Successful Regression in Patients with Progressive Keratoconus by Corneal Crosslinking

2021 ◽  
Author(s):  
Tobias Röck ◽  
Eva-Maria Konrad ◽  
Daniel Röck ◽  
Matthias Bramkamp ◽  
Gunnar Blumenstock ◽  
...  
Keyword(s):  
Statutory Health Insurance ◽  
Observation Time ◽  
Collagen Crosslinking ◽  
Corrected Visual Acuity ◽  
Before And After ◽  
Study Population ◽  
Corneal Collagen Crosslinking ◽  
The Mean ◽  
The University ◽  
Corneal Collagen

Abstract Background Since 2019, corneal collagen crosslinking (CXL) is included in the catalog of procedures covered by statutory health insurance in Germany. CXL is an established ophthalmological procedure for the last 20 years. The aim of this investigation was the measurement of progression before and after CXL. Material und Methods 65 consecutive eyes with progressive keratoconus from 53 patients were included in the retrospective study, which were observed at the University Eye Hospital Tübingen at least two years before and at least two years after CXL. The time of observation took place from October 2009 until March 2018. Parameters of interest had been the best corrected visual acuity (BCVA) and the keratometric values from the elevation maps measured by a Scheimpflug camera. Results 65 eyes of 53 patients had been documented. The study population included 46 (86.8%) male and 7 (13.2%) female subjects. The mean age was 24 ± 8 years. The averaged observation time between the primary consultation and CXL showed 25 ± 15 months. Preoperatively the mean BCVA pointed out in a significant increase (0.13 ± 0.17 [first visit] vs. 0.23 ± 0.22 [preOP], p < 0.0001) while the mean Kmax resulted in a statistically significant increase (46.34 ± 3.33 dpt [first visit] vs. 48.78 ± 4.17 dpt [preOP], p < 0.0001). The mean thinnest point of the cornea showed a significant decrease (490.48 ± 34.23 µm [first visit] vs. 468.62 ± 29.84 µm [preop], p < 0.0001). Postoperatively the mean BCVA resulted in a significant improvement at the 12th postoperative month in comparison to the preoperative measurement (0.23 ± 0.22 [preOP] vs. 0.16 ± 0.14 [12 months], p = 0.04 respectively 0.17 ± 0.17 [24 months], p = 0.0006). The mean Kmax demonstrated in the 12th postoperative month a significant reduction (48.78 ± 4.17 dpt [preOP] vs. 47.91 ± 3.41 dpt [12 months], p = 0.0009 respectively 48 ± 4.56 dpt [24 months], p = 0.0051). The mean thinnest point of the cornea indicated a decrease at the 12th postoperative month (468.62 ± 29.84 µm [preOP] vs. 459.82 ± 35.88 µm [12 months], p = 0.0078 respectively 453.47 ± 43.39 µm [24 months], p = 0.0227). Conclusion CXL is a successful procedure for the therapy of progressive keratoconus.

scholarly journals Outcome of Corneal Collagen Crosslinking for Progressive Keratoconus in Paediatric Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Deepa Viswanathan ◽  
Nikhil L. Kumar ◽  
John J. Males
Keyword(s):  
Young Patients ◽  
Ultraviolet A ◽  
Effective Treatment Option ◽  
Collagen Crosslinking ◽  
Paediatric Patients ◽  
Corneal Grafting ◽  
Minimum Angle ◽  
Corneal Collagen Crosslinking ◽  
The Mean ◽  
Corneal Collagen

Purpose. To evaluate the efficacy of corneal collagen crosslinking for progressive keratoconus in paediatric patients.Methods. This prospective study included 25 eyes of 18 patients (aged 18 years or younger) who underwent collagen crosslinking performed using riboflavin and ultraviolet-A irradiation (370 nm, 3 mW/cm2, 30 min).Results. The mean patient age was 14.3 ± 2.4 years (range 8–17) and mean followup duration was 20.1 ± 14.25 months (range 6–48). Crosslinked eyes demonstrated a significant reduction of keratometry values. The mean baseline simulated keratometry values were 46.34 dioptres (D) in the flattest meridian and 50.06 D in the steepest meridian. At 20 months after crosslinking, the values were 45.67 D (P=0.03) and 49.34 D (P=0.005), respectively. The best spectacle corrected visual acuity (BSCVA) and topometric astigmatism improved after crosslinking. Mean logarithm of the minimum angle of resolution (logMAR) BSCVA decreased from 0.24 to 0.21 (P=0.89) and topometric astigmatism reduced from mean 3.50 D to 3.25 D (P=0.51).Conclusions. Collagen crosslinking using riboflavin and ultraviolet-A is an effective treatment option for progressive keratoconus in paediatric patients. Crosslinking stabilises the condition and, thus, reduces the need for corneal grafting in these young patients.

scholarly journals EFFICACY OF CORNEAL COLLAGEN CROSSLINKING WITH RIBOFLAVIN AND ULTRAVIOLET-A IN PROGRESSIVE KERATOCONUS.

