comparing 1 month and 3 months after the procedure. There were no cases of disease progression 3 months after ACXL in the group. CONCLUSION Our study suggests that the assessment of the demarcation line in the corneal stroma is more reliable 3 months compared to 1 month after ACXL. We also observed a trend towards higher patient age in eyes where the demarcation line was clearly visible 3 months after ACXL. We did not confirm a relationship between the stage of keratoconus and the depth of the line, nor a difference in its mean and maximum depth 1 month and 3 months after the procedure.
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Brar S, Ganesh S, Reddy SS, Bn N, Shahanand D. A Prospective, Comparative, Clinical Study to Evaluate the Safety and Efficacy of Two Different 0.1% Riboflavin Solutions Used in Collagen Crosslinking Treatment for Patients with Keratoconus. Clin Ophthalmol 2021; 15:2607-2617. [PMID: 34188439 PMCID: PMC8232965 DOI: 10.2147/opth.s313647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the safety and efficacy of 0.1% riboflavin in two different solutions which is used in corneal collagen crosslinking (CXL) for the treatment of keratoconus. Methods This was a prospective, randomized, comparison study which included 100 eyes of 61 patients with progressive keratoconus who underwent CXL with riboflavin 0.1% solution as a photosensitizer, using the standard Dresden protocol of using 3mW/cm2 UV-A irradiation for 30 minutes which corresponds to a total energy of 5.4 J/cm2. The recruited patients were divided into 2 groups ie, Flavin Group and Peschke-D group by computer generated randomization. Postoperative examinations were conducted on 1 day, 1 month, 3 months, 6 months and 12 months after the crosslinking. Results For both groups, the mean manifest spherical equivalent (SE), astigmatism, best corrected distance visual acuity, keratometry values, thinnest pachymetry values, demarcation line depth and endothelial cell density preoperatively and at postoperative 12 months were comparable with no statistically significant differences. At 12 months postoperatively, 62% of eyes in the Flavin group, and 68% of eyes in the Peschke-D group had postoperative manifest SE of within ± 1.00 D. During UV-A exposure, the cornea in the Flavin group showed intraoperative thinning of 112 microns (27%) as compared with a thinning of 108.12 microns (26.5%) observed in the Peschke group (p=1.67) from the initial pachymetry readings. No eye in either group had any immediate or long-term postop vision threatening complications such as infectious keratitis, corneal melt, non-resolving corneal oedema or endothelial decompensation. Conclusion Both riboflavin solutions were equally safe and effective in the management of progressive keratoconus, and resulted in similar changes in terms of mean manifest spherical equivalent (SE), astigmatism, best corrected distance visual acuity, keratometry values, thinnest pachymetry values, demarcation line depth and endothelial cell density at the end of 12 months postoperatively. Trial Registration Number Ctri/2019/11/021841 (Www.ctri.nic.in).
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Affiliation(s)
- Sheetal Brar
- Department of Phaco-Refractive Surgery, Nethradhama Superspecialty Eye Hospital, Bangalore, Karnataka, India
| | - Sri Ganesh
- Department of Phaco-Refractive Surgery, Nethradhama Superspecialty Eye Hospital, Bangalore, Karnataka, India
| | - Shilpa S Reddy
- Department of Phaco-Refractive Surgery, Nethradhama Superspecialty Eye Hospital, Bangalore, Karnataka, India
| | - Nagesh Bn
- Department of Phaco-Refractive Surgery, Nethradhama Superspecialty Eye Hospital, Bangalore, Karnataka, India
| | - Dhwni Shahanand
- Department of Phaco-Refractive Surgery, Nethradhama Superspecialty Eye Hospital, Bangalore, Karnataka, India
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Wilson A, Marshall J. A review of corneal biomechanics: Mechanisms for measurement and the implications for refractive surgery. Indian J Ophthalmol 2021; 68:2679-2690. [PMID: 33229643 PMCID: PMC7856929 DOI: 10.4103/ijo.ijo_2146_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Detailed clinical assessment of corneal biomechanics has the potential to revolutionize the ophthalmic industry through enabling quicker and more proficient diagnosis of corneal disease, safer and more effective surgical treatments, and the provision of customized and optimized care. Despite these wide-ranging benefits, and an outstanding clinical need, the provision of technology capable of the assessment of corneal biomechanics in the clinic is still in its infancy. While laboratory-based technologies have progressed significantly over the past decade, there remain significant gaps in our knowledge regarding corneal biomechanics and how they relate to shape and function, and how they change in disease and after surgical intervention. Here, we discuss the importance, relevance, and challenges associated with the assessment of corneal biomechanics and review the techniques currently available and underdevelopment in both the laboratory and the clinic.
