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

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.

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

European Journal of Ophthalmology ◽

10.1177/1120672118760149 ◽

2018 ◽

Vol 28 (4) ◽

pp. 415-418 ◽

Cited By ~ 10

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.

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Corneal Cross-linking in Patients Younger than 18 Years: Long-term Follow-up in Three Israeli Medical Centers

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1084 ◽

2014 ◽

Vol 3 (2) ◽

pp. 84-87

Author(s):

David Zadok ◽

Isaac Avni ◽

Erez Bakshi ◽

Irina S Barequet ◽

Isaac Aizenman ◽

...

Keyword(s):

Visual Acuity ◽

Pediatric Population ◽

Cross Linking ◽

Safe Procedure ◽

Medical Centers ◽

Manifest Refraction ◽

Uncorrected Visual Acuity ◽

Long Term Follow Up

ABSTRACT Purpose To report refractive, topographic and safety outcomes of corneal cross-linking (CXL) in patients younger than 18 years of age with progressive keratoconus. Materials and methods In this retrospective study, we enrolled 31 eyes of 21 children aged 11 to 17 years that underwent corneal riboflavin-ultraviolet A induced CXL due to progressive keratoconus at three different ophthalmology departments in Israel. They were followed for 3 to 48 months (average 23 ± 13.6 months). Evaluated parameters were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction, pachymetry, slit- lamp examination and corneal topography at baseline and at 1,3,6,12,24 and 48 months. Results We found a nonsignificant improvement in UCVA and BSCVA with a small reduction of manifest cylinder and no significant change in spherical equivalent or K-values. Following CXL, stability of UCVA and BSCVA at the last follow-up examination was found in 71 and 77% of treated eyes, respectively. No permanent adverse events have been recorded throughout the study period. Conclusion In our series, CXL was a safe procedure in the pediatric population. Stabilization of progressive keratoconus was achieved in visual acuity, refractive and topography parameters with no improvement in corneal indices in contrary to adult CXL treatment. How to cite this article Bakshi E, Barequet IS, Aizenman I, Levinger S, Avni I, Zadok D. Corneal Corss-linking in Patients Younger than 18 Years: Long-term Follow-up in Three Israeli Medical Centers. Int J Kerat Ect Cor Dis 2014;3(2):84-87.

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Corneal Cross-Linking for Progressive Keratoconus in Children: Our Experience

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1009 ◽

2012 ◽

Vol 1 (1) ◽

pp. 53-56 ◽

Cited By ~ 12

Author(s):

Erez Bakshi ◽

Yaniv Barkana ◽

Yakov Goldich ◽

Isaac Avni ◽

David Zadok

Keyword(s):

Visual Acuity ◽

Medical Center ◽

Statistical Significance ◽

Cross Linking ◽

Long Term Stability ◽

Corrected Visual Acuity ◽

Department Of Ophthalmology ◽

Manifest Refraction ◽

Uncorrected Visual Acuity

ABSTRACT Purpose To assess the effect of corneal cross-linking on progressive keratoconus in children. Method In this retrospective study we enrolled nine eyes of nine consecutive children aged 11 to 17 years old who underwent corneal riboflavin-UVA induced cross-linking for progressive keratoconus at the Department of Ophthalmology at Assaf Harofeh Medical Center. They were followed for 6 to 24 months (average 16 ± 8.1 months). Evaluated parameters were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, pachymetry, slit lamp examination and corneal topography. Results Cross-linking resulted in stability of visual acuity in seven of the nine (77.8%) treated eyes. We found a nonsignificant improvement in UCVA and BSCVA with a small reduction of manifest cylinder. Furthermore, there was an improvement in spherical equivalent that was close to statistical significance (p = 0.07). There was 0.86 D reduction of average Kmax value postoperatively (p = 0.36). Most patients (7 of 9, 77.8%) showed a long-term stability or reduction in Kmax. Conclusion In this study, we demonstrated the efficacy of corneal cross-linking in arresting the progression of keratoconus in children. We believe that larger scale studies in this age group should be performed to further establish the relevance of this technique in children. How to cite this article Bakshi E, Barkana Y, Goldich Y, Avni I, Zadok D. Corneal Cross-Linking for Progressive Keratoconus in Children Our Experience. Int J Keratoco Ectatic Corneal Dis 2012;1(1):53-56.

