scholarly journals Factors influencing haze formation and corneal flattening, and the impact of haze on visual acuity after conventional collagen cross-linking: a 12-month retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anita Csorba ◽  
Kinga Kránitz ◽  
Péter Dormán ◽  
Andrea Popper-Sachetti ◽  
Huba Kiss ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Rank Test ◽  
Cross Linking ◽  
Grey Scale ◽  
Scale Unit ◽  
Haze Formation ◽  
Post Hoc ◽  
The Impact ◽  
Collagen Cross Linking ◽  
Corneal Flattening

Abstract Background Our aim was to determine associations of pachymetry, keratometry, and their changes with haze formation and corneal flattening after collagen cross-linking, and to analyse the relationship between postoperative haze and visual outcome. Methods Retrospective analysis was performed on 47 eyes of 47 patients with keratoconus using the Pentacam HR Scheimpflug camera before and 1, 3, 6 and 12 months after cross-linking. Corneal backscattered light values in grey scale unit were recorded in the anterior, center and posterior corneal layers and in four concentric rings. Surface area- and thickness-corrected grey scale unit values were assessed with an additional calculation. Friedman test with post hoc Wilcoxon signed-rank test was used to analyse changes in visual acuity, pachymetry, keratometry and densitometry. Spearman’s rank correlation test was used to detect correlations of haze formation and corneal flattening with pachymetry, keratometry and their postoperative change. Generalized estimating equations analysis was used to investigate the influence of densitometry values on postoperative visual acuity after controlling for the effect of preoperative keratometry. Results One year after treatment, significant flattening was observed in maximum and mean keratometry readings (p < 0.001). Significantly increased densitometry values were observed in three central rings compared to baseline (post hoc p < 0.0125). According to receiver operating characteristic curve, densitometry value of the anterior layer of 0–2 mm ring was the most characteristic parameter of densitometry changes after cross-linking (area under the curve = 0.936). Changes in haze significantly correlated with preoperative maximum keratometry (R = 0.303, p = 0.038) and with the changes in maximum keratometry (R = -0.412, p = 0.004). Changes in maximum keratometry correlated with preoperative maximum keratometry (R = -0.302, p = 0.038). Postoperative haze had a significant impact on uncorrected and best corrected distance visual acuity (β coefficient = 0.006, p = 0.041 and β coefficient = 0.003, p = 0.039, respectively). Conclusions Our findings indicate that in more advanced keratoconus more significant corneal flattening effect parallel with haze formation can be observed after cross-linking. Despite significant reduction of keratometry, postoperative corneal haze may limit final visual acuity.

Long term results of accelerated corneal collagen cross-linking in pediatric keratoconus

2021 ◽  
pp. 112067212110183
Author(s):  
Yasin Cinar ◽  
Cagla Cilem Han ◽  
Alparslan Sahin ◽  
Zeba A Syed
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
University Hospital ◽  
Long Term Results ◽  
Cross Linking ◽  
Distance Visual Acuity ◽  
The Mean ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose: To evaluate the long term visual, refractive, and corneal tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACXL) in the management of pediatric keratoconus (KC). Methods: This retrospective study included patients under 18 years old with progressive KC who underwent ACXL between 2012 and 2019 at Dicle University Hospital. Complete ophthalmic examination was performed including uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Evaluations were performed preoperatively and at 6 months intervals postoperatively. Results: Forty-nine eyes of 49 patients were included in the study. The mean age of patients at the time of ACXL was 14.2 ± 1.8 (range: 9.5–17.3) years. Mean follow up was 4.61 ± 1.90 (range: 2.0–8.1) years. The mean LogMAR UDVA improved from 0.94 ± 0.41 to 0.81 ± 0.43, 0.69 ± 0.41, and 0.67 ± 0.33 after 1, 3, and 5 years respectively ( p = 0.001). The mean LogMAR CDVA improved from 0.58 ± 0.36 to 0.46 ± 0.31, 0.34 ± 0.23, and 0.39 ± 0.27 after 1, 3, and 5 years respectively ( p = 0.015). The mean refractive cylinder improved significantly from 6.01 ± 2.07 diopters (D) to 5.46 ± 1.87, 5.38 ± 2.18, and 5.02 ± 2.31 D after 1, 3, and 5 years respectively ( p = 0.005). As compared to preoperative values, steep keratometry and maximum keratometry were not significantly different ( p = 0.805 and 0.448, respectively) following ACXL, while flat keratometry significantly improved after ACXL ( p = 0.012). Although central corneal thicknesses decreased significantly ( p = 0.029), the decrease in thinnest corneal thickness was not statistically significant ( p = 0.205). Conclusion: Epithelium-off ACXL seems to be effective for halting KC progression with long term clinical benefits in pediatric patients.

scholarly journals Two Years’ Experience in Keratoconus Treatment using Collagen Cross-linking

2017 ◽  
Vol 6 (1) ◽  
pp. 11-13
Author(s):  
Dimitrii Dementiev ◽  
Maria Sysoeva ◽  
Anna Shipunova
Keyword(s):  
Visual Acuity ◽  
Cross Linking ◽  
Stage Of Disease ◽  
Central Cornea ◽  
Uncorrected Visual Acuity ◽  
Keratorefractive Surgery ◽  
Cornea Thickness ◽  
Central Cornea Thickness ◽  
Collagen Cross Linking

ABSTRACT Purpose To evaluate safety, efficacy, and stability of cross-linking (CLX) procedure as a method for keratoconus treatment in the I and II stage of disease. Materials and methods Twenty eyes of 15 patients (13 males, 2 females, average age 31 years) with keratoconus I stage (13 eyes) and II stage (2 eyes) (by Krumeich classi­fication) were treated by CLX procedure, using riboflavin Medio Cross for standard CLX); riboflavin Medio Cross TE for transepithelial CLX was used to treat keratectasia after previous keratorefractive surgery; in all the cases UV CBM X linker (Vega, CSO) was used. The study included evaluation of uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) pre- and postoperative, pachymetry (central cornea thickness) (Visante OCT, Zeiss) pre- and postoperative, total astigmatism pre- and postoperative, using keratotopography (Atlas, Zeiss). Diagnosis and analysis have been performed at the International Center for Ophthalmology in Moscow, Russian ­Federation, since 2012 to 2014 years. Follow-up period was from 1 to 24 months. Results Average UCVA preoperative was 0.4 (Decimal), and average BCVA was 0.64. Average UCVA postoperative was 0.49; average BCVA was 0.66. Total astigmatism preoperative was 2.81 D; total astigmatism postoperative 2.80 D. Central cornea thickness (CCT) preoperative 454 mkm; CCT post­operative 447 mkm. Conclusion Cross-linking indicated safety, stability, and efficacy for treatment of I and II stage keratoconus at the end of follow-up period. Cross-linking is not effective in the treatment of II and III stage of disease. Further study is required. How to cite this article Dementiev D, Sysoeva M, Shipunova A. Two Years’ Experience in Keratoconus Treatment using Collagen Cross-linking. Int J Kerat Ect Cor Dis 2017;6(1):11-13.

scholarly journals Corneal Safety and Stability in Cases of Small Incision Lenticule Extraction with Collagen Cross-Linking (SMILE Xtra)

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Ihab Mohamed Osman ◽  
Hany Ahmed Helaly ◽  
Mohsen Abou Shousha ◽  
Amir AbouSamra ◽  
Islam Ahmed
Keyword(s):  
Visual Acuity ◽  
Cross Linking ◽  
Small Incision Lenticule Extraction ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Corneal Densitometry ◽  
Lenticule Extraction ◽  
Safety And Stability ◽  
Collagen Cross Linking

Purpose. To assess the safety and stability in cases of small incision lenticule extraction with collagen cross-linking (SMILE Xtra). Methods. This study was a retrospective interventional comparative study that included 60 eyes of 30 patients divided equally into two groups: SMILE Xtra and SMILE alone. The inclusion criteria were patients >18 years of age, myopic error >6 D, thinner cornea <520 microns, and abnormal corneal topography. Outcome data were recorded including uncorrected distance visual acuity and corrected distance visual acuity (UDVA and CDVA), manifest refraction spherical equivalent (MRSE), central corneal thickness, average keratometry, endothelial cell density, corneal resistance factor (CRF), and corneal densitometry. The follow-up period was 24 months. Results. There was a significant difference between the 2 groups regarding UDVA, CDVA, and MRSE at 1 month. In the SMILE Xtra group, 90% of eyes had postoperative UDVA of 20/20 and 97% had UDVA of 20/30 at 24 months. At 24 months, 26 eyes (87%) vs. 25 eyes (84%) were within ±0.50 D of attempted correction in SMILE Xtra and SMILE groups, respectively. Regarding stability, both groups showed improvement of MRSE at 1st month postoperatively and remained stable along the 24 months of follow-up. CRF and corneal densitometry were higher in the SMILE Xtra group along the whole follow-up period (p=0.001). Conclusion. Combining corneal cross-linking with SMILE procedure (SMILE Xtra) is a promising tool to prevent ectasia in high-risk patients. It is a safe and simple procedure that can be offered to patients undergoing SMILE with risk for ectasia. Trial registration no: PACTR201810577524718.

Evolution of corneal flattening after repeated corneal cross-linking during a 6-year follow-up

2020 ◽  
pp. 112067212094566
Author(s):  
Michael A Grentzelos ◽  
Nafsika Voulgari ◽  
Clarice Giacuzzo ◽  
Konstantinos Droutsas ◽  
George D Kymionis
Keyword(s):  
Endothelial Cells ◽  
Visual Acuity ◽  
Case Report ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Distance Visual Acuity ◽  
Corneal Opacification ◽  
Corrected Distance Visual Acuity ◽  
Corneal Flattening

Purpose: To report the evolution of corneal flattening after repeated corneal cross-linking (CXL) in a patient with progressive keratoconus during a 6-year follow-up. Methods: Case report. Results: A 27-year-old female underwent CXL for progressive keratoconus. Postoperatively, corneal topography revealed keratoconus progression with an increase of 1.20 diopters (D) in maximum keratometry (Kmax) and CXL was repeated. After the second treatment, a continuing significant corneal flattening (up to 16.00 D in Kmax) was observed during the first 5 years followed by stabilization during the last sixth year of follow-up. Both uncorrected and corrected distance visual acuity were improved while corneal thickness was decreased. There were no complications such as corneal opacification or endothelial cells decrease during the follow-up period. Conclusion: Repeated CXL can induce an excessive corneal flattening more pronounced during the first years of follow-up followed by stabilization thereafter.

scholarly journals Safety and Visual Outcome of Visian Toric ICL Implantation after Corneal Collagen Cross-Linking in Keratoconus: Up to 2 Years of Follow-Up

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Rafic Antonios ◽  
Ali Dirani ◽  
Ali Fadlallah ◽  
Elias Chelala ◽  
Adib Hamade ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Outcome ◽  
Cross Linking ◽  
Implantable Collamer Lens ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Effective Option ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose. To evaluate the long-term safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus.Methods. This was a retrospective study of 30 eyes (19 patients), with progressive keratoconus, who underwent sequential CXL followed by Visian toric ICL implantation after 6 months.Results. At baseline, 6 eyes had stage I, 14 eyes stage II, and 10 eyes stage III keratoconus graded by Amsler-Krumeich classification. At 6 months after CXL, onlyK(steep) andK(max) decreased significantly from baseline, with no change in visual acuity or refraction. Flattening in keratometric readings was stable thereafter. There was significant improvement in mean uncorrected distance visual acuity (1.57 ± 0.56 to 0.17 ± 0.06 logMAR,P<0.001) and mean corrected distance visual acuity (0.17 ± 0.08 to 0.11 ± 0.05 logMAR,P<0.001) at 12 months after ICL implantation that was maintained at the 2-year follow-up. Mean cylinder power and mean spherical equivalent (SE) also decreased significantly after ICL implantation. A small hyperopic shift in SE (+0.25 D) was observed at 2 years that did not alter visual outcomes.Conclusions. Visian toric ICL implantation following CXL is an effective option for improving visual acuity in patients with keratoconus up to 2 years.

scholarly journals Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus

2016 ◽  
Vol 5 (2) ◽  
pp. 71-76
Author(s):  
Igor Kaiserman ◽  
Lily Karmona ◽  
Tzahi Sela ◽  
Oz Franco ◽  
Avi Shoshani ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Contact Lenses ◽  
Cross Linking ◽  
Visual Rehabilitation ◽  
Surface Ablation ◽  
Uncorrected Visual Acuity ◽  
Promising Treatment ◽  
Functional Vision ◽  
Collagen Cross Linking

ABSTRACT Purpose In this article, we present the results of eight eyes of patients who underwent combined same-day partial topography-guided surface ablation followed by accelerated collagen cross-linking (CXL) procedure at Care-Vision Laser Centers to achieve stabilization of corneal ectasia and enhance visual rehabilitation in keratoconus. Materials and methods A retrospective nonrandomized review of 8 eyes of 6 patients who underwent the Athens Protocol for progressive keratoconus. Each patient underwent topography-guided ablation followed by CXL procedure. Follow-up Follow-up was done on day 1, day 7, and then at 1, 3, 6, and 12 months. Results There was a rapid and significant improvement in uncorrected visual acuity and best-corrected visual acuity in 100% eyes, a reduction of keratometric values, and symmetry between vertical hemimeridians. Topographic evaluation showed a marked improvement in irregularity. There were no signs of keratoconic progression noted in any of the eyes on last follow-up. No adverse events were reported in any patient. Conclusion Simultaneous surface ablation + CXL seems to be a promising treatment capable of offering patients functional vision and halting progression of the disorder. Precis Simultaneous topography-guided custom ablation treatment and photorefractive keratectomy with CXL offers keratoconic patients intolerant to contact lenses both stabilization of the cornea and improved functional vision with spectacles correction. How to cite this article Karmona L, Sela T, Franco O, Shoshani A, Munzer G, Kaiserman I. Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):71-76.

scholarly journals About a new approach to surgical treatment of corneal endothelial dystrophy

2018 ◽  
Vol 11 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Sergey Yu Astakhov ◽  
Inna A Riks ◽  
Sanasar S Papanyan ◽  
Sergey A Novikov ◽  
Georgiy Z Dzhaliashvili
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Functional State ◽  
Clinical Case ◽  
Corneal Dystrophy ◽  
Cross Linking ◽  
Common Disease ◽  
New Approach ◽  
Collagen Cross Linking

Primary endothelial dystrophy of the cornea is a fairly common disease in people older than 50 years. Well-developed methods of conservative treatment, as a rule, do not lead to improvement or stabilization of the functional state of the cornea. The choice of tactics of surgical treatment from the existing variety of techniques is complicated. There are isolated reports of the restoration of corneal transparency after descemet membrane removal. The author's method of endothelial corneal dystrophy treatment addressed in this particular clinical case - a combination of isolated descemetorhexis and collagen cross-linking - resulted in impressive increase in visual acuity and significant improvement in objective criteria for the morpho-functional state of the cornea. (For citation: Astakhov SYu, Riks IA, Papayan SS, et al. About a new approach to surgical treatment of corneal endothelial dystrophy. Ophthalmology Journal. 2018;11(1):78-84. doi: 10.17816/OV11178-84).

scholarly journals Epi-off-lenticule-on corneal collagen cross-linking in thin keratoconic corneas