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Affiliation(s)
- Abby Wilson
- Wolfson School of Mechanical, Manufacturing and Electrical Engineering, Loughborough University, Loughborough, UK
| | - John Marshall
- Wolfson School of Mechanical, Manufacturing and Electrical Engineering, Loughborough University, Loughborough, UK
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Lang SJ, Maier P, Reinhard T. Crosslinking und Keratokonus. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1205-7737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungEin Keratokonus führt zu einer progressiven Vorwölbung und Verdünnung der
Hornhaut. Um dies aufzuhalten, kann ein Crosslinking durchgeführt werden. Dabei
ist eine Behandlung nach dem „Dresdener Protokoll“ eine effektive und sichere
Behandlungsmöglichkeit, aber auch zahlreiche neue Anwendungsprotokolle
(akzeleriertes Crosslinking, transepitheliales Crosslinking) und sogar weitere
Indikationen (refraktive Eingriffe, infektiöse Keratitis) wurden in den letzten
Jahren veröffentlicht.
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Lang SJ, Maier P, Reinhard T. [Crosslinking and Keratoconus]. Klin Monbl Augenheilkd 2021; 238:733-747. [PMID: 33873207 DOI: 10.1055/a-1472-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Keratoconus leads to a progressive protrusion and thinning of the cornea. In order to stop this, corneal crosslinking can be performed if the progression of the disease is proven. Crosslinking according to the "Dresden protocol" includes abrasion of the corneal epithelium, application of riboflavin eye drops and irradiation with UV-A light of an intensity of 3 mW/cm² for 30 minutes. The efficacy has been shown in several prospective randomized studies. One of the more recent developments is accelerated crosslinking, which allows a shorter irradiation time. On the other hand, the possibility of transepithelial crosslinking was presented, which does not require an abrasion of the cornea. This should reduce the occurrence of postoperative pain. The range of indications has also been expanded. Corneal crosslinking is used for post-LASIK keratectasia as well. It is also being considered for use in infectious keratitis. Topographically controlled crosslinking can likewise be used to try to positively influence the refractive power of the cornea. The risks of crosslinking include the occurrence of pain, haze or scarring, endothelial cell damage and, rarely, the occurrence of keratitis.
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Sengillo JD, Kunkler AL, Medert C, Fowler B, Shoji M, Pirakitikulr N, Patel N, Yannuzzi NA, Verkade AJ, Miller D, Sliney DH, Parel JM, Amescua G. UV-Photokeratitis Associated with Germicidal Lamps Purchased during the COVID-19 Pandemic. Ocul Immunol Inflamm 2020; 29:76-80. [PMID: 33215961 DOI: 10.1080/09273948.2020.1834587] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To report photokeratitis caused by the improper use of germicidal lamps purchased during the COVID-19 pandemic. METHODS Case series. RESULTS Seven patients presented with acute ocular surface pain after exposure to UV-emitting germicidal lamps. Visual acuity was 20/30 or better in 13 of 14 eyes (93%). Anterior segment examination revealed varying degrees of conjunctival injection and diffusely distributed punctate epithelial erosions (PEEs) in every patient. No intraocular inflammation was identified across the cohort and all fundus examinations were normal. Treatment varied by provider and included artificial tears alone or in combination with antibiotic ointments and/or topical steroids. Five patients were followed via telehealth, one patient returned for an in-office visit, and one patient was lost to follow-up. Five of six patients endorsed complete resolution of symptoms within 2-3 days. CONCLUSIONS Patients should follow manufacturer recommendations when using UV-emitting germicidal lamps and avoid direct exposure to the ocular surface.
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Affiliation(s)
- Jesse D Sengillo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anne L Kunkler
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Charles Medert
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Benjamin Fowler
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marissa Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nathan Pirakitikulr
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nimesh Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Angela J Verkade
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David H Sliney
- Department of Environmental Science and Engineering, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Jean-Marie Parel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Ghaffari SR, Khaheshi S, Alipour F, Mashhadi Farahani S, Beheshtnejad AH, Hafezi F. Reduced fluence corneal cross-linking in mild to moderate keratoconus: One year-follow-up. Eur J Ophthalmol 2020; 31:2206-2212. [PMID: 33092399 DOI: 10.1177/1120672120966560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of reduced fluence CXL (lower dose of UV-A irradiation) in mild to moderate keratoconus. SETTING Farabi Eye Hospital, Tehran, Iran. DESIGN Non-randomized prospective comparative interventional case series. Every eligible patient included in the study (mild to moderate progressive keratoconus) was randomly allocated to case (reduced fluence) and control (standard) groups, except for bilateral patients. In these patients the eye with more advanced disease was allocated to control group and the other eye was randomly assigned in either case or control group. Operators performing refraction and images and the data analyst were masked, but patients and physicians were not. METHODS Forty-six eyes of 38 patients were recruited. Group 1 received 7 min (fluence of 3.8 J/cm2), while group 2 received 10 min of 9 mW/cm2 UV-A (fluence of 5.4 J/cm2). Visual, keratometric and biomechanical outcomes were compared between groups. RESULTS At last follow-up (mean12 months, range 6-24 months), there were no statistically significant differences in changes in uncorrected visual acuity, best corrected distance visual acuity, Kmax, Kmean, corneal hysteresis, corneal resistance factor, endothelial cell counts, demarcation line depth, and intraoperative pain scores between groups (all p-values < 0.05). CONCLUSION The results of this study show comparable one-year outcomes between 3.8 and 5.4 J/cm2 accelerated CXL in mild to moderate keratoconus. Should the results of this study be confirmed in longer follow-ups, using a reduced fluence setting could be considered as an alternative to standard treatment in these patients.
