Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus (original) (raw)
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Clinical Ophthalmology, 2014
To evaluate the outcome of collagen cross-linking (CXL) without corneal epithelial debridement in patients treated for progressive keratoconus for whom the standard epitheliumoff treatment cannot be applied, as their central corneal thickness (CCT) is less than 400 µm. Patients and methods: This was a prospective, uncontrolled, interventional study involving 32 eyes of 30 patients with progressive keratoconus and CCT of less than 400 µm. All patients received CXL treatment with application of riboflavin and exposure to ultraviolet light A for 30 minutes without corneal epithelial debridement. Patients were followed up to 12 months postoperatively. The main outcomes were changes in maximum-K reading, manifest refractive spherical equivalent, CCT, and best-corrected visual acuity (logarithm of minimum angle of resolution). Patients were also asked to report any pain or discomfort during the procedure. Results: At the end of the 12-month follow-up, CCT showed no significant change: from 392±5.17 µm preoperatively to 390±4.45 µm (P=0.102). Maximum-K reading decreased significantly, from 49.19±2.30 D preoperatively to 46.96±6.03 D postoperatively (P,0.05). The mean manifest spherical equivalent showed no significant change: from 4.04±1.51 D preoperatively to 4.17±1.63 D postoperatively (P=0.110). Mean best-corrected visual acuity showed no significant change: from 0.29±0.12 preoperatively to 0.31±0.11 postoperatively (P=0.110). Conclusion: Epithelium-on CXL exhibits potential as a method for treating patients with progressive keratoconus and CCT of less than 400 µm, in which the standard epithelium-off CXL cannot be applied. Over 12 months of follow-up, the epithelium-on CXL was safe and effective, with results comparable to that achieved with the epithelium-off technique in thicker corneas, and reduced rates of operative and postoperative discomfort.
Eye and Vision, 2021
Purpose To assess clinical results of the 9 mW/5.4 J/cm2 accelerated crosslinking (ACXL) in the treatment of progressive keratoconus (KC) over a span of 5 years. Methods The prospective open non-randomized interventional study (Siena Eye-Cross Study 2) included 156 eyes of 112 patients with early progressive KC undergoing the Epi-Off 9 mW/5.4 J/cm2 ACXL at the Siena Crosslinking Centre, Italy. The mean age was 18.05 ± 5.6 years. The 20-min treatments were performed using the New KXL I (Avedro, Waltham, USA), 10 min of 0.1% HPMC Riboflavin soaking (VibeX Rapid, Avedro, Waltham, USA) and 10 min of continuous-light UV-A irradiation. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), Kmax, coma, minimum corneal thickness (MCT), surface asymmetry index (SAI), endothelial cell count (ECC) were measured, and corneal OCT performed. Results UDVA and CDVA improved significantly at the 3rd (P = 0.028), Δ + 0.17 Snellen lines and 6th postoperative month, respect...
Clinical & Experimental Ophthalmology
Importance: Keratoconus is a debilitating condition with a disproportionately high impact on health resources and vision-specific quality of life. Background: This study aimed to compare 2-year outcomes of epithelium-off pulsed (p-ACXL) and epithelium-off continuous (c-ACXL) accelerated corneal crosslinking in progressive keratoconus. Design: Prospective, interventional case series. Participants: Eighty eyes of 80 patients were included. Methods: The visual, refractive and tomographic results of the two crosslinking protocols were compared. Main Outcome Measures: Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE) and maximum keratometry (K MAX) on corneal tomography assessment. Results: The mean patient age was 22.51 ± 6.12 years (SD) and 22.08 ± 5.72 years in the p-ACXL and c-ACXL groups, respectively. The mean CDVA significantly improved from 0.30 ± 0.16 logMAR at baseline to 0.23 ± 0.17 logMAR at 24 months (P = .04) in the p-ACXL group and from 0.36 ± 0.22 logMAR to 0.26 ± 0.27 logMAR (P = .02) in the c-ACXL group. The mean induced change in MRSE (+1.79 ± 2.30 D vs +0.27 ± 3.19 D, P = .04) and K MAX (−1.75 ± 1.80 D vs −0.39 ± 1.95 D, P = .04) were superior in the c-ACXL group compared to the p-ACXL group at 24 months. No complications were encountered. Conclusions and Relevance: In this prospective study, both p-ACXL and c-ACXL treatments were safe methods to halt the progression of keratoconus within a follow-up period of 24 months. c-ACXL appeared to offer superior refractive and tomographic outcomes when compared to p-ACXL but this did not translate into better visual outcomes.
