scholarly journals Accelerated Corneal Collagen Cross-Linking in Pediatric Patients: Two-Year Follow-Up Results

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Rohit Shetty ◽  
Harsha Nagaraja ◽  
Chaitra Jayadev ◽  
Natasha Kishore Pahuja ◽  
Mathew Kurian Kummelil ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pediatric Patients ◽  
Vernal Keratoconjunctivitis ◽  
Cross Linking ◽  
Specular Microscopy ◽  
Safe Procedure ◽  
Distant Visual Acuity ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose.To evaluate the effectiveness and safety of accelerated corneal collagen cross-linking (ACXL) in patients below 14 years of age with progressive keratoconus.Materials and Methods. Thirty eyes of 18 patients with established progressive keratoconus underwent preoperative and postoperative visual acuity assessment, topography, and specular microscopy prior to ACXL and were followed up for 24 months.Results.Mean age of the patients was 12.7 years with ten males and eight females. There was an improvement in the mean postoperative uncorrected distant visual acuity (from0.76±0.26to0.61±0.25;P=0.005), mean corrected distant visual acuity (from0.24±0.19to0.12±0.12;P<0.001), mean spherical refraction (from-3.04 DS±3.60to-2.38 DS±3.37;P=0.28), mean cylinder (from-3.63 DC±1.82to-2.80 DC±1.48;P=0.008), and spherical equivalent (from-4.70 D±3.86to-3.75 D±3.49;P=0.15). Three eyes of two patients with vernal keratoconjunctivitis (VKC) showed progression. There were no intra- or postoperative complications.Conclusion.In pediatric patients ACXL is an effective and safe procedure for the management of keratoconus. Optimal management of VKC is important to arrest the progression of keratoconus.

scholarly journals Corneal collagen cross-linking in pediatric patients with keratoconus

2020 ◽  
Vol 148 (1-2) ◽  
pp. 70-75 ◽  
Author(s):  
Svetlana Stanojlovic ◽  
Vedrana Pejin ◽  
Tanja Kalezic ◽  
Jelica Pantelic ◽  
Borivoje Savic
Keyword(s):  
Visual Acuity ◽  
Pediatric Patients ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Rubbing Behavior ◽  
Distant Visual Acuity ◽  
One Year ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Introduction/Objective. The aim of this study was to report visual, refractive, and tomographic outcomes of corneal collagen cross-linking (CXL) in pediatric keratoconus. Methods. This retrospective study included 17 eyes of 12 patients with progressive keratoconus who underwent epithelium-off CXL at the age ? 18 years. Following data were analyzed at baseline and postoperatively at one, three, six, nine, 12 months for all the patients, and annually where available: uncorrected distant visual acuity (UDVA) and best spectacle-corrected distant visual acuity (CDVA), refraction and corneal tomography. Results. Mean UDVA improved significantly from 0.52 ? 0.38 at baseline to 0.24 ? 0.29 logarithm of minimum angle resolution (log MAR) at one year (p = 0.011) and remained stable at two-year follow-up (0.21 ? 0.34 log MAR). Mean CDVA was 0.15 ? 0.21 at baseline and 0.06 ? 0.13 log MAR at one year (p = 0.248). Maximum keratometry showed a significant flattening of 1.30 ? 1.99 D (p = 0.011) after a year and remained stable two years after CXL. Minimum keratometry significantly decreased with a mean change of 1.34 ? 1.37 (p = 0.001). Mean reduction of corneal thickness after CXL was 55.35 ? 64.42 ?m (P=0.003). After a year, seven (42%) eyes showed Kmax regression, nine (53%) stabilization, and one (5%) progression. Conclusion. In our study CXL effectively prevented progression of keratoconus in 95% of pediatric patients after a year, while improving UDVA and keratometry values. One patient with eye rubbing behavior showed signs of keratoconus progression after CXL treatment.

scholarly journals Corneal Collagen Cross-Linking with and without Epithelial Removal: A Contralateral Study with 0.5% Hypotonic Riboflavin Solution

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Aleksandar Stojanovic ◽  
Wen Zhou ◽  
Tor Paaske Utheim
Keyword(s):  
Visual Acuity ◽  
Postoperative Pain ◽  
Patient Questionnaire ◽  
Cross Linking ◽  
Specular Microscopy ◽  
Group 2 ◽  
Collagen Cross Linking ◽  
Corneal Collagen ◽  
Group 1

Purpose. Our main purpose was to compare safety and efficacy in the treatment of progressive keratoconus with “epithelium-on” and “epithelium-off” corneal collagen cross-linking (CXL). Our secondary purpose was to evaluate efficacy of CXL when hypotonic 0.5% riboflavin is used as photosensitizer.Methods. One eye of 20 patients with bilateral progressive keratoconus was randomly treated for “epithelium-on” CXL (group 1) while the fellow eye underwent “epithelium-off” CXL (group 2). Hypotonic 0.5% riboflavin was used in both groups. Visual acuity, refraction, corneal topography, and wavefront aberrometry were evaluated at baseline and after 1, 6, and 12 months. Specular microscopy was performed on 10 patients preoperatively and after 12 months. Postoperative pain was evaluated using a patient questionnaire.Results. Uncorrected and corrected distance visual acuity improved significantly in both groups. Refraction, topography, and aberrometry showed nonsignificant changes from the preoperative status throughout the 12-month follow-up in both groups. Moreover, the outcomes between the groups were comparable at all follow-up points. Endothelial cell-count was stable. Postoperative pain length was shorter in group 1P<0.001.Conclusion. “Epithelium-on” and “epithelium-off” CXL using hypotonic 0.5% riboflavin were equally safe and effective in stabilization of keratoconus. Topography and aberrometry outcomes in both groups failed to show any significant improvements. This study is registered at ClinicalTrials.gov:NCT01181219.

