Evaluation of corneal changes after conventional versus accelerated corneal cross-linking: a randomized controlled trial (original) (raw)
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Long-term results of accelerated and conventional corneal cross-linking
International Ophthalmology, 2020
The aim of this study is to compare the long-term follow-up outcomes of traditional and accelerated corneal cross-linking (CXL) for keratoconus. Methods This retrospective comparative cohort study included patients with keratoconus who underwent corneal cross-linking (CXL) between August 2008 and December 2016. Patients treated before August 2013 underwent the traditional Dresden protocol, and those treated subsequently received the accelerated protocol, i.e., 0.1% riboflavin soaking for 10 min, followed by pulsed UV-A irradiation at 30 mW/cm 2 for 8 min, and a total irradiation power of 7.2 J/cm 2. The primary outcome was the success rate in halting the disease progression. The postoperative changes in visual acuity, keratometry readings, endothelial cell count and complications following accelerated CXL and conventional CXL were compared. Results This study evaluated 113 eyes over a mean follow-up period of 37.61 ± 16.34 months. It was found that 89.6% and 95.7% of the eyes were successfully treated with the traditional and accelerated protocols, respectively (p = 0.239). The corrected-distance visual acuity improved in both groups, but it was significantly better following the accelerated protocol (p = 0.037). Traditional protocol group had more postoperative complications than the accelerated group (8.9% versus 2%), although not reaching statistically significant difference (p = 0.142). There were no significant differences in the topographic (p = 0.122) and refractive (p = 0.570) outcomes. Conclusion Accelerated CXL and conventional CXL are both safe and effective, and the long-term follow-up showed that the accelerated protocol was similar to the standard one in terms of halting keratoconus and achieving visual outcomes. Because of its potential benefits, the accelerated protocol may be considered for the treatment of progressive keratoconus.
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.
Refractive Changes After Two Years Accelerated Corneal Cross-Linking in Patients with Keratoconus
Vision Pan-America, The Pan-American Journal of Ophthalmology, 2017
Purpose: to describe the visual and topographical changes after accelerated corneal collagen cross-linking (ACXL) in keratoconus-affected eyes. Methods: a retrospective case series study was made. Clinical records of patients with keratoconus-affected eyes that underwent ACXL treatment and had 24 months of follow-up were reviewed. Data regarding demographics, visual acuity (VA), refraction and Sheimpflug values before and post ACXL were analyzed. We included patients with keratoconus older than 12 years old, with corneal thickness greater than 400 microns and steepest keratometry <60 diopters by Sheimpflug (Pentacam), with reported uncorrected distant visual acuity (UDVA), manifest refraction and best-corrected visual acuity (BCVA) evaluation pre ACXL and 24 months after surgery. The exclusion criteria were: history of ocular trauma, anterior segment surgery, retinal detachment or any type of maculopathy. Results: 21 eyes were included. Mean age was 27 years. Mean uncorrected dis...
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.
Corneal higher-order aberration changes after accelerated cross-linking for keratoconus
BMC Ophthalmology, 2022
Aim: To evaluate changes in corneal higher-order aberrations (HOAs) following epithelium-off accelerated corneal cross-linking (A-CXL) and to explore the impact on visual acuity. Methods: In this retrospective case series, 32 eyes of 24 patients with keratoconus (KC) underwent A-CXL. Treatment was delivered at 10 mW/cm 2 for 9 min with a total dose of 5.4 J/cm 2. The following anterior corneal HOAs: total corneal HOAs, trefoil, secondary trefoil, coma, secondary coma, secondary astigmatism and spherical aberrations were analysed using the Scheimpflug-Placido Sirius (CSO, Italy) corneal topographer at baseline and 12 months following treatment. Multivariate analysis was used to evaluate the independent effect of HOA subtypes on changes in uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Results: At one year post CXL, UDVA and CDVA were significantly improved,-0.13 ± 0.19 LogMAR (P = 0.0005) and-0.08 ± .0.11 LogMAR (P = 0.0003), respectively. The mean preoperative trefoil, secondary trefoil, secondary coma and secondary astigmatism were 0.95 ± 0.46; µm, 0.20 ± 0.11; µm, 0.29 ± 0.19; µm and 0.42 ± 0.17 µm, respectively. At one year, the mean values decreased significantly to 0.77 ± 0.47 µm, 0.15 ± 0.11 µm, 0.25 ± 0.18 µm and 0.34 ± 0.18 µm, respectively (P < 0.05, for all). No independent relationship between any HOA changes and change in UDVA was observed. A reduction in secondary coma aberration was associated with a change in CDVA (95% CI 0.01-1.34, P = 0.048; β = 0.67). Conclusion: A 9-min protocol of Accelerated corneal cross-linking is an effective treatment in improving corneal HOAs at 12 months follow up, in eyes with progressive keratoconus at one year follow-up. A change in secondary coma had a statistically significant and independent effect on CDVA.
