scholarly journals Conventional Versus Accelerated Collagen Cross-Linking for Keratoconus: A Comparison of Visual, Refractive, Topographic and Biomechanical Outcomes

2017 ◽  
Vol 11 (1) ◽  
pp. 262-272 ◽  
Author(s):  
Jyh Haur Woo ◽  
Jayant Venkatramani Iyer ◽  
Li Lim ◽  
M Htoon Hla ◽  
Jodhbir S Mehta ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Loss ◽  
Corneal Topography ◽  
Resistance Factor ◽  
Corneal Hysteresis ◽  
Cross Linking ◽  
Corneal Resistance Factor ◽  
Accelerated Crosslinking

Objective: The aim was to compare the visual, refractive, topographic and biomechanical outcomes in patients with progressive keratoconus treated with either conventional or accelerated crosslinking at one year follow up. Methods: It is a prospective, non-randomised interventional study of 76 patients who underwent conventional (CXL; 3mW/cm2 for 30 minutes) or accelerated cross linking (KXL; 30mW/cm2 for 4 minutes) for progressive keratoconus. Baseline and postoperative visual acuity, manifest refraction, corneal topography, pachymetry, endothelial cell density and biomechanical parameters of corneal hysteresis and corneal resistance factor were evaluated and compared. Results: The 2 groups were comparable in terms of uncorrected and best corrected visual acuity and spherical equivalent. Both groups showed no significant increase in K1, K2 and Kmean from baseline at 12 months. There was also no difference between the CXL and KXL group for postoperative corneal topography as well as central and minimal pachymetry up to 12 months. There was a significant increase in both corneal hysteresis (0.62mm Hg, P=0.04) and corneal resistance factor (0.91mm Hg, P=0.003) in the KXL group at 12 months but not in the CXL group. There was no significant endothelial cell loss throughout follow up in both the groups. Conclusion: We have established comparability of the 2 protocols in stabilizing the progression of keratoconus. Our findings also suggested an added biomechanical advantage of accelerated crosslinking at 1 year follow up.

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 Whether Keratectasia Area Shown in Corneal Topography Is Appropriate for Evaluating the Effect of Corneal Cross-Linking for Keratoconus: A 12-Month Follow-Up Study

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Jia Wang ◽  
Zhiwei Li ◽  
Huankai Zhang ◽  
Ning Gao ◽  
Guoying Mu
Keyword(s):  
Endothelial Cell ◽  
Linear Regression ◽  
Early Stage ◽  
Morphological Changes ◽  
Corneal Thickness ◽  
Corneal Topography ◽  
Cross Linking ◽  
Follow Up Study ◽  
Before And After

Purpose. To analyze the keratectasia area (KEA) shown in corneal topography before and after corneal cross-linking (CXL) in patients with progressive keratoconus (KC) and figure out whether KEA is appropriate for evaluating the effect of CXL. Methods. A retrospective analysis was conducted in 34 eyes from 24 progressive KC patients who have underwent CXL from 2015 to 2017. Area with K-value more than 47D shown in the corneal topography was marked and identified as KEA. Keratometry (K1, K2, and Kmax), KEA, thinnest corneal thickness (TCT), and endothelial cell density (ECD) were evaluated preoperatively or at months 3, 6, and 12 postoperatively. The changes of KEA before and after operation were evaluated. The relation of KEA and other parameters, including Kmax and TCT, was analyzed. Results. Linear regression model revealed the KEA, Kmax, K1, and K2 decreased after CXL in model y = 0.9622 -0.02408 x (P<0.05), y = 0.9982 -0.003469 x(P<0.05), y = 0.9977 + -0.001347 x(P<0.05), y = 0.9992 + -0.001779 x(P<0.05) (y represents KEA, Kmax, K1, or K2; x represents time (month)). The KEA is significantly decreased in early stage (before month 3) (P<0.05); however, the Kmax, K1, and K2 have no significant decrease in early stage (P= 0.09, 0.19, 0.32). Conclusions. The KEA is more sensitive than K-value in describing the morphological changes of cornea after CXL, especially in early stage after treatment.

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.