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.

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.

Corneal collagen cross-linking for management of keratoconus in patients affected by Tourette syndrome

2020 ◽  
pp. 112067212094510
Author(s):  
Karl Anders Knutsson ◽  
Giorgio Paganoni ◽  
Oriella Ambrosio ◽  
Giulio Ferrari ◽  
Paolo Rama
Keyword(s):  
Visual Acuity ◽  
Tourette Syndrome ◽  
Case Series ◽  
Young Male ◽  
Cross Linking ◽  
Male Patients ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose: To present a series of two patients affected by Tourette syndrome (TS) and progressive keratoconus. Case series: Two young male patients with keratoconus and TS were referred to our center. In both patients eye rubbing was present and in one patient, an ocular tic was present determining blepharospasm. Progression of keratoconus occurred in both cases and corneal collagen cross-linking (CXL) was performed. All treated eyes showed topographic stability with stable refraction and conserved visual acuity, with a follow-up period ranging from 1.5 to 2.5 years. Conclusion: Patients with keratoconus and TS should be observed frequently to document topographical and refractive changes, and in case of progressing disease, CXL should be performed in order to prevent further progression.

Corneal collagen cross-linking with and without simultaneous intrastromal corneal ring segment implantation: One-year pilot study

2019 ◽  
pp. 112067211988787 ◽  
Author(s):  
Indra Prasad Sharma ◽  
Ramendra Bakshi ◽  
Monica Chaudhry
Keyword(s):  
Visual Acuity ◽  
Confidence Interval ◽  
Randomized Study ◽  
Cross Linking ◽  
Intrastromal Corneal Ring ◽  
Ring Segment ◽  
One Year ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Aim: The aim of this study was to assess and compare the visual, refractive, and topographic outcomes of keratoconic eyes treated with corneal collagen cross-linking combined with and without same day intrastromal corneal ring segment over the first 12 months. Methods: This prospective randomized study analyzed 38 eyes of 30 consecutive keratoconus patients aged 26.21 ± 6.97 (range = 15–41) years. A total of 20 eyes were treated with collagen cross-linking alone, and 18 eyes underwent collagen cross-linking combined with simultaneous femtosecond laser-assisted intrastromal corneal ring segment. Visual acuity, manifest refraction, and corneal topography (using a rotating Scheimpflug topographer) were assessed and compared between the two groups at baseline, 6, and 12 months. Results: On an average follow-up duration of 12.2 ± 0.50 (range = 11–13) months, both collagen cross-linking alone and collagen cross-linking with simultaneous intrastromal corneal ring segment implantation were effective. However, collagen cross-linking plus intrastromal corneal ring segment resulted in an additional improvement of uncorrected distance visual acuity of 0.16 (95% confidence interval = 0.01 to 0.32) logarithm of the minimum angle of resolution units (p = 0.035), cylindrical power by 1.16 D (95% confidence interval = 0.25 to 2.06, p = 0.014), and spherical equivalent by 1.40 D (95% confidence interval = −2.71 to −0.08, p = 0.038) at 1 year. During the study period, no serious intraoperative or postoperative complications were noted in either group. Conclusion: One-year follow-up results suggest that collagen cross-linking with simultaneously combined intrastromal corneal ring segment implantation could yield an additive visual and refractive outcome. The combined procedure is safe and merits consideration for the treatment of progressive keratoconus to achieve better visual rehabilitation.

scholarly journals Corneal Collagen Cross-Linking in Pellucid Marginal Degeneration: 2 Patients, 4 Eyes

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Serife Bayraktar ◽  
Zafer Cebeci ◽  
Merih Oray ◽  
Nilufer Alparslan
Keyword(s):  
Visual Acuity ◽  
Long Term Results ◽  
Cross Linking ◽  
Specular Microscopy ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Ring Segment ◽  
The Right ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose. To report the long-term results of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A irradiation in 4 eyes of 2 patients affected by pellucid marginal degeneration (PMD).Methods. This study involved the retrospective analysis of 4 eyes of 2 patients with PMD that underwent CXL treatment. Of the eyes, three had only CXL treatment and one had CXL treatment after an intrastromal corneal ring segment implantation. We have pre- and postoperatively evaluated uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCDVA), corneal topography (Pentacam), specular microscopy, and pachymetry.Results. Patient 1 was a woman, aged 35, and Patient 2 was a man, aged 33. The right eye of Patient 1 showed an improvement in her BCDVA, from 16/40 to 18/20 in 15 months, and her left eye improved from 12/20 to 18/20 in 20 months. Patient 2’s right eye showed an improvement in his BCDVA, from 18/20 to 20/20 in 43 months, and his left eye improved from 16/20 to 18/20 in 22 months. No complications were recorded during or after the treatment.Conclusion. CXL is a safe tool for the management of PMD, and it can help to stop the progression of this disease.

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 Accelerated corneal collagen cross-linking in clinical management of infectious keratitis

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092641
Author(s):  
Miao Li ◽  
Tao Yu ◽  
Xin Gao ◽  
Xin-Yi Wu
Keyword(s):  
Visual Acuity ◽  
Clinical Efficacy ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Cross Linking ◽  
Infectious Keratitis ◽  
Biomechanical Parameters ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Objective To evaluate the clinical efficacy of corneal collagen cross-linking (CXL) in the treatment of infectious corneal diseases. Methods This study retrospectively analyzed the clinical efficacy of CXL in 65 eyes with infectious keratitis in Jinan Second People’s Hospital from December 2016 to June 2018. During 6 months of follow-up after CXL treatment, the results of confocal microscopy and anterior segment optical coherