scholarly journals Simultaneous topography-guided photorefractive keratectomy with accelerated collagen cross-linking in the treatment of stage I keratoconus

2019 ◽  
Vol 12 (4) ◽  
pp. 28-34
Author(s):  
A. V. Ivanova ◽  
A. S. Sklyarova ◽  
K. B. Letnikova ◽  
A. T. Khandzhyan ◽  
N. V. Khodzhabekyan
Keyword(s):  
Visual Acuity ◽  
Combined Treatment ◽  
Functional Results ◽  
Biomechanical Properties ◽  
Stage I ◽  
Photorefractive Keratectomy ◽  
Cross Linking ◽  
Uncorrected Visual Acuity ◽  
Corneal Collagen Crosslinking ◽  
Collagen Cross Linking

Purpose: to evaluate the efficiency of simultaneous topography-guided photorefractive keratectomy (PRK) with accelerated collagen cross-linking in the treatment of stage I keratoconus.Material and methods. 38 patients (49 eyes) aged 18 to 44 with stage I keratoconus were treated with simultaneous topography-guided PRK combined with accelerated corneal collagen crosslinking. Along with standard ophthalmological testing, patients underwent aberrometry, confocal microscopy, optical coherence tomography of the cornea, imaging of the anterior eye section on a Scheimpflug analyzer, and examination of the biomechanical properties of the cornea. The follow-up period was 2 years.Results. Two years after surgery, uncorrected visual acuity which originally was 0.23 ± 0.03 showed a statistically significant increase and reached 0.72 ± 0.02; best corrected visual acuity improved from 0.44 ± 0.03 to 0.89 ± 0.02; the refractive power of the cornea fell from 45.03 ± 0.28 to 42.55 ± 0.31 D; the spherical component of refraction reduced from -2.00 ± 0.19 to -0.73 ± 0.09 D; the cylinder component reduced from 2.46 ± 0.14 to 0.79 ± 0.07 mm, the thinnest point of the cornea reduced from 486.30 ± 4.78 to 406.80 ± 6.51 μm. The highest order aberrations showed the following results: Coma index reduced from 0.27 ± 0.12 to 0.08 ± 0.07, Tilt reduced from 0.53 ± 0.11 to 0.10 ± 0,09, and Trefoil reduced from 0.13 ± 0.04 to 0.05 ± 0.02.Conclusion. The analysis of clinical and functional results, biomechanical properties and structures of the cornea confirmed the efficacy and safety of the combined treatment of patients with stage I keratoconus.

scholarly journals Combined Intacs SK and Corneal Collagen Cross-linking for the Treatment of Keratoconus

2012 ◽  
Vol 1 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Hanna Garzozi
Keyword(s):  
Visual Acuity ◽  
Combined Treatment ◽  
Cross Linking ◽  
Corneal Resistance Factor ◽  
Corrected Visual Acuity ◽  
Manifest Refraction ◽  
Uncorrected Visual Acuity ◽  
Significant Change ◽  
Collagen Cross Linking ◽  
Corneal Collagen

ABSTRACT Purpose To evaluate the efficacy of the combined treatment of Intacs SK (Severe keratoconus) and corneal collagen cross- linking in the management of advanced keratoconus (KC). Setting Private laser center, Haifa, Israel. Affiliated to Hadassah Hospital, Jerusalem. Methods This is a retrospective study. Intacs SK were implanted using manual technique in eyes with moderate-to- severe keratoconus followed by collagen corneal cross-linking (CXL). Evaluation included uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction, slit-lamp examination and corneal topography. Ocular response analyzer (ORA) was used to assess the corneal hysteresis (CH) and the corneal resistance factor (CRF). Results We report on improvement of the UCVA, BSCVA, decrease in myopia, astigmatism and keratometry readings. No significant change in CRF or CH was noted. Conclusion The combined treatment of Intacs SK and corneal CXL for the treatment of advanced keratoconus is safe and effective. The combined treatment resulted in improved UCVA, BSCVA, keratometry readings and regularization of the topography but no significant change in CRF and HS. How to cite this article Barbara R, Garzozi H, Barbara A. Combined Intacs SK and Corneal Collagen Cross-linking for the Treatment of Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):109-116.