Evaluation of corneal hysteresis and corneal resistance factor after corneal cross-linking for keratoconus

2011 ◽  
Vol 250 (4) ◽  
pp. 565-573 ◽  
Author(s):  
Maria Gkika ◽  
Georgios Labiris ◽  
Athanassios Giarmoukakis ◽  
Anna Koutsogianni ◽  
Vassilios Kozobolis
Keyword(s):  
Resistance Factor ◽  
Corneal Hysteresis ◽  
Cross Linking ◽  
Corneal Resistance Factor

scholarly journals Comparison of refractive predictability and endothelial cell loss in femtosecond laser-assisted cataract surgery and conventional phaco surgery: prospective randomised trial with 6 months of follow-up

2019 ◽  
Vol 4 (1) ◽  
pp. e000233 ◽  
Author(s):  
Therese Krarup ◽  
Rasmus Ejstrup ◽  
Anouck Mortensen ◽  
Morten la Cour ◽  
Lars Morten Holm
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Cell Loss ◽  
Absolute Difference ◽  
Endothelial Cell Loss ◽  
Distance Visual Acuity ◽  
The Mean

ObjectiveFemtosecond laser-assisted cataract surgery (FLACS) decreases the use of energy and provides a more precise capsulorhexis compared with conventional phaco surgery (CPS). The purpose of this study was to examine if the lower energy use in FLACS caused less endothelial cell loss compared with CPS and if there was a difference in refractive predictability between CPS and FLACS.Methods and analysisThis was a randomised controlled study of 96 patients with a 6-month follow-up comparing one eye surgery by FLACS and the contralateral eye operated by CPS (divide and conquer technique). Both eyes had intraocular aspheric lenses implanted. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), central corneal endothelial cell count and hexagonality (non-contact endothelial cell microscope) were assessed preoperatively at 40 and at 180 days postoperatively.ResultsThe mean phaco energies were 6.55 (95% CI 5.43 to 7.66) and 9.77 (95% CI 8.55 to 10.95) U/S (p<0.0001) by FLACS and CPS, respectively. At day 40, the mean endothelial cell loss (ECL) was 344 cells/mm2 (95% CI 245 to 443) by FLACS (12.89%) and 497 cells/mm2 (95% CI 380 to 614) by CPS (18.19%) (p=0.027). At day 180, ECL was 362 cells/mm2 (95% CI 275 to 450) in FLACS (13.56%) and 465 cells/mm2 (95% CI 377 to 554) in CPS (17.03%) (p=0.036).The mean absolute difference from the attempted refraction was 0.43 (95% CI 0.36 to 0.51) dioptres (D) at day 40 and 0.46 D (95% CI 0.39 to 0.53) at day 180 by FLACS compared with 0.43 D (95% CI 0.36 to 0.51) at day 40 (p=0.95) and 0.46 D (95% CI 0.37 to 0.52) at day 180 (p=0.91) with CPS.ConclusionECL was significantly lower in FLACS compared with CPS at both day 40 and day 180. ECL was correlated to the energy used. We found no difference in refractive predictability or CDVA between the groups.

scholarly journals Corneal Cross-Linking (with a Partial Deepithelization) in Keratoconus with Five Years of Follow-Up

2016 ◽  
Vol 8 ◽  
pp. OED.S38364 ◽  
Author(s):  
Virgilio Galvis ◽  
Alejandro Tello ◽  
Néstor I. Carreño ◽  
Alvaro I. Ortiz ◽  
Rodrigo Barrera ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
Case Series ◽  
Cross Linking ◽  
Spherical Equivalent ◽  
Corneal Endothelial Cells ◽  
Corneal Resistance Factor ◽  
Endothelial Cell Count ◽  
Corrected Visual Acuity

We performed a retrospective interventional case series including 80 eyes of 48 patients with keratoconus (KC) who were treated with modified corneal cross-linking (CXL) for KC (with a partial deepithelization in a pattern of stripes). The average follow-up was 5.8 years (with a minimum of 5 years). At the last follow-up visit, compared with preoperative values, there were no significant changes in spherical equivalent, average keratometry, corneal thickness, corneal hysteresis, or corneal resistance factor. The distance-corrected visual acuity was 20/39 preoperatively and 20/36 postoperatively ( P = 0.3). The endothelial cell count decreased by 4.7% ( P < 0.005). These findings suggest that this modified corneal CXL technique is a safe and effective alternative to halt the progression of KC up to five years after the procedure. However, some concerns remain as to whether this technique can affect in some degree the corneal endothelial cells.