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Affiliation(s)
- Seyed Reza Ghaffari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Khaheshi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Alipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Farhad Hafezi
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland.,ELZA Institute, Dietikon, Switzerland.,Department of Ophthalmology, University of Wenzhou, Wenzhou, China
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Webb JN, Langille E, Hafezi F, Randleman JB, Scarcelli G. Biomechanical Impact of Localized Corneal Cross-linking Beyond the Irradiated Treatment Area. J Refract Surg 2019; 35:253-260. [PMID: 30984983 DOI: 10.3928/1081597x-20190304-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the stiffening effect of localized corneal cross-linking (L-CXL) within and beyond the irradiated region in three dimensions. METHODS Ten porcine eyes were debrided of epithelium and incrementally soaked with 0.1% riboflavin solution. Using a customized, sharp-edged mask, half of the cornea was blocked while the other half was exposed to blue light (447 nm). The three-dimensional biomechanical properties of each cornea were then measured via Brillouin microscopy. An imaging system was used to quantify the optimal transition zone between cross-linked and non-cross-linked sections of the cornea when considering light propagation and scattering. RESULTS A broad transition zone of 610 µm in width was observed between the fully cross-linked and non-cross-linked sections, indicating the stiffening response extended beyond the irradiated region. Light propagation and the scattering induced by the riboflavin-soaked cornea accounted for a maximum of 25 and 159 ± 3.2 µm, respectively. CONCLUSIONS The stiffening effect of L-CXL extends beyond that of the irradiated area. When considering L-CXL protocols clinically, it will be important to account for increased stiffening in surrounding regions. [J Refract Surg. 2019;35(4):253-260.].
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Ziaei M, Vellara H, Gokul A, Patel D, McGhee CNJ. Prospective 2-year study of accelerated pulsed transepithelial corneal crosslinking outcomes for Keratoconus. Eye (Lond) 2019; 33:1897-1903. [PMID: 31273313 DOI: 10.1038/s41433-019-0502-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/27/2019] [Accepted: 04/24/2019] [Indexed: 01/17/2023] Open
Abstract
AIMS To report 2-year outcomes of transepithelial, accelerated, pulsed, corneal crosslinking (t-ACXL) for patients with progressive keratoconus. METHODS Prospective, interventional case series at a university hospital tertiary referral centre. Forty eyes with progressive keratoconus undergoing t-ACXL were included. Treatment was performed with pulsed illumination (1 s on/1 s off) using 45 mW/cm2 for 5 min and 20 s, for a surface dose of 7.2 J cm2. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal tomography, anterior segment optical coherence tomography (OCT) and confocal microscopy were evaluated preoperatively and at 12 and 24 months postoperatively. RESULTS The mean patient age was 23.32 ± 5.18 years (SD) (range 14-42 years). The mean CDVA significantly improved from 0.38 ± 0.32 logMAR at baseline to 0.30 ± 0.21 logMAR at 24 months (P < 0.01). There was no significant difference in UDVA, MRSE, asymmetry indices, tomographic parameters and endothelial density. The improvement in visual acuity was inversely correlated with preoperative CDVA and preoperative KMax. No complications were encountered. CONCLUSIONS In this prospective study, t-ACXL appeared safe and effective in halting progression of keratoconus within a follow-up period of 24 months.