2020 ◽  
pp. 1-3
Author(s):  
Priyanka Raut ◽  
Nikhilesh * Wairagade ◽  
Praneeta Sakarkar
Keyword(s):  
P Value ◽  
Spherical Equivalent ◽  
Ultraviolet A ◽  
Collagen Crosslinking ◽  
Institutional Ethics ◽  
Uncorrected Visual Acuity ◽  
Corneal Collagen Crosslinking ◽  
The Mean ◽  
A Prospective Study ◽  
Corneal Collagen

PURPOSE-To evaluate outcomes of collagen crosslinking in patients having progressive keratoconus. METHODS- A prospective study was done in eyes that underwent corneal collagen crosslinking for treatment of progressive keratoconus. This study was performed after approval from Institutional Ethics Committee and informed consent was obtained from all the patients. Data was analysed with the help of JASP0.8.3.1 and MS-Excel 2013. RESULT-The mean age was 20.94 ± 2.04 years. 21 (63.63%) were males, 12 (36.36 %) were females. The mean uncorrected visual acuity (UCVA) pre-operative and post-operative at 6 months were 0.64 ± 0.37 and 0.53 ± 0.31 (logMAR) respectively (p value 0.03). Mean spherical equivalent pre-operatively and post-operatively at 6 months were -2.85 ± 2.14 and -2.38 ± 1.70 respectively (p < 0.001). Mean keratometry (Mean K) preoperative and post-operative were 49.85 ± 4.10 Dioptres (D) and 49.22 ± 4.09 D respectively (p = 0.0007). CONCLUSION- Corneal collagen crosslinking with UV-A and riboavin is a safe and effective method for halting the deterioration of progressive keratoconus.

Oxidative stress markers dynamics in keratoconus patients’ tears before and after corneal collagen crosslinking procedure

2020 ◽  
Vol 190 ◽  
pp. 107897 ◽  
Author(s):  
Ioana-Miruna Balmus ◽  
Anisia Iuliana Alexa ◽  
Roxana-Elena Ciuntu ◽  
Ciprian Danielescu ◽  
Bogdan Stoica ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Oxidative Stress Markers ◽  
Collagen Crosslinking ◽  
Stress Markers ◽  
Before And After ◽  
Corneal Collagen Crosslinking ◽  
Corneal Collagen

scholarly journals MyoRing Implantation in Comparison with MyoRing Implantation Combined with Corneal Collagen Crosslinking for Keratoconus

2019 ◽  
Vol 16 (1S) ◽  
pp. 85-90
Author(s):  
G. M. Kazakbaeva
Keyword(s):  
Corneal Thickness ◽  
Efficacy And Safety ◽  
Collagen Crosslinking ◽  
Corrected Visual Acuity ◽  
Number Of Patients ◽  
Significant Difference ◽  
Corneal Collagen Crosslinking ◽  
The Difference ◽  
Corneal Collagen

Purpose: tо estimate the effectiveness of complete corneal ring (MyoRing) implantation compared with MyoRing implantation combined with corneal collagen crosslinking (CXL) for keratoconus treatment for 36 months follow-up. Patients and Methods. There were 101 patients (124 eyes) with progressing keratoconus aged 18–59 years in the study. Intracorneal rings were implanted in all patients. The patients were divided into 2 groups. MyoRing implantation was performed in a series of 59 patients (76 eyes) with keratoconus II–III Amsler classification, 42 patients (48 eyes) had MyoRing implantation combined with CXL. Implantation of a MyoRing in the corneal pocket was performed using a PocketMaker microkeratome and corneal intrastromal implantation system. Results. Keratometry was reduced in both groups; after MyoRing implantation for 8,45 D and MyoRing combined with CXL for 7,44 D, the spherical equivalent decreased for 7,72 and 6,29 D respectively, after 36 months. The cylinder decreased to 3,33 D with MyoRing alone and to 3,11 D with MyoRing combined with CXL. The smallest corneal thickness remained stable during 36 months after the procedure. There was an improvement in uncorrected and corrected visual acuity, and the difference in the CRF within the period of up to 12 months after the operation. It can be explained by the pseudochase formation in the group with a combined procedure. Conclusion. The implantation of the MyoRing IRC and the combination of MyoRing with CXL showed efficacy and safety in stabilizing keratoconus stabilization, as well as correction of comorbided ametropia 3 years after surgery. Both MyoRing implantation and MyoRing combined with CXL were effective in the stabilization of progressive keratoconus, as well as the correction of ametropia 3 years after surgery. There was no significant difference in MyoRing implantation and its combination with corneal crosslinking in visual and refractive results. The refractive power of the cornea was only one exeption. Long follow-up and randomized prospective studies with a large number of patients are needed.

