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 Combined small-incision lenticule extraction and intrastromal corneal collagen crosslinking to treat mild keratoconus: Long-term follow-up

2015 ◽  
Vol 41 (11) ◽  
pp. 2524-2532 ◽  
Author(s):  
Enrique O. Graue-Hernandez ◽  
Gabriela L. Pagano ◽  
Guillermo Garcia-De la Rosa ◽  
Arturo Ramirez-Miranda ◽  
Jesus Cabral-Macias ◽  
...  
Keyword(s):  
Small Incision Lenticule Extraction ◽  
Collagen Crosslinking ◽  
Small Incision ◽  
Long Term Follow Up ◽  
Lenticule Extraction ◽  
Corneal Collagen Crosslinking ◽  
Corneal Collagen

scholarly journals Avaliação dos Resultados do Tratamento Antiangiogénico na Neovascularização Coroideia Associada à Miopia Patológica

2014 ◽  
Vol 27 (1) ◽  
pp. 49 ◽  
Author(s):  
Beatriz Carvalho ◽  
Paulo Freitas-Costa ◽  
João Pinheiro-Costa ◽  
Manuel Falcão ◽  
Ângela Carneiro ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Choroidal Neovascularization ◽  
Vision Loss ◽  
Long Term Results ◽  
Myopic Choroidal Neovascularization ◽  
Corrected Visual Acuity ◽  
Foveal Center ◽  
Best Corrected Visual Acuity

<strong>Introduction:</strong> Choroidal neovascularization secondary to pathological myopia is one of the leading causes of irreversible central vision loss in younger patients. The purposes of our study is to evaluate the long-term results of antiangiogenic treatment, with ranibizumab and/or bevacizumab, in myopic choroidal neovascularization and define the predictive factors for visual and anatomic outcomes.<br /><strong>Material and Methods:</strong> In this study were included 84 eyes from 81 patients with myopic choroidal neovascularization. Eighty-four (100%) eyes accomplish 12 months of follow-up, 67 (79.8%) 24 months, 54 (64.3%) 36 months, 29 (34.5%) 48 months, and 15 (16.7%) 60 months. We retrieved data related to best corrected visual acuity measured with ETDRS chart, foveal center thickness on optical coherence tomography and fluorescein angiographic findings, before and after treatment.<br />Results: The best corrected visual acuity and foveal center thickness improvements were statistically significant for all follow-up times (p &lt; 0.05). Mean baseline best corrected visual acuity was 43.7 ± 20.1 letters and mean baseline foveal center thickness was 304.8 ± 127.9μm. Mean best corrected visual acuity was 55.6 ± 18.5, 52.1 ± 22.3, 52.1 ± 22.6, 50.3 ± 23.8 and 47.8 ± 24.5 for 12, 24, 36, 48 and 60 months of treatment, respectively. Mean foveal center thickness was 209.7 ± 86.2, 190.6 ± 76.1, 174.7 ± 60.6, 189.8 ± 96.7 and 159.4 ± 73.3 for the same follow-up times. Baseline best corrected visual acuity was the only predictive factor for better visual outcome (p &lt; 0.001).<br /><strong>Discussion/Conclusion:</strong> Intravitreal anti-VEGF injections in patients with myopic choroidal neovascularization yielded a significant and sustained functional and anatomic improvement. Randomized long-term clinical trials are needed to determine the sustained efficacy of these drugs.

scholarly journals Long-term results of corneal collagen crosslinking with ectatic forms of corneal dystrophy

2020 ◽  
Vol 12 (4) ◽  
pp. 29-34 ◽  
Author(s):  
Oleg A. Frolov ◽  
Sergey Yu. Astakhov ◽  
Sergey Yu. Astakhov ◽  
Sergey A. Novikov ◽  
Sergey A. Novikov
Keyword(s):  
Corneal Dystrophy ◽  
Treatment Method ◽  
Long Term Results ◽  
Corneal Surface ◽  
Collagen Crosslinking ◽  
Corneal Ectasia ◽  
Corneal Collagen Crosslinking ◽  
Corneal Collagen

Corneal collagen crosslinking is one of the most effective methods of prophylactics and treatment of progressive corneal ectasias. In the literature, there are occasional data related to remote results concerning only the most common form of ectasias keratoconus. In published studies, no remote results are met concerning the efficacy of corneal collagen crosslinking in other forms of corneal ectasias, which are now on the rise, including secondary ectasias that became more frequent with refractive surgery. The number of diagnosed cases of pellucid marginal degeneration increased as well. The literature shows no data on comparative analysis of remote results concerning the efficacy of this method in treatment of various forms of corneal ectasias. The aim of the investigation was to evaluate the efficacy of corneal collagen crosslinking based on the analysis of long-term results of this treatment method for various forms of corneal ectasias. Materials and methods. The results of corneal collagen crosslinking in patients with various forms of corneal ectasia 6 years after surgery were analyzed. The nosological structure of the study included patients with keratoconus, pellucid marginal degeneration, and secondary ectasia. The group of patients with keratoconus included 30 patients (30 eyes), that with pellucid marginal degeneration 30 patients (30 eyes), and that with secondary ectasia 30 patients (30 eyes). Corneal collagen crosslinking was performed by the same specialist, during the first or the second year of follow-up. Then changes in the state of the cornea and visual functions were monitored for 6 years. To assess the efficacy, preoperative examination results and interim data were used. Results. In all groups, there was an increase in the best corrected visual acuity, a decrease in the index of asymmetry of the corneal surface and its refractive power in the center of ectasia. However, best corneal collagen crosslinking results were obtained in groups of patients with keratoconus and secondary corneal ectasia.

