scholarly journals Accelerated cross-linking technique using a protective corneal donor flap in the treatment of progressive keratoconus on «thin» corneas

2021 ◽  
pp. 26-31
Author(s):  
A.V. Tereshchenko ◽  
◽  
I.G. Trifanenkova ◽  
S.K. Dem'yanchenko ◽  
Y.Y. Golubeva ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Donor Cornea ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
The Difference ◽  
Definition Of ◽  
Thin Cornea ◽  
Observation Period

Purpose. To develop a method of accelerated ultraviolet crosslinking with an initial corneal thickness equal to or less than 400 microns using a protective donor corneal flap. Definition of safety and effectiveness of this method in the treatment of progressive keratoconus. Material and methods. 20 patients (20 eyes) with a diagnosis of progressive keratoconus 2–3 stages were included in the study. The accelerated crosslinking was carried out with an IROC-VX-2000 device (Switzerland). A protective donor corneal flap was cut out by using a Femto LDV Z8 femtosecond laser (Ziemer, Switzerland). The thickness of the protective flap of the donor cornea was determined as the difference between 450 μm and the obtained value of the patient's pachymetry in 30 minutes of saturation with Dextralink in μm. Results. Indicators of uncorrected visual acuity and corrected visual acuity returned to the level of preoperative values and did not tend to decrease until the end of the observation period for 6 months. The average keratometry indices gradually decreased: after 3 months – 50.3 ± 1.5 μm, after 6 months – 48.9 ± 1.8 μm, by 12 months – 46.7 ± 2.1 μm. A decrease in elevation indicators of the anterior and posterior surfaces was marked on elevation maps throughout the observation period. Conclusion. The proposed ultraviolet crosslinking technique using a protective donor corneal flap in patients with corneal thickness 400 μm or less is reproducible. This technique proves its effectiveness and safety and allows to stabilize the condition in patients with progressive keratoconus with adequate visual function. This makes this technique necessary, taking into account the lack of adequate cross-linking technology with a thin cornea. Keywords: progressive keratoconus, thin cornea, ultraviolet crosslinking, protective donor corneal flap.

Comparative study on corneal cross-linking with isotonic and hypotonic riboflavin: can hypotonic riboflavin be applied in thinner corneas?

2021 ◽  
Vol 2 (1) ◽  
pp. 14-19
Author(s):  
Ana Sofia Lopes ◽  
◽  
Susana Henriques ◽  
Peter Pêgo ◽  
Cristina Vendrell ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retrospective Study ◽  
Comparative Study ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Corrected Visual Acuity ◽  
The Difference ◽  
Best Corrected Visual Acuity

AIM: To compare the results of corneal cross-linking (CXL) with isotonic (IR) and hypotonic riboflavin (HR) in patients with keratoconus and to verify the efficacy of keratoconus in thinner corneas. METHODS: Retrospective study of 29 eyes/keratoconus patients submitted to CXL, 15 eyes with application of IR (IR group) and 14 eyes with application of HR (HR group). The parameters analysed included (1-year follow-up): best corrected visual acuity (BCVA), sphere and cylinder, central and finer pachymetry, mean and maximum keratometry (Km and Kmax respectively), complications and progression. RESULTS: An increase on the BCVA scale (logMAR, logarithm of the minimal angle of resolution) was observed in the two groups: 0.26±0.57 (IR) and 0.47±0.72 (HR) before treatment, and 0.13±0.79 (IR) and 0.29±1.52 (HR) at the 1y. Only at 1y, the difference was statistically significant (P=0.018, group IR with higher BCVA). The central pachymetry (μm) decreased at 1mo in both groups, and increased in the following months: 497±28 μm (IR) and 432±14 μm (HR) before treatment, and 480±31 μm (IR) and 424±15 μm (HR) to the 1y. The thinner pachymetry (μm) presented the same evolution: 487±29 μm (IR) and 410±20 μm (HR) before treatment, and 468±33 μm (IR) and 413±13μm (HR) at 1y. Km and Kmax decreased in both groups (P>0.05). Six eyes from each group presented transitory haze. No eye progressed to the 1y. CONCLUSION: The use of hypotonic riboflavin seems to be a valid alternative for performing the traditional corneal cross-linking technique in eyes with a central corneal thickness of <400 μm.

scholarly journals Clinical Outcomes of Small Incision Lenticule Extraction with Accelerated Cross-Linking (ReLEx SMILE Xtra) in Patients with Thin Corneas and Borderline Topography