scholarly journals Long-term efficacy and safety after corneal collagen crosslinking in pediatric patients: Three-year follow-up

2018 ◽  
Vol 28 (4) ◽  
pp. 415-418 ◽  
Author(s):  
Maria A Henriquez ◽  
Sandra Villegas ◽  
Mirel Rincon ◽  
Carmen Maldonado ◽  
Luis Izquierdo
Keyword(s):  
Visual Acuity ◽  
Progression Rate ◽  
Collagen Crosslinking ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Corneal Collagen Crosslinking ◽  
Best Corrected Visual Acuity ◽  
Corneal Collagen

Purpose: To evaluate the effectiveness of standard corneal collagen crosslinking for children with progressive keratoconus. Methods: Prospective study including 26 eyes of 26 patients younger than 18 years old with progressive keratoconus at Oftalmosalud Instituto de Ojos, Lima, Peru. Standard epi-off corneal crosslinking was performed in all eyes between January 2012 and January 2013. Pre- and postoperative evaluation (at 3 years) included uncorrected and best-corrected visual acuity and Scheimpflug analysis. Crosslinking failure was defined as an increase in maximum keratometry (Kmax) of more than 1 diopter after 1 year or more. Results: Mean uncorrected visual acuity improvement was 0.24 LogMAR (p = 0.07) and mean best-corrected visual acuity improvement was 0.18 LogMAR (p = 0.01). None of the eyes lost more than one line in the best-corrected visual acuity. Four eyes (15.38%) lost two lines in the uncorrected visual acuity at 3 years postoperative. Mean steeper keratometry improvement was 1.14 diopters (p = 0.60). Progression rate was 23.07%. Conclusion: Standard epi-off corneal collagen crosslinking is safe and effective to halt the progression of the keratoconus with significant improvement in the best-corrected visual acuity at 3-year follow-up.

scholarly journals MyoRing Implantation with and without Corneal Collagen Crosslinking for the Management of Keratoconus

2020 ◽  
Author(s):  
Mehrdad Mohammadpour ◽  
Ahmad Masoumi ◽  
Mahmoud Dehghan ◽  
Mohammad Nasser Hashemian ◽  
Shahab Addin Karami ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Corneal Stroma ◽  
Safety And Efficacy ◽  
Collagen Crosslinking ◽  
Randomized Controlled ◽  
Uncorrected Distance Visual Acuity ◽  
Corneal Collagen Crosslinking ◽  
The Mean ◽  
Corneal Collagen

Purpose: To evaluate the safety and efficacy of femtosecond laser-assisted MyoRing implantation with concurrent corneal collagen crosslinking (CXL) compared to MyoRing alone for the treatment of progressive keratoconus. Methods: A total of 60 patients were enrolled in this randomized controlled trial. The patients were randomly allocated into two groups. In the first group, MyoRing was implanted, while in the second, it was inserted in the corneal stroma using the same technique, along with simultaneous CXL. Visual, refractive, topographic, and abberometric outcomes were measured preoperatively and at every postoperative visit. Results: Data of 47 patients were available at the end of the study; 28 in the MyoRing group and 19 in the MyoRing + CXL group. The mean uncorrected distance visual acuity (UDVA) improved from 0.79 ± 0.39 logMAR to 0.52 ± 0.31 logMAR (P < 0.05) in the MyoRing + CXL group and from 0.65 ± 0.38 logMAR to 0.62 ± 0.23 logMAR (P = 0.70) in the MyoRing group. CDVA changed from 0.33 ± 0.19 logMAR to 0.25 ± 0.16 logMAR (P = 0.10) in the MyoRing + CXL group and 0.32 ± 0.22 logMAR to 0.33 ± 0.17 logMAR (P > 0.5) in the MyoRing group. The mean keratometry (Km) decreased from 47.5 ± 2.7 D to 43.8 ± 3.2 D (P < 0.001) in the MyoRing group and 49.3 ± 3.4 D to 45.1 ± 3.0 D (P < 0.001) in the MyoRing + CXL group. Besides, horizontal coma was significantly lower in the MyoRing + CXL group (P = 0.022). Conclusion: MyoRing insertion combined with CXL is a safe and effective method for the treatment of keratoconus. The visual and topographic outcomes were comparable to that for MyoRing insertion after 10 months; however, horizontal coma was significantly lower in the MyoRing + CXL group.