2020 ◽  
Vol 40 (12) ◽  
pp. 3403-3412
Author(s):  
Carlo Cagini ◽  
F. Riccitelli ◽  
M. Messina ◽  
F. Piccinelli ◽  
G. Torroni ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Density ◽  
Corneal Thickness ◽  
Endothelial Cell Density ◽  
Cross Linking ◽  
Corneal Transplant ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Abstract Purpose To evaluate the safety and efficacy of corneal collagen cross-linking (CXL) performed on overlaying a corneal lenticule to thin recipient corneas of progressive keratoconus (KC) patients. Methods In this study were enrolled eyes of patients affected by progressive KC with a minimum corneal thickness less than 400 µm, after overlaying a lenticule of human corneal stroma prepared with the femtosecond laser. The lenticules used were 100 µm thick and of 8.5 mm diameter in all the cases. Both the host cornea and the lenticules were subjected to epithelial debridement. CXL was carried out according to the standard protocol. Visual acuity, refraction, slit-lamp examination, endothelial cell density, pachymetry and keratometry, anterior segment tomography (AS-OCT) and confocal microscopy were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Results CXL was performed in 10 eyes of 8 patients (main age 23), corneal thickness range 379–414 µm, mean 387.6 µm. One patient was lost at follow-up. In all other cases, visual acuity and the endothelial cell density remained stable over a 12-month follow-up. Preoperative mean K1 and mean K2 were 46.91 ± 1.9 and 50.75 ± 2.93, respectively, and at 12 months mean K1 was 47.36 ± 2.66 and mean K2 50.53 ± 3.35. The AS-OCT clearly showed a demarcation line in all patients at 1, 3 (mean depth 283 µm and 267 µm, respectively) and in some cases at 6 months. Reduced keratocyte density and stromal oedema were observed immediately up to 1 month after treatment, while a slight subepithelial haze was present at 1-month and completely disappeared by 6 months. Conclusion This new technique seems to offer a therapeutic opportunity for young patients suffering from progressive KC with very thin corneas, in which the standard treatment is not indicate, and delay or avoid the need for a corneal transplant.

scholarly journals Corneal Collagen Cross-Linking for Keratoconus: Systematic Review

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Hidenaga Kobashi ◽  
Shi Song Rong
Keyword(s):  
Systematic Review ◽  
Visual Acuity ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Control Group ◽  
Significant Heterogeneity ◽  
Eligibility Criteria ◽  
Significant Difference ◽  
One Year ◽  
Collagen Cross Linking

Purpose. To evaluate the efficacy of collagen cross-linking (CXL) one year after treatment for keratoconus compared to no treatment by summarizing randomized controlled trials (RCTs) using a systematic review. Methods. Trials meeting the selection criteria were quality appraised, and the data were extracted by two independent authors. The outcome parameters included maximum keratometry (Kmax), corneal thickness at the thinnest point, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), spherical equivalent (SE) refraction, and cylindrical refraction one year after CXL. We compared the changes in the above parameters with the control group. Results. We identified five RCTs involving 289 eyes that met the eligibility criteria for this systematic review. The changes in BSCVA from baseline to one year exhibited a significant difference between the two groups. There was no statistically significant difference between the two groups for changes in corneal thickness and cylindrical refraction. We did not conduct a meta-analysis in Kmax, UCVA, and SE refraction because their I2 values were greater than 50%. Conclusions. According to the systematic review, CXL may be effective in halting the progression of keratoconus for one year under certain conditions, although evidence is limited due to the significant heterogeneity and paucity of RCTs.

Corneal collagen cross-linking for management of keratoconus in patients affected by Tourette syndrome

2020 ◽  
pp. 112067212094510
Author(s):  
Karl Anders Knutsson ◽  
Giorgio Paganoni ◽  
Oriella Ambrosio ◽  
Giulio Ferrari ◽  
Paolo Rama
Keyword(s):  
Visual Acuity ◽  
Tourette Syndrome ◽  
Case Series ◽  
Young Male ◽  
Cross Linking ◽  
Male Patients ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose: To present a series of two patients affected by Tourette syndrome (TS) and progressive keratoconus. Case series: Two young male patients with keratoconus and TS were referred to our center. In both patients eye rubbing was present and in one patient, an ocular tic was present determining blepharospasm. Progression of keratoconus occurred in both cases and corneal collagen cross-linking (CXL) was performed. All treated eyes showed topographic stability with stable refraction and conserved visual acuity, with a follow-up period ranging from 1.5 to 2.5 years. Conclusion: Patients with keratoconus and TS should be observed frequently to document topographical and refractive changes, and in case of progressing disease, CXL should be performed in order to prevent further progression.

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