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Sri Ganesh ◽  
Sheetal Brar
Keyword(s):  
Visual Acuity ◽  
Clinical Outcomes ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Small Incision Lenticule Extraction ◽  
Uncorrected Visual Acuity ◽  
Distant Visual Acuity ◽  
Lenticule Extraction ◽  
The Mean

Purpose. To study the safety and clinical outcomes of ReLEx SMILE with accelerated cross-linking in individuals with thinner corneas, borderline topography, and higher refractive errors.Methods. Eligible patients first underwent SMILE procedure for correction of myopic refractive error. Following the removal of lenticule, 0.25% riboflavin in saline was injected into the interface and allowed to diffuse for 60 seconds. Finally, eye was exposed to UV-A radiation of 45 mW/cm2for 75 seconds through the cap. Total energy delivered was 3.4 J/cm2.Results. 40 eyes of 20 patients with mean age of 26.75 ± 5.99 years were treated. Mean follow-up was 12 months ± 28.12 days. Mean spherical equivalent (SE) was −5.02 ± 2.06 D preoperatively and −0.24 ± 0.18 D postoperatively. The mean central corneal thickness (CCT) and keratometry changed from 501 ± 25.90 µm to 415 ± 42.26 µm and 45.40 ± 1.40 D to 41.2 ± 2.75 D, respectively. Mean uncorrected visual acuity (UCVA) was 20/25 or better in all eyes. No eyes lost lines of corrected distant visual acuity (CDVA). There were no complications like haze, keratitis, ectasia, or regression.Conclusion. Based on the initial clinical outcome it appears that SMILE Xtra may be a safe and feasible modality to prevent corneal ectasia in susceptible individuals.

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

2012 ◽  
Vol 1 (1) ◽  
pp. 53-56 ◽  
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.

scholarly journals Topographic and Biomechanical Changes after Application of Corneal Cross-Linking in Recurrent Keratoconus

2019 ◽  
Vol 16 (20) ◽  
pp. 3872 ◽  
Author(s):  
Pedrotti ◽  
Caldarella ◽  
Fasolo ◽  
Bonacci ◽  
Gennaro ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Spherical Equivalent ◽  
First Line ◽  
First Line Therapy ◽  
Corrected Visual Acuity ◽  
Line Therapy ◽  
Biomechanical Changes ◽  
Biomechanical Parameters

Background: Recurrent keratoconus (RKC) develops as a progressive thinning of the peripheral and the inferior cornea after keratoplasty, in both graft and host, causing secondary astigmatism, refractive instability, and reduced visual acuity. We evaluated the effectiveness of corneal cross-linking (CXL) in patients diagnosed with RKC. Methods: Accelerated-CXL via the epi-off technique was performed in15 patients (18 eyes) diagnosed with RKC. Topographic and biomechanical changes were assessed at 12 months. Results: Differences in maximum keratometry, thinnest corneal thickness, and biomechanical parameters (deformation amplituderatio, inverse concave radius, applanation 1 velocity, and applanation 2 velocity, stiffness A1) versus baseline were statistically significant (p < 0.05).Best corrected visual acuity was improved in 13 eyes and unchanged in 4;manifest refractive spherical equivalent was reduced in 13 eyes, increased in 3,and unchanged in 1 eye; topographic astigmatism was reduced in 9 eyes, remained stable in 1 eye, and increased in 7 eyes. Conclusions: Improved topographic and biomechanic indexes at 1 year after CXL suggest it‘s potential as first-line therapy for RKC, as it is for KC.

scholarly journals Clinical Experience of Using Intraocular Lenses

2019 ◽  
Vol 16 (3) ◽  
pp. 304-309
Author(s):  
A. D. Chernysheva ◽  
V. O. Afanasyeva
Keyword(s):  
Visual Acuity ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Intraocular Lenses ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
The Mean ◽  
Basic Studies ◽  
The Given ◽  
Observation Period

Aim: to analyze the data obtained from using of intraocular lenses — the hydrophobic IOL Citrin and a hydrophilic IOL Aquamarine, produced by Russian company — NanOptic. Materials and methods. A total of 56 IOLs, produced by NanOptic (38 hydrophobic IOLs Citrine and 18 hydrophilic IOLs Aquamarine) were implanted. The observation period was from 3 to 12 months. The indication for phacoemulsification was age cataract. The age of the patients was 54–85. Patients before the operation were conducted basic studies. The mean uncorrected visual acuity before the operation was (UCVA) 0.121 ± 0.120 (0.001–0.3), and the mean corrected visual acuity was (BCVA) 0.187 ± 0.140 (0.001–0.6). All patients underwent standard phacoemulsification. Results. The early postoperative period was without any complications. In the postoperative period the mean UCVA in patients with “Citrine” and “Aquamarine” was 0.90 ± 0.10 (0.7–1.0) and 0.96 ± 0.07 (0.8–1.0) accordingly, and the mean BCVA was 0.94 ± 0.07 (0.8–1.0) and 0.99 ± 0.02 (0.9–1.0) accordingly. In all cases, the refraction obtained was consistent with the prediction. The error in IOL calculation was minimal and permissible. There weren’t any case of secondary cataract in patients with hydrophobic IOLs, and 3 cases of lens posterior capsule fibrosis of 1 degree in patients with hydrophilic IOLs in 3–12 months observation. The position of IOL in capsule bag was stable. Conclusions. The results of implantation of new Russian-made IOLs on the given parameters appeared to be satisfactory, that allows to recommend them for implantation in cataract surgery.

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

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
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.

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 Effects of Lamellar Keratectomy and Intrastromal Injection of 0.2% Fluconazole on Fungal Keratitis

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Xinying You ◽  
Jun Li ◽  
Suxia Li ◽  
Weiyun Shi
Keyword(s):  
Wound Healing ◽  
Visual Acuity ◽  
Corneal Thickness ◽  
Fungal Keratitis ◽  
Maximum Depth ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Antifungal Chemotherapy ◽  
Intrastromal Injection ◽  
Best Corrected Visual Acuity

Purpose. To evaluate effects of lamellar keratectomy and intrastromal injection of 0.2% fluconazole (LKIIF) on fungal keratitis.Methods. Data for 54 eyes of consecutive patients with fungal keratitis treated with LKIIF were retrospectively analyzed. The lesions in these eyes did not heal or were aggravated after antifungal chemotherapy for 7 days. The maximum lesion diameters were ≤5 mm and maximum depth was not more than half of full corneal thickness. Cases were followed up for at least 90 days.Results. Forty-six eyes were cured (85.2%). The wound healing times were 3–16 days and were less than 7 days in 28 cases (51.9%). In cured eyes, uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were both 20/250–20/20. The UCVA improved in 38 eyes and was unchanged in seven eyes. BCVA improved in 44 eyes and was unchanged in two eyes. When followed up for more than 90 days, 89% (41 of 46 eyes) showed improvement in UCVA and 11% were unchanged. Regarding BCVA, 98% improved and one eye was unchanged. No other complications were observed except neovascularization in one eye and thinner corneas.Conclusions. LKIIF was quick and effective for small fungal keratitis confined to half of the corneal thickness.

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.

Accelerated Corneal Crosslinking for Treatment of Progressive Keratoconus in Pediatric Patients

2016 ◽  
Vol 27 (3) ◽  
pp. 319-325 ◽  
Author(s):  
Döndü M. Ulusoy ◽  
Emre Göktaş ◽  
Necati Duru ◽  
Ayşe Özköse ◽  
Mustafa Ataş ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pediatric Patients ◽  
Corneal Thickness ◽  
Efficacy And Safety ◽  
Ultraviolet A ◽  
Corneal Crosslinking ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Group 2 ◽  
Group 1

Purpose To evaluate the safety and efficacy of accelerated corneal crosslinking (CXL) in patients with progressive keratoconus aged 18 years or less. Methods A total of 28 eyes from 19 patients with progressive keratoconus aged 18 years or less were enrolled. We divided participants into 2 groups according to corneal thickness (CT). Group 1 included 13 eyes of 8 patients with CT ≥450 µm; group 2 included 15 eyes of 11 patients with CT <450 µm. Each participant underwent accelerated CXL using 10-minute ultraviolet A irradiance at 9 mW/cm2 for a total energy dose of 5.4 J/cm2. The efficacy and safety of the procedure were assessed postoperatively at 1, 3, 6, and 12 months with Pentacam and visual acuity. Results In uncorrected visual acuity, group 1 showed a statistically significant +0.12 logMAR improvement at 3 months postoperatively (p = 0.003), and in group 2, there was a statistically significant +0.3 logMAR improvement at 1 month postoperatively (p = 0.005). In best-corrected visual acuity, there was a +0.15 logMAR (p<0.001) and +0.22 logMAR (p = 0.005) improvement in group 1 and group 2, respectively, at 12 months postoperatively. All mean keratometric values including K1 and K2 dropped by at least 1 D or remained stable (< ± 1 D) in both groups after accelerated CXL treatment. Conclusions The findings showed that accelerated CXL treatment seems to be effective in slowing or halting the progression of keratoconus and that no permanent apparent complications are noted 6 months after accelerated CXL.

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