scholarly journals Risk Factors For Progression Following Corneal Collagen Crosslinking In Keratoconus

2021 ◽  
Author(s):  
Ayhan Saglik ◽  
Gökçen Özcan ◽  
Ömür Uçakhan
Keyword(s):  
Risk Factors ◽  
Allergic Conjunctivitis ◽  
Female Gender ◽  
Progression Rate ◽  
Collagen Crosslinking ◽  
Central Cone ◽  
Corneal Collagen Crosslinking ◽  
The Mean ◽  
Corneal Collagen

Abstract Purpose: To assess risk factors for progression following corneal collagen crosslinking (CXL) in eyes with keratoconus. Methods: Charts of patients who developed progression following conventional CXL treatment (Dresden protocol) were retrospectively evaluated in two centers (Center 1, and Center 2). 871 eyes of a total of 676 patients were analyzed. Progression was defined as >1 diopter (D) increase in maximum keratometry (Kmax) readings compared to baseline. Results: Progression was noted in 20 eyes of 20 patients (progression rate 3%). The mean age of the patients was 17.65 ± 5.76 (11–34) years and the mean follow-up following CXL was 36.70 ± 25.72 (12–84) months. The gender distribution was 13 (65%) females, and seven (35%) males. Four eyes (20%) had mild, 13 eyes (65%) had moderate, and three eyes (15%) had severe keratoconus at baseline. Fifteen eyes (75%) had allergic conjunctivitis and 20 eyes (100%) reported eye-rubbing. Cone location was central in 17 (85%) eyes and peripheral in 3 (15%) eyes. A mean of 2.21 ± 1.30 D (1.00 – 5.30 D) steepening was determined at Kmax 6 to 82 months following CXL treatment. Conclusions: Progression rate was found to be higher in the patients under the age of 17 years, female gender, allergic conjunctivitis, high preoperative Kmax (>57 D), thin corneas (<430 µm) . The majority of progressive patients were central cone and moderate keratoconus.

Efficacy of pulsed-light accelerated crosslinking in the treatment of progressive keratoconus: Two-year results

2019 ◽  
Vol 30 (6) ◽  
pp. 1256-1260 ◽  
Author(s):  
Selman Belviranli ◽  
Refik Oltulu
Keyword(s):  
Visual Acuity ◽  
Total Dose ◽  
First Year ◽  
Ultraviolet A ◽  
Pulsed Light ◽  
Collagen Crosslinking ◽  
Corrected Visual Acuity ◽  
Corneal Collagen Crosslinking ◽  
Second Year ◽  
Corneal Collagen

Purpose: The aim of this study was to evaluate the 2-year results of epithelium-off pulsed-light accelerated corneal collagen crosslinking treatment in progressive keratoconus using 30 mW/cm2 ultraviolet A light for 6 min with a total dose of 5.4 J/cm2. Methods: A total of 30 eyes of 22 patients with documented progressive keratoconus and treated with epithelium-off pulsed-light accelerated corneal collagen crosslinking using the KXL® crosslinking device (Avedro Inc, Waltham, MA, USA) were included in this retrospective study. Corneal tomographic measurements and best spectacle-corrected visual acuity were compared using analysis of variance with repeated measurements between the baseline visit (before the corneal collagen crosslinking treatment), and the sixth month, first, and second year visits. Results: Flat keratometry (K1), steep keratometry (K2), and mean keratometry (Km) decreased significantly at sixth month, first, and second years ( p < 0.001, p = 0.001, and p < 0.001, respectively). Maximum keratometry (Kmax) decreased from 55.40 ± 4.90 D at baseline to 54.82 ± 4.68 D, 54.80 ± 5.12 D, and 54.65 ± 5.36 D at sixth month, first year, and second year, respectively ( p = 0.007). The best spectacle-corrected visual acuity improved from 0.34 ± 0.24 logMAR at baseline to 0.25 ± 0.16 logMAR, 0.22 ± 0.15 logMAR, and 0.17 ± 0.13 logMAR at sixth month, first year, and second year, respectively ( p < 0.001). At the second year visit, best spectacle-corrected visual acuity remained stable (no lines lost) with respect to the baseline in 8 eyes and increased 1 or more lines in 22 eyes. Conclusion: Pulsed-light accelerated corneal collagen crosslinking using 30 mW/cm2 ultraviolet A light for 6 min with a total dose of 5.4 J/cm2 is an effective treatment modality in cases with progressive keratoconus—it stops progression at 2 years also regresses some of the cases.

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