scholarly journals Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy

2021 ◽  
Author(s):  
Bishr Agha ◽  
Raimund Forster ◽  
Thomas Kohnen ◽  
Ingo Schmack
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Anterior Segment ◽  
Cell Loss ◽  
Endothelial Cell Loss ◽  
Refractive Outcome ◽  
Refractive Outcomes ◽  
Scheimpflug Imaging ◽  
Fuchs Endothelial Dystrophy ◽  
Anterior Segment Parameters

Abstract Purpose To evaluate the potential impact of rebubbling on the anterior segment parameters and refractive outcomes in patients with graft detachment following uneventful DMEK for Fuchs endothelial dystrophy (FED). Methods Retrospective institutional cohort study of comparing 34 eyes of 31 patients with rebubbling for graft detachment following Descemet membrane endothelial keratoplasty (DMEK) to 33 eyes of 28 patients with uneventful DMEK. Main outcome parameters were various corneal parameters obtained by Scheimpflug imaging, refractive outcome, corrected distance visual acuity (CDVA), and endothelial cell density (ECD). Results Anterior and posterior corneal astigmatism, corneal densitometry, central corneal thickness, and anterior chamber depth and volume showed no significant differences. Preoperative distribution of astigmatism axis orientations showed a high proportion of anterior corneal with-the-rule astigmatism (71%) in eyes requiring rebubbling. Mean postoperative cylinder in the rebubbling group (1.21 ± 0.85 D) was significantly higher compared to the controls (p = 0.04), while differences in spherical equivalent (SE) were insignificant (p = 0.24). Postoperative CDVA was 0.11 ± 0.11 in the control group compared to 0.21 ± 0.17 in the rebubbling group (p = 0.03). Eyes with subsequent rebubbling demonstrated a significantly higher endothelial cell loss (56% versus 37%) (p < 0.001). Conclusion Apart from higher cylinder values, refractive outcome and corneal parameters assessed by Scheimpflug imaging were comparable in eyes with rebubbling and controls. However, a reduced visual acuity and an increased endothelial cell loss should be taken into consideration prior to rebubbling especially in eyes with circumscribed graft detachment.

Endothelial cell density change in fully dislocated XEN Gel IMPLANT after trabeculectomy: A case report

2021 ◽  
pp. 112067212198963
Author(s):  
Martina Menchini ◽  
Francesco Sartini ◽  
Filippo Tatti ◽  
Enrico Peiretti ◽  
Michele Figus
Keyword(s):  
Endothelial Cell ◽  
Anterior Chamber ◽  
Cell Density ◽  
Cell Loss ◽  
Endothelial Cell Density ◽  
Endothelial Cell Loss ◽  
Density Reduction ◽  
History Of ◽  
Cell Loss Rate

Purpose: To report a case of fully dislocated XEN Gel Implant device into the anterior chamber, 18 months after its implantation and its impact on endothelial cell density. Result: A 75-year-old man with a history of multiple glaucoma surgeries during the last three years presented with an entirely dislocated XEN Gel implant into the anterior chamber. An endothelial cell density reduction was observed over 18 months. Thus, the implant was removed. In the short-term after surgery, the endothelial cell loss rate reduced. Conclusion: XEN Gel Implant can dislocate into the anterior chamber, increasing endothelial cell loss in an eye already underwent multiple surgical procedures with subsequent adverse events. Therefore, if the implant seems displaced, the endothelial cell density should be monitored, and the length of the free-tube segment within the anterior chamber should be measured, during the patient’s follow-up.

Seven years follow-up of corneal cross-linking (CXL) in pediatric patients: Evaluation of treated and untreated eye

2021 ◽  
pp. 112067212110206
Author(s):  
Iliya Simantov ◽  
Lior Or ◽  
Inbal Gazit ◽  
Biana Dubinsky-Pertzov ◽  
David Zadok ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Uncorrected Distance Visual Acuity ◽  
Mild Reduction ◽  
Change In The Mean ◽  
The Mean

Background: Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes. Methods: Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography. Results: Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years; p = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years; p = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D); p < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm ( p = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D ( p = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL. Conclusion: CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.

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.

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