Epithelium-on Corneal Cross-linking for Progressive Keratoconus: Two-year Outcomes
International Journal of Keratoconus and Ectatic Corneal Diseases
Corneal cross-linking (CXL) has been established as a successful treatment tool for the treatment of progressive keratoconus in terms of slowing or halting progressive corneal steepening and thinning and even on some occasions, reversing the steepening. To date the Dresden epithelium-off protocol is regarded as the gold standard and the epithelium-on (epi-on) approaches have met with less success. Both doctors and patients would welcome an epi-on CXL procedure that provided good outcomes as the morbidity with epi-on CXL is so much less and the safety is enhanced. Patient comfort is greater with the epi-on techniques when compared to epi-off. This study looked at 82 eyes that had documented progression of keratoconus and then underwent epi-on CXL using the CXLO system. The results show that corneal steepening can be halted and even reversed over a 2-year follow-up period with no complications noted. Over the 24 months post treatment on average there was a decrease in all keratometry values, BAD and ISV when compared to before treatment with IHD being marginally increased. Further studies over a longer follow-up period are required but recent publications using the same approach are validating the findings seen in this study.
BMC ophthalmology, 2015
Corneal cross-linking is widely used to treat keratoconus. However, to date, only limited data from randomized trials support its efficacy. The efficacy and safety of corneal cross-linking for halting progression of keratoconus were investigated in a prospective, randomized, blinded, placebo controlled, multicentre trial. Twenty-nine keratoconus patients were randomized in three trial centres. The mean age at inclusion was 28 years. Longitudinal changes in corneal refraction were assessed by linear regression. The best corrected visual acuity, surface defects and corneal inflammation were also assessed. These data were analysed with a multifactorial linear regression model. A total of 15 eyes were randomized to the treatment and 14 to the control group. Follow-up averaged 1098 days. Corneal refractive power decreased on average (+/-standard deviation) by 0.35 +/- 0.58 dioptres/year in the treatment group. The controls showed an increase of 0.11 +/- 0.61 dioptres/year. This differenc...
Pakistan journal of medical sciences
The purpose of this study was to evaluate the safety and efficacy of transepithelial corneal collagen cross linking (TE-CXL) with modified riboflavin and accelerated UVA irradiance in thin corneas with pachymetry less than 400 microns at thinnest point, untreatable by epithelium off corneal collagen cross linking (CXL) in adult Pakistani population with progressive keratoconus. This quasi experimental study included twenty six eyes of 26 patients with progressive keratoconus who underwent accelerated transepithelial CXL in Armed forced institute of ophthalmology with 12 months follow up. Modified riboflavin, ParaCel ((riboflavin 0.25%, Benzalkonium chloride, EDTA, Trometamol, hydroxypropyl methylcellulose) and vibeX Xtra (riboflavin 0.25%) (Avedro, USA)) were applied to cornea in two stages. Uncorrected and Corrected Distant Visual Acuities (UDVA, CDVA), spherical equivalent (SE), astigmatism, pachymetry at thinnest point (Pachy thin), apex keratometry (Kmax), simulated and steep ke...
Analysis of the effectiveness of transepithelial crosslinking in patients with keratoconus
2019
Objective: To evaluate the clinical results of Transepithelial Crosslinking (CXL) by analyzing its efficacy in patients with progressive keratoconus. Methods: Retrospective cross-sectional study with 49 eyes and 37 patients aged 10 to 50 years submitted to the CXL technique in 2017 at the Instituto Panamericano da Visão, in Goiânia, Goiás, Brazil. The Avedro KXL system was programmed in pulsed mode with interval (1/1 second), using 45 mW/cm² with 7.2 J and 0.25% riboflavin solution of Avedro with irradiated corneas for 8 minutes. Data were collected: sex, age, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), astigmatism, pachymetry at the thinnest point and keratometric astigmatism in the preoperative and postoperative periods at 1, 6 and 12 months. The Kolmogorov-Smirnov, Pearson's Chi-square, Friedman, Dunnett, and the Spearman correlation were used. Results: Twenty-three patients (62.2%) were female and 14 (37.8%) male. The mean age was 27.8...