Accelerated versus Standard Corneal Cross-linking for Progressive Keratoconus in Syria
Journal of ophthalmic and vision research, 2021
Purpose: To compare the outcomes of accelerated versus standard corneal cross-linking for the treatment of progressive keratoconus. Methods: In this retrospective comparative study, 63 eyes of 40 patients with progressive keratoconus were divided into two groups; 27 eyes in group one were treated with an accelerated protocol (10 mW/cm 2 , 9 min) and 36 eyes in group two were treated with the standard method (3 mW/cm 2 , 30 min). Visual acuity, refraction, corneal topography, corneal tomography, and anterior and posterior corneal higher-order aberrations (HOAs) were assessed preoperatively and 18-30 months postoperatively. Results: The LogMAR uncorrected and corrected distance visual acuity values were improved in both groups postoperatively. However, the improvement was significantly higher in group one (P < 0.05, all). The flattening in the anterior keratometry readings, flat K, steep K, and average K were significantly higher in group two (P < 0.001, all). The maximum anterior keratometry (AKf) values significantly decreased in both groups, whereas the maximum posterior keratometry (AKb) values increased. The reduction in the minimum corneal thickness (ThKmin) was significantly greater (36.49um) in group two, compared to 10.85um in group one. There was a significant increase in the posterior average keratometry, and a significant decrease in the posterior astigmatism, along 3 mm meridian in S-CXL (P = 0.03, P = 0.008, respectively), while the corresponding values showed no statistical significance in group one (P > 0.05). The anterior corneal trefoil was significantly reduced in group one (P = 0.002), whereas anterior total HOAs and coma were significantly improved in group two (P < 0.0014, all). The posterior corneal spherical aberration decreased significantly in group one (P = 0.02), while group two revealed significant reduction in the posterior trefoil values (P = 0.011). The change in the anterior maximum keratometry was significantly and positively correlated to the preoperative maximum keratometry in group two (P = 0.53, P = 0.003). Conclusion: An accelerated cross-linking protocol using 10 mW/cm 2 for 9 min showed more visual improvement and less pachymetric reduction when compared to the standard protocol, however, anterior corneal flattening, posterior corneal steepening, and the change in the posterior astigmatism were significantly higher in the standard protocol; while corneal HOAs were improved in both protocols.
The effect of cross-linking procedure on corneal wavefront aberrations in patients with keratoconus
Vojnosanitetski pregled, 2021
Background/Aim. Corneal cross-linking (CXL) treatment shows the best results in stabilizing the cornea and stopping the progress of the ectatic process. The aim of the study was to assess the impact of CXL on the keratoconus regarding higher-order aberrations (HOAs) and potential improvement of visual function. Methods. In 19 patients, a standard epithelium-off CXL was performed with an energy density of three mW/cm2 for half an hour. The cornea was examined by Pentacam topography before CXL and one and six months after CXL. Best-corrected visual acuity (BCVA), topographic data, and aberrations were collected. Results. A significant reduction in vertical coma was observed from preoperative -1.03 ? 1.89 to -0.74 ? 1.73 (p = 0.004) six months after CXL, and in spherical aberration from preoperative -0.22 ? 1.05 to -0.08 ? 1.13 (p = 0.002) six months after CXL. Root mean square (RMS) HOAs six months after CXL also significantly reduced from 2.31 ? 1.82 to 2.26 ? 1.84 six months after C...
Vojnosanitetski pregled, 2021
Background/Aim: The aim of our study was to assess the impact of cross-linking (CXL) on the keratoconus regarding higher-order aberrations (HOAs) and potential improvement of visual function. Methods: In 19 patients a standard epithelium-off CXL was performed with an energy density of 3 mW/cm2 for half an hour. The cornea was examined by Pentacam topography before, one and six months after CXL. Best-corrected visual acuity (BCVA), topographic data and aberrations were collected. Results: A significant reduction in vertical coma was observed from preoperative -1.03 ? 1.89 to -0.74 ? 1.73 (p=0.004) 6 months after CXL, and in spherical aberration from preoperative -0.22 ? 1.05 to -0.08 ? 1.13 (p=0.002) 6 months after CXL. RMS-HOA 6 months after CXL also showed a significant reduction from 2.31 ? 1.82 to 2.26 ? 1.84 6 months after CXL (p=0.001). BCVA improved from preoperative 0.43 ? 0.15 to 0.71 ? 0.19 6 months after surgery (p<0.001). Conclusion: CXL is a very potent treatment meth...
Corneal Higher-order Aberrations Changes after Accelerated Cross-linking for Keratoconus
2022
Aim: To evaluate changes in corneal higher-order aberrations (HOAs) after accelerated corneal cross-linking (A-CXL) and the effect of change in HOAs on visual acuity between baseline and one year after A-CXL.Methods: In this retrospective case-series, 32 eyes of 24 patients with keratoconus (KC) underwent accelerated corneal cross-linking. The following anterior corneal HOAs: total corneal HOAs, trefoil, secondary trefoil, coma, secondary coma, secondary astigmatism and spherical aberrations were measured and analysed using the Scheimpfug-Placido Sirius (CSO, Italy) topographer at baseline and 12 months after CXL. Multivariate analysis was used to evaluate the independent effect of HOA subtypes on changes in uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Results: At one year post CXL, UDVA and CDVA were significantly improved, -0.13 ± 0.19 LogMar (P = 0.0005) and -0.08 ±.0.11 LogMar (P = 0.0003), respectively. The mean preoperative trefoil, se...