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 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 Implantable Collamer Lens for Correction of Refractive Errors in Patients with Keratoconus following Collagen Cross-Linking: One Year Follow-up

2014 ◽  
Vol 3 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Hassenien Safa Shuber
Keyword(s):  
Visual Acuity ◽  
Cross Linking ◽  
Refractive Errors ◽  
Implantable Collamer Lens ◽  
Uncorrected Visual Acuity ◽  
Efficacy Index ◽  
The Mean ◽  
One Year ◽  
Collagen Cross Linking

ABSTRACT Objective The purpose of this study is to assess the predictability, safety, efficacy and stability of correction of refractive errors in patients with keratoconus using Visian implantable collamer lens (ICL) following collagen cross-linking. Materials and methods This prospective, non-comparative study evaluated 20 eyes of 14 patients with keratoconus subjected to implantation of intraocular collamer lens at least 1 year following collagen cross-linking and stable refraction. Mean preoperative myopia was −8.43 ± 5.13 Diopters (D) (–3.5 to −20.0D and mean cylinder was −2.19 ± 1.28D (0.0 to −4.5D). The preoperative spherical equivalent (SE) was −9.52 ± 5.33D (–3.75 to −21.25D). During the 12 months follow-up, uncorrected visual acuity, best corrected visual acuity, refraction, intraocular pressure and vaulting are measured. Results At 12 months postoperatively, 90% of eye had refractive cylinder of <1.0D with (p = 0.003) and 20 (100%) eyes was within ±0.75D of sphere at 1 year (r2 = 0.99) and (p = 0.0085). The mean postoperative BCVA in decimal was 0.498 ± 0.232, while the mean preoperative BCVA was 0.484 ± 0.285. The safety index at 12 months was 1.02. The mean postoperative UCVA in decimal was 0.498 ± 0.232 and the mean preoperative BCVA is 0.484 ± 0.29 and the efficacy index at 12 months was 1.01. Conclusion Implantation of Visian Intraocular collamer lens is predictable, safe and effective way to correct refractive error in patients with keratoconus following collagen cross-linking. How to cite this article Shuber HS. Implantable Collamer Lens for Correction of Refractive Errors in Patients with Keratoconus following Collagen Cross-Linking: One Year Follow-up. Int J Kerat Ect Cor Dis 2014;3(1):29-35.

scholarly journals Collagen Cross-Linking and Keratoconus in Pediatric Patients

2012 ◽  
Vol 1 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Joseph Pikkel ◽  
Hanna Garzozi
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Pediatric Patients ◽  
Resistance Factor ◽  
Corneal Hysteresis ◽  
Cross Linking ◽  
Corneal Resistance Factor ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Collagen Cross Linking

ABSTRACT Purpose To evaluate the efficacy of corneal cross-linking on keratoconic eyes in the pediatric age group. Setting Private laser center, Haifa, Israel, affiliated to Hadassah Hospital, Jerusalem. Methods This is a retrospective study of 29 eyes of 20 children treated with corneal cross-linking with aim to arrest the progression of keratoconus. We preformed collagen corneal cross-linking using riboflavin 0.1% and UVA irradiation. Follow- up ranged between 6 and 46 months (mean 25.5 months). Evaluation included uncorrected visual acuity, best spectacle corrected visual acuity, manifest refraction, slit lamp examination and corneal topography. Ocular response analyzer was used to assess the corneal resistance factor, corneal hysteresis and cornea compensated intraocular pressure. Results The results show improvement in uncorrected visual acuity and best spectacle-corrected visual acuity and reduction in astigmatism. There was no statistically significant change in sphere, keratometry, corneal resistance factor, corneal hysteresis or cornea compensated intraocular pressure. Conclusion Corneal cross-linking demonstrates efficacy in arresting the progression of keratoconus as well as improving uncorrected and best corrected visual acuity and reducing astigmatism. How to cite this article Barbara R, Pikkel J, Garzozi H, Barbara A. Collagen Cross-Linking and Keratoconus in Pediatric Patients. Int J Keratoco Ectatic Corneal Dis 2012;1(1):57-60.