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

Acta Médica Portuguesa ◽

10.20344/amp.2038 ◽

2014 ◽

Vol 27 (1) ◽

pp. 49 ◽

Cited By ~ 1

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

Introduction: 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. Material and Methods: 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. Results: The best corrected visual acuity and foveal center thickness improvements were statistically significant for all follow-up times (p < 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 < 0.001). Discussion/Conclusion: 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.

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Visual Acuity, Retinal Sensitivity, and Macular Thickness Changes in Diabetic Patients without Diabetic Retinopathy after Cataract Surgery

Journal of Diabetes Research ◽

10.1155/2017/3459156 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Spela Stunf Pukl ◽

Nataša Vidović Valentinčič ◽

Mojca Urbančič ◽

Irena Irman Grčar ◽

Rok Grčar ◽

...

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Cataract Surgery ◽

Diabetic Patients ◽

Retinal Sensitivity ◽

Diabetic Retina ◽

Corrected Visual Acuity ◽

Prospective Comparative Study

Aim. Functional and morphological macular study after cataract surgery in a group of diabetics without diabetic retinopathy compared to nondiabetics to evaluate the effect of surgical oxidative stress on diabetic retina.Methods. Prospective, comparative study. Preoperative eye exam, best corrected visual acuity (BCVA) measured by ETDRS letters, and optical coherence tomography (OCT) were followed by standard cataract surgery. The follow-up visits at 1, 3, and 6 months postoperatively included BCVA, OCT, and microperimetry, to analyze changes within and between the groups.Results. The BCVA improved significantly in diabetics and controls: 64.2 to 81.0 and 61.9 to 82.1 ETDRS at 6 months, respectively. The central macula at OCT significantly thickened in both groups, while the central 5 fields, corresponding to the microperimetry area, subclinically thickened from 284.20 to 291.18 μm at 6 months only in diabetics (p=0.026). A matching slight decrease in the microperimetry sensitivity from 1 to 6 months was found also only in diabetics, with mean average difference −0.75 dB (p=0.04).Conclusion. Underlying diabetes does not influence the surgical outcome in diabetics without diabetic retinopathy. However, slight thickening of wider macula and corresponding decrease in retinal sensitivity observed in diabetics 6 months postoperatively might influence visual function on long term.

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Arginine-Restricted Therapy Resistant Bilateral Macular Edema Associated with Gyrate Atrophy

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/137270 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Sibel Doguizi ◽

Mehmet Ali Sekeroglu ◽

Mustafa Alpaslan Anayol ◽

Pelin Yilmazbas

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Peripheral Zone ◽

Restricted Diet ◽

Comprehensive Understanding ◽

Gyrate Atrophy ◽

Case Presentation ◽

Corrected Visual Acuity

Introduction. Gyrate atrophy is a rare genetical metabolic disorder affecting vision. Here, we report a 9-year-old boy with gyrate atrophy associated with bilateral macular edema at the time of diagnosis and the effect of long term metabolic control on macular edema.Case Presentation. A 9-year-old boy presented with a complaint of low visual acuity (best corrected visual acuity: 20/80 in both eyes, refractive error: −12.00 D). Dilated fundus examination revealed multiple bilateral, sharply defined, and scalloped chorioretinal atrophy areas in the midperipheral and peripheral zone. Spectral-domain optical coherence tomography revealed bilateral cystoid macular edema in both eyes. Serum ornithine level was high (622 μmol/L). An arginine-restricted diet reduced serum ornithine level (55 μmol/L). However, visual findings including macular edema remained unchanged in 2 years of follow-up.Conclusion. Arginine-restricted diet did not improve macular edema in our patient with gyrate atrophy. A more comprehensive understanding of the underlying factors for macular edema will lead to the development of effective therapies.