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Affiliation(s)
- Mohammed Ziaei
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Hans Vellara
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Dipika Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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Ziaei M, Gokul A, Vellara H, Meyer J, Patel D, McGhee CNJ. Prospective two‐year study of clinical outcomes following epithelium‐off pulsed versus continuous accelerated corneal crosslinking for keratoconus. Clin Exp Ophthalmol 2019; 47:980-986. [DOI: 10.1111/ceo.13567] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/27/2019] [Accepted: 06/01/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Mohammed Ziaei
- Department of Ophthalmology, New Zealand National Eye CentreUniversity of Auckland Auckland New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye CentreUniversity of Auckland Auckland New Zealand
| | - Hans Vellara
- Department of Ophthalmology, New Zealand National Eye CentreUniversity of Auckland Auckland New Zealand
| | - Jay Meyer
- Department of Ophthalmology, New Zealand National Eye CentreUniversity of Auckland Auckland New Zealand
| | - Dipika Patel
- Department of Ophthalmology, New Zealand National Eye CentreUniversity of Auckland Auckland New Zealand
| | - Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye CentreUniversity of Auckland Auckland New Zealand
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14
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Martinez JD, Arboleda A, Naranjo A, Aguilar MC, Durkee H, Monsalve P, Dubovy SR, Donaldson KE, Miller D, Amescua G, Parel JM. Long-term outcomes of riboflavin photodynamic antimicrobial therapy as a treatment for infectious keratitis. Am J Ophthalmol Case Rep 2019; 15:100481. [PMID: 31198886 PMCID: PMC6556526 DOI: 10.1016/j.ajoc.2019.100481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/25/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To report the long-term outcomes of three patients with infectious keratitis treated with riboflavin photodynamic antimicrobial therapy (PDAT). Observations Case series reporting three patients with infectious keratitis unresponsive to standard medical treatment who underwent riboflavin photodynamic antimicrobial therapy (PDAT) as an adjunct therapy. One male and two female patients were treated, the median age of presentation was 58 years (range, 29-79 years). The organisms isolated and treated were Pseudomonas aeruginosa, Mycobacterium chenolae, and Curvularia spp. Different risk factors to develop corneal infection ulcers were identified, including corneal abrasion in a contact lens user, history of penetrating keratoplasty with chronic use of topical corticosteroids, and organic trauma. The median follow-up was 47 months (range 37-54 months), and there were no complications secondary to riboflavin PDAT treatment. Two cases underwent optical penetrating keratoplasty after infection was resolved and ocular surface was quiet for at least 3 years. Conclusions and importance Riboflavin PDAT can be used as an adjunct treatment in infectious keratitis to strengthen the corneal collagen fibers, delay keratolysis, and allow more time for antimicrobials to work and this way prevent a corneal perforation.
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Affiliation(s)
- Jaime D Martinez
- Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alejandro Arboleda
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Naranjo
- Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariela C Aguilar
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Heather Durkee
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pedro Monsalve
- Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Pathology, University of Miami, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sander R Dubovy
- Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA.,Department of Pathology, University of Miami, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kendall E Donaldson
- Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Darlene Miller
- Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Ocular Microbiology Laboratory, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Guillermo Amescua
- Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jean-Marie Parel
- Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,University of Liege Sart-Tillman CHU Dept. of Ophthalmology, Liege, Belgium
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15
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Yu F, Zong C, Jin S, Zheng J, Chen N, Huang J, Chen Y, Huang F, Yang Z, Tang Y, Ding G. Optimization of Extraction Conditions and Characterization of Pepsin-Solubilised Collagen from Skin of Giant Croaker (Nibea japonica). Mar Drugs 2018; 16:md16010029. [PMID: 29342895 PMCID: PMC5793077 DOI: 10.3390/md16010029] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/06/2018] [Accepted: 01/10/2018] [Indexed: 12/22/2022] Open
Abstract
In the present study, response surface methodology was performed to investigate the effects of extraction parameters on pepsin-solubilised collagen (PSC) from the skin of the giant croaker Nibea japonica. The optimum extraction conditions of PSC were as follows: concentration of pepsin was 1389 U/g, solid-liquid ratio was 1:57 and hydrolysis time was 8.67 h. Under these conditions, the extraction yield of PSC was up to 84.85%, which is well agreement with the predict value of 85.03%. The PSC from Nibea japonica skin was then characterized as type I collagen by using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The fourier transforms infrared spetroscopy (FTIR) analysis revealed that PSC maintains its triple-helical structure by the hydrogen bond. All PSCs were soluble in the pH range of 1.0-4.0 and decreases in solubility were observed at neutral or alkaline conditions. All PSCs had a decrease in solubility in the presence of sodium chloride, especially with a concentration above 2%. So, the Nibea japonica skin could serve as another potential source of collagen.
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Affiliation(s)
- Fangmiao Yu
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Chuhong Zong
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Shujie Jin
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Jiawen Zheng
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Nan Chen
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Ju Huang
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Yan Chen
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Fangfang Huang
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Zuisu Yang
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Yunping Tang
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
| | - Guofang Ding
- Zhejiang Provincial Engineering Technology Research Center of Marine Biomedical Products, School of Food and Pharmacy, Zhejiang Ocean University, Zhoushan 316022, China.
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