scholarly journals 10-Year Results of Standard Cross-Linking in Patients with Progressive Keratoconus in Romania

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Cristina Nicula ◽  
Radu Pop ◽  
Anca Rednik ◽  
Dorin Nicula
Keyword(s):  
Visual Acuity ◽  
Clinical Signs ◽  
Functional Results ◽  
Mean Value ◽  
Favorable Effect ◽  
Cross Linking ◽  
Spherical Equivalent ◽  
Uncorrected Visual Acuity

Purpose. The purpose of the current study was to evaluate the long-term functional results based on keratometric measurements, spherical and cylinder equivalent in patients with progressive keratoconus treated with conventional “epi-off” corneal collagen cross-linking (CXL). Methods. We conducted a retrospective study in which 113 eyes from 90 keratoconus-treated patients with CXL between 2006 and 2008 in Oculens Eye Clinic from Cluj-Napoca, Romania, were included. The diagnosis of keratoconus was based on corneal topography and its clinical signs. All patients were evaluated preoperatively, and a follow-up was performed at 1, 3, and 6 months and every year from 1 to 10 years after conventional CXL. Results. All keratometry measurements improved significantly during the follow-up. Compared to preoperative values, the improvement of Kmax become statistically significant at 1 year after CXL (mean change compared to baseline −0.9 D, p<0.001) and remained statistically significant thereafter up to 10 years (mean change compared to baseline −2.3 D, p<0.001). As compared to preoperative values, mean spherical equivalent and mean cylinder improved during the follow-up, from a mean of −6.22 D before CXL to a mean value of −5.0 at 10 years, following CXL for spherical equivalent and from −4.4 D at baseline to −3.4 D at 10 years for cylinder (p<0.05 for both). Uncorrected visual acuity increased, remaining statistically significant, by 0.104 logMAR at 10 years after CXL (p=0.0015), and best-corrected visual acuity increased by 0.135 logMAR at 10 years after CXL (p=0.015). We did not observe any case of severe complication. Conclusion. Our results show that CXL has a favorable effect on the progression of KC. The reduced K values, cylinder and spherical equivalent, and increased visual acuity remained the same 10 years after the procedure.

scholarly journals Corneal Collagen Cross-Linking Combined with an Artiflex Iris-Fixated Anterior Chamber Phakic Intraocular Lens Implantation in a Patient with Progressive Keratoconus

2017 ◽  
Vol 8 (3) ◽  
pp. 482-488 ◽  
Author(s):  
Sharif Hashmani ◽  
Nauman Hashmani ◽  
Roha Saeed Memon
Keyword(s):  
Visual Acuity ◽  
Anterior Chamber ◽  
Intraocular Lens ◽  
Vision Loss ◽  
Cross Linking ◽  
Phakic Intraocular Lens ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Collagen Cross Linking ◽  
Corneal Collagen

We present here the case of a 24-year-old male who experienced progressive keratoconus and vision loss which adversely affected his ability to carry out everyday tasks. This landed him in the Hashmanis Hospital for consultation. He had a preoperative best corrected visual acuity of 6/12. He underwent multiple Oculus Pentacam examinations, which showed progressive keratoconus. Corneal collagen cross-linking (CXL) was performed to stabilize his cornea and, subsequently, an Artiflex anterior chamber iris-fixated phakic intraocular lens (ACIF-PIOL) was implanted to alleviate his refractive errors. The patient achieved a postoperative uncorrected visual acuity of 6/12. This report shows that CXL combined with ACIF-PIOL can be safe and effective in those with progressive keratoconus.

Transepithelial photorefractive keratectomy on the same day of the initial consultation for the correction of myopia

2021 ◽  
pp. 112067212110334
Author(s):  
Olga Reitblat ◽  
Assaf Gershoni ◽  
Michael Mimouni ◽  
Eitan Livny ◽  
Yoav Nahum ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Clinical Outcomes ◽  
Photorefractive Keratectomy ◽  
Spherical Equivalent ◽  
Initial Visit ◽  
Safety Outcome ◽  
Uncorrected Visual Acuity ◽  
Safety Indices

Purpose: To examine the clinical outcomes, efficacy, safety, and predictability of transepithelial photorefractive keratectomy (Trans-PRK) operations performed on the day of the first screening visit in comparison with operations scheduled at a following appointment. Methods: Data of consecutive patients with myopia of various degrees, who underwent Trans-PRK, were retrospectively analyzed. Findings were compared between patients who underwent Trans-PRK on the same day of first consultation to patients that underwent surgery at subsequent visits, following initial consultation on a different day. Results: The study included 599 eyes treated on the initial visit day and 1936 eyes treated on a subsequent visit. Mean final spherical equivalent was close to emmetropia in both groups ( p = 0.183). Efficacy indices were 0.928 ± 0.192 in the initial-visit group and 0.945 ± 0.163 in the second-visit group ( p = 0.152). Safety indices were 0.954 ± 0.156 and 0.955 ± 0.151 ( p = 0.707), respectively. No differences between the groups were seen in uncorrected visual acuity (UDVA) of ⩾20/20, ⩾20/25, and ⩾20/32. Only the sub-analysis of patients reaching UDVA of 20/40 or better was slightly lower in the first-visit (95.5%) compared with the second-visit group (97.9%, p = 0.001). Results of attempted correction within ±0.50 D were: 63.3% and 69.0%, respectively ( p = 0.009). Complications profiles in the two groups were comparable. Conclusions: Trans-PRK completed on the day of the first screening appointment demonstrated a similar safety outcome compared with subsequent-visits procedures, and slightly lower, yet comparable, results regarding efficacy and predictability.

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.

Impact of oral contraceptive use and menstrual phases on patellar tendon morphology, biochemical composition, and biomechanical properties in female athletes

2013 ◽  
Vol 114 (8) ◽  
pp. 998-1008 ◽  
Author(s):  
Mette Hansen ◽  
Christian Couppe ◽  
Christina S. E. Hansen ◽  
Dorthe Skovgaard ◽  
Vuokko Kovanen ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Female Athletes ◽  
Maximum Voluntary Contraction ◽  
Biomechanical Properties ◽  
Cross Sectional Area ◽  
Cross Linking ◽  
Sectional Area ◽  
Cross Sectional ◽  
Collagen Cross Linking

Sex differences exist with regards to ligament and tendon injuries. Lower collagen synthesis has been observed in exercising women vs. men, and in users of oral contraceptives (OC) vs. nonusers, but it is unknown if OC will influence tendon biomechanics of women undergoing regular training. Thirty female athletes (handball players, 18–30 yr) were recruited: 15 long-term users of OC (7.0 ± 0.6 yr) and 15 nonusers (>5 yr). Synchronized values of patellar tendon elongation (obtained by ultrasonography) and tendon force were sampled during ramped isometric knee extensor maximum voluntary contraction to estimate mechanical tendon properties. Furthermore, tendon cross-sectional area and length were measured from MRI images, and tendon biopsies were obtained for analysis of tendon fibril characteristics and collagen cross-linking. Overall, no difference in tendon biomechanical properties, tendon fibril characteristics, or collagen cross-linking was observed between the OC users and nonusers, or between the different phases of the menstrual cycle. In athletes, tendon cross-sectional area in the preferred jumping leg tended to be larger than that in the contralateral leg ( P = 0.09), and a greater absolute ( P = 0.01) and normalized tendon stiffness ( P = 0.02), as well as a lower strain ( P = 0.04), were observed in the jumping leg compared with the contralateral leg. The results indicate that long-term OC use or menstrual phases does not influence structure or mechanical properties of the patellar tendon in female team handball athletes.

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