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Explantation and Rotation of Intracorneal Ring Segments with the Support of Femtosecond Laser: An Asymmetrical Version

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1047 ◽

2013 ◽

Vol 2 (1) ◽

pp. 40-42

Author(s):

E Levinger ◽

S Levinger ◽

A Hirsh

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Lower Segment ◽

Medical Optics ◽

Corrected Visual Acuity ◽

Body Sensation ◽

Uncorrected Visual Acuity ◽

The Right ◽

Visual Results

ABSTRACT Purpose To report a 25-year-old man who presented with advance keratoconus in the right eye with uncorrected visual acuity (UCVA) of 0.2 and best spectacle-corrected visual acuity (BSCVA) of 0.33 with +0.50 −9.25 × 45°. Materials and methods Clinical examination and corneal topography revealed grade III keratoconus in the right eye. Intracorneal ring segments (INTACS SK; Addition Technology, Des Plaines, IL) were implanted without surgical complications at 400 µm, with the 450 µm segments implanted superiorly and inferiorly using the femtosecond laser (Intralase®, Advanced Medical Optics, Inc, Abbott Park, IL). Results For 3 months postoperatively, BSCVA remained at 0.5 with plano −4.50 × 25°. The patient was complaining of foreign body sensation in the upper part of the eye and glare asking the surgeon to remove the two segments. The superior segment was removed and the lower segment was rotated 30° counter clockwise. Three months later, UCVA was 0.67 and remained stable for 24 months of follow-up. Conclusion This report shows that implanting the thicker segment inferiorly provides better visual results. How to cite this article Levinger E, Levinger S, Hirsh A. Explantation and Rotation of Intracorneal Ring Segments with the Support of Femtosecond Laser: An Asymmetrical Version. Int J Kerat Ect Cor Dis 2013;2(1):40-42.

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Intrastromal Corneal Ring Segment Implantation (Keraring 355°) in Patients with Central Keratoconus: 6-Month Follow-Up

Journal of Ophthalmology ◽

10.1155/2015/916385 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 14

Author(s):

Khosrow Jadidi ◽

Seyed Aliasghar Mosavi ◽

Farhad Nejat ◽

Mostafa Naderi ◽

Leila Janani ◽

...

Keyword(s):

Visual Acuity ◽

Invasive Procedure ◽

Cost Effective ◽

Corrected Visual Acuity ◽

Intrastromal Corneal Ring ◽

Uncorrected Visual Acuity ◽

Ring Segment ◽

Efficacy Index ◽

Preliminary Study

We evaluate the efficacy and safety of Keraring 355° intrastromal corneal ring segment (ICRS) implantation aided by PocketMaker microkeratome for the correction of keratoconus. Patients underwent ICRS insertion using mechanical dissection with PocketMaker microkeratome and completed 6 months of follow-up. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, safety, efficacy index, and adverse events were reported for six months postoperatively. We evaluated 15 eyes of 15 patients (12 men) with a mean age of 28.87 ± 6.94 years (range 21–49 years). At final postoperative examination, there was a statistically significant reduction in the spherical equivalent refractive error compared to preoperative measurements (−5.46 ± 1.52 to −2.01 ± 1.63 D,P<0.001). Mean preoperative UCVA (logMAR) before implantation was 0.79 ± 0.48, and postoperative UCVA was 0.28 ± 0.15,P=0.001. Mean preoperative BSCVA (logMAR) before implantation was 0.36 ± 0.21; at final follow-up examination BSCVA was 0.18 ± 0.9,P=0.009. MeanKdecreased from 48.33 to 43.31 D,P<0.001. All patients were satisfied with ICRS implantation; 86.7% were moderately to very happy with the results. No intraoperative or postoperative complications were demonstrated. This preliminary study shows that ICRS (Keraring 355°) implantation is an efficient, cost-effective, and minimally invasive procedure for improving visual acuity in nipple type keratoconic corneas.

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Two-Year Accelerated Corneal Cross-Linking Outcome in Patients with Progressive Keratoconus

BioMed Research International ◽

10.1155/2015/325157 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 24

Author(s):

Arleta Waszczykowska ◽

Piotr Jurowski

Keyword(s):

Visual Acuity ◽

Corneal Thickness ◽

Long Term Results ◽

Cross Linking ◽

Mean Values ◽

Significant Difference ◽

Uncorrected Visual Acuity ◽

The Mean

Purpose. To evaluate the long-term results of accelerated corneal cross-linking (CXL) in patients with progressive keratoconus.Methods. Sixteen patients underwent accelerated CXL at 6 mW/cm2for 15 minutes in one eye. The follow-up visits were scheduled on 7 days, 14 days, and 3, 12, and 24 months after the treatment.Results. There were no significant differences (P>0.05) between preoperative and 2-year postoperative mean values, respectively, in terms of uncorrected visual acuity, best spectacle-corrected visual acuity, maximum keratometryKmax⁡, minimum keratometryKmin⁡, corneal astigmatism, and corneal eccentricity index. We noted a significant flattening of the cornea in 18.7% of patients with a higher preoperativeKmax⁡value (>50 D) and its steepening in patients with a lowerKmax⁡value (<50 D) (6.25%). There was no significant difference in the central corneal thickness and the apical corneal thickness preoperatively and 2 years postoperatively. The mean demarcation line depth was282±11 μm. Persistent corneal haze was noted in 25% of patients.Conclusions. Accelerated CXL appears to be a relatively effective procedure for the treatment of keratoconus in 2-year follow-up.

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Clinical outcomes after intracorneal ring segment implantation for keratoconus management in corneas with mild apical haze

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211003378 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110033

Author(s):

Mohamed Elalfy ◽

Sundas Maqsood ◽

Aja Reinhold ◽

Georgios D. Panos ◽

Aye Khine ◽

...

Keyword(s):

Visual Acuity ◽

Therapeutic Option ◽

Exclusion Criterion ◽

Queen Victoria ◽

Corrected Visual Acuity ◽

Uncorrected Visual Acuity ◽

Ring Segment ◽

Corneal Opacities ◽

Intracorneal Ring Segment

Purpose: The implantation of intracorneal ring segments represents an effective and safe therapeutic option for visual improvement in patients with keratoconus. The presence of corneal opacities is considered an exclusion criterion for this operation. Methods: This is a retrospective cohort study of six eyes of six keratoconus patients at Queen Victoria Hospital, East Grinstead, UK, between January 2012 and December 2016. Femtosecond laser-assisted intracorneal ring segment implantation was performed in six eyes with apical corneal haze. Preoperative and postoperative visual acuity, keratometry readings, as well as corneal pachymetry were compared at 6-month follow-up. Results: Uncorrected visual acuity (UCVA) [LogMAR] improved significantly from median 1.05 [95% confidence interval (CI): 0.83–0.13] preoperatively to 0.9 (95% CI: 0.63–1.00) at 6 months postoperatively ( p = 0.03). Corrected visual acuity (CDVA) also improved significantly from median 0.75 (95% CI: 0.43–1.00) preoperatively to 0.4 (95% CI: 0.23–0.50) at 6 months postoperatively ( p = 0.03). Keratometric readings, K-max (diopters) and K-mean (diopters), decreased significantly from 54.5 and 47.85 preoperatively to 53.45 and 46.42 postoperatively, respectively ( p = 0.03). Corneal pachymetry showed no significant changes postoperatively. Conclusion: The results of this study show that the presence of apical haze should not exclude the implantation of intracorneal ring segments in patients with keratoconus.

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