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 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 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.

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 Topography-guided transepithelial accelerated corneal collagen cross-linking for low refractive error correction in keratoconus treatment: a pilot study

2019 ◽  
Author(s):  
Ling Sun ◽  
Yu Zhao ◽  
Xiaoyu Zhang ◽  
Mi Tian ◽  
Jing Zhao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Refractive Error ◽  
Corneal Endothelial Cell ◽  
Cross Linking ◽  
Cell Counts ◽  
Corrected Visual Acuity ◽  
Collagen Cross Linking ◽  
Endothelial Cell Counts ◽  
Corneal Collagen

Abstract Purpose To investigate the safety and efficacy of topography-guided transepithelial accelerated corneal collagen cross-linking for low refractive error correction in keratoconus patients. Methods This was a prospective self-controlled study. Eighteen patients (18 eyes) were enrolled and assessed at 6 visits (pre-operation, 1 d, 1 m, 3 m, 6 m and 1 y post-operation). The examination at every visit included analysis of un-corrected visual acuity (UCVA), best corrected visual acuity (BCVA), corneal topography and corneal endothelial cell counts. Data are expressed as the mean ± standard deviation (SD). The P-value was determined using repeated measures ANOVA. Results No complications occurred in any of the eyes throughout the entire follow-up period. At each visit after the operation, the corneal K values and spherical equivalent (SE) were reduced, while visual acuity values were increased compared with those pre-operation, although these results were not statistically significant. During the follow-up, corneal endothelial cell counts were stable. Regarding the topography, part of the corneal cone was flattened after the operation. Conclusion Topography-guided transepithelial accelerated corneal collagen cross-linking is safe and may correct low refractive error in keratoconus treatment. Further studies and improvement are needed.

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 Topography-guided transepithelial accelerated corneal collagen cross-linking for low refractive error correction in keratoconus treatment: a pilot study

2019 ◽  
Author(s):  
Ling Sun ◽  
Yu Zhao ◽  
Xiaoyu Zhang ◽  
Mi Tian ◽  
Jing Zhao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Refractive Error ◽  
Corneal Endothelial Cell ◽  
Cross Linking ◽  
Cell Counts ◽  
Corrected Visual Acuity ◽  
Collagen Cross Linking ◽  
Endothelial Cell Counts ◽  
Corneal Collagen

Abstract Purpose To investigate the safety and efficacy of topography-guided transepithelial accelerated corneal collagen cross-linking for low refractive error correction in keratoconus patients. Methods This was a prospective self-controlled study. Eighteen patients (18 eyes) were enrolled and assessed at 6 visits (pre-operation, 1 d, 1 m, 3 m, 6 m and 1 y post-operation). The examination at every visit included analysis of un-corrected visual acuity (UCVA), best corrected visual acuity (BCVA), corneal topography and corneal endothelial cell counts. Data are expressed as the mean ± standard deviation (SD). The P-value was determined using repeated measures ANOVA. Results No complications occurred in any of the eyes throughout the entire follow-up period. At each visit after the operation, the corneal K values and spherical equivalent (SE) were reduced, while visual acuity values were increased compared with those pre-operation, although these results were not statistically significant. During the follow-up, corneal endothelial cell counts were stable. Regarding the topography, part of the corneal cone was flattened after the operation. Conclusion Topography-guided transepithelial accelerated corneal collagen cross-linking is safe and may correct low refractive error in keratoconus treatment. Further studies and improvement are needed.

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

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.

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.

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