Corneal Collagen Crosslinking for Corneal Ectasias: A Review

2016 ◽  
Vol 27 (3) ◽  
pp. 253-269 ◽  
Author(s):  
David P.S. O’Brart
Keyword(s):  
Case Series ◽  
Collagen Crosslinking ◽  
Randomized Controlled Clinical Trials ◽  
Long Term Follow Up ◽  
Corneal Collagen Crosslinking ◽  
Meta Analyses ◽  
Term Data ◽  
Corneal Collagen

Purpose To review the published literature on corneal collagen crosslinking (CXL). Methods Importance has been placed on seminal publications, systemic reviews, meta-analyses, and randomized controlled clinical trials. Where such evidence was not available, cohort studies, case-controlled studies, and case series with follow-up greater than 12 months were examined. Results Corneal collagen crosslinking with riboflavin and ultraviolet A (UVA) 370 nm radiation appears to be capable of arresting the progression of ectatic corneal disorders, with most studies reporting significant improvements in visual, keratometric, and topographic measurements. Its mode of action at the molecular level is undetermined. Follow-up is limited to 5-10 years but suggests sustained stability and enhancement in corneal shape with time. Nearly all published long-term data and comparative studies are with epithelium-off techniques. Epithelium-on investigations suggest some efficacy but less than with epithelium-off treatments and long-term data are unavailable. Accelerated techniques with higher UVA fluencies and shorter treatments times, delivering the same UVA energy dosage, are the subject of recent investigation, with some laboratory and clinical studies suggesting reduced efficacy compared to the standard 3 mW/cm2 for 30 minutes irradiation procedure. Combined methodologies of CXL with techniques such as photorefractive keratectomy and intrastromal rings show promise but long-term follow-up is indicated. Sight-threatening complications of CXL are rare. Conclusions Studies of epithelium-off CXL with irradiation at 3 mW/cm2 for 30 minutes support its efficacy. Refinement in techniques may allow for safer and more rapid procedures with less patient discomfort but require further investigation.

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 Transepithelial High Fluence Crosslinking for Keratoconus – Case Report of 1-year Follow-up

2015 ◽  
Vol 09 (01) ◽  
pp. 21
Author(s):  
Roberto Pinelli ◽  
Zahran Yazan Amin ◽  
◽  
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Corneal Topography ◽  
High Fluence ◽  
Efficacy And Safety ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Best Corrected Visual Acuity

Purpose:To evaluate the efficacy and safety of transepithelial crosslinking for halting the progression of keratoconus.Methods:Uncorrected and corrected visual acuity, simulated keratometry, corneal topography and pachymetry data were evaluated at baseline and 1 year after bilateral transepithelial crosslinking using ParaCel™ and the KXL™ device (Avedro, Waltham, Massachusetts, US).Results:The keratometry, uncorrected visual acuity, best corrected visual acuity at the baseline and after 1 year of follow-up was stable and even improved with time.Conclusion:Transepithelial crosslinking can safely and effectively halt the progression of keratoconus as demonstrated by follow-up.

scholarly journals Evaluating the Effectiveness of Accelerated and Accelerated Cornea Pulsing Crosslinking Based on the Presence of a Demarcation Line

2019 ◽  
Vol 16 (1S) ◽  
pp. 127-131
Author(s):  
L. I. Khalimova
Keyword(s):  
Visual Acuity ◽  
Central Zone ◽  
Demarcation Line ◽  
Clinical Observations ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Stromal Edema

Purpose of the study is to assess the state of the demarcation line of the stroma after accelerated and pulsed accelerated ultraviolet cornea crosslinking. Patients and methods. Clinical observations included 24 patients (31 eyes) with keratoconus (KC), aged 18–46 years, men — 11 (45.9 %), women — 13 (54.1 %). Accelerated (a-CXL) crosslinking was carried out in continuous mode with a power of 18 mW/cm2 for 5 minutes (13 eyes), pulsed accelerated (i-ACXL) with a power of 18 mW/cm2 for 10 minutes, in mode 1 sec light / 1 sec pause (18 eyes). Conducted generally accepted and additional methods of ophthalmic research. The follow-up periods were 1, 3, and 6 months after surgery. Results. According to optical coherent tomography, the demarcation line was detected in all cases after a-CXL and i-ACXL. At 1 month after the crosslinking, there were no significant differences between the a-CXL and i-ACXL groups in terms of uncorrected visual acuity, corrected visual acuity, maximal correction. The average depth with demarcation at 1 month after the procedure in the central zone of the cornea was 216.41 ± 36.67 μm in the a-CXL group and 236.41 ± 37.08 μm in the i-ACXL group. Using confocal microscopy in vivo in both groups 1 month after surgery apoptosis of keratocytes and stromal edema were detected. A gradual restoration of the cornea to its original state was observed after 6 months. Conclusion. Research results have shown that accelerated and pulsed accelerated cross-linking are safe and effective technologies to stabilize the progression of keratoconus. Both crosslinking protocols provide a significant reduction in the duration of the procedure compared to the traditional one. Revealed deeper arrangement of the demarcation line when performing pulsed accelerated crosslinking compared to the accelerated. Further long-term and more extensive studies of accelerated and pulsed accelerated cornea ultraviolet crosslinking will provide improved information on their effectiveness in the long-term.

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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