Predictive Factors of the Standard Cross-linking Outcomes in Adult Keratoconus: One-Year Follow-Up
Journal of Ophthalmology, 2017
Purpose. To evaluate the effects of preoperative presumed predictor factors on clinical and topographic outcomes in adult keratoconus (KC) 1 year after the standard corneal cross-linking (CXL). Design. Retrospective cohort study. Methods. The study included 84 KC patients (136 eyes) who were treated with conventional CXL. Postoperative best-corrected visual acuity (BCVA) and K max were considered the main predicted variables. The entire participants were divided into subgroups with cutoff values in accordance with the predictive variables. The predicted postoperative outcomes at one year were compared between the subgroups. Next, the predictive variables were analyzed by univariate and multivariate linear regression. Results. In respect to the BCVA, univariate analysis showed that the worse BCVA, the higher K max, and the relative thinner corneas were relatively good predictors of improvement, while multivariate evaluation revealed a strong interrelation with preoperative BCVA only....
Balkan Medical Journal, 2020
Background: Corneal cross-linking treatment is the unique treatment method that can cease the progression of keratoconus disease. Because of the long duration of conventional treatment, accelerated cross-linking treatment methods are being developed. Aims: To compare two different accelerated corneal cross-linking protocols in terms of postoperative visual acuity and topographic findings (higher-order aberrations and keratometry values). Study Design: Retrospective comparative study. Methods: Sixty-five eyes of 43 patients (30 men and 13 women) who underwent two different accelerated corneal cross-linking protocols (10 min, 9 mW/cm 2 and 5 min, 18 mW/cm 2) for progressive keratoconus were retrospectively analyzed. Patients were divided into two groups according to the accelerated corneal cross-linking treatment protocol: group 1 (10 min, 9 mW/cm 2 , 32 eyes of 21 patients) and group 2 (5 min, 18 mW/cm 2 , 33 eyes of 22 patients). Uncorrected visual acuity and best-corrected visual acuity values and topographic findings (central corneal thickness and flat and steep keratometry values) were recorded preoperatively and 6 months after corneal cross-linking treatment. High-order aberration values measured with Pentacam preoperatively and 6 months after corneal cross-linking were also recorded. Results: In both groups, a significant improvement was detected in the uncorrected visual acuity and best-corrected visual acuity levels preoperatively and 6 months postoperatively (group 1: p=0.001, p=0.001 and group 2: p=0.001, p=0.001, respectively). In addition, central corneal thickness values decreased significantly in both groups (p=0.006 and 0.001). Trefoil values showed no significant difference preoperatively and 6 months postoperatively in group 1 (p=0.160 and 0.620, respectively). In groups 1 and 2, coma values were found to decrease significantly in the 6 th postoperative month compared with preoperative values (p=0.001 and 0.020, respectively). There was no significant difference between preoperative and 6 th month postoperative horizontal and vertical trefoil values in both groups (p=0.850 and 0.140, respectively). There was no significant difference between the two groups in terms of preoperative and 6 th month postoperative higher-order aberrations, refractive errors, keratometry values, and uncorrected visual acuity and best-corrected visual acuity levels. Conclusion: Both accelerated corneal cross-linking procedures provide similar improvement in topographic findings, coma values and visual acuity.
Matched Comparison Study of Total and Partial Epithelium Removal in Corneal Cross-linking
Journal of Refractive Surgery, 2015
PURPOSE: To compare the 1-year results of total versus partial epithelium removal in corneal cross-linking in the treatment of progressive keratoconus. METHODS: This retrospective study compared the results of total (the total group) versus partial (the partial group) approaches of epithelium removal in corneal cross-linking. Eighty eyes of 65 patients (40 eyes in each group) were enrolled. The mean age of the participants was 25.48 ± 4.80 years and 62.5% were male. Oneyear changes in vision parameters, refraction, and Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) indices were compared between the two groups using repeated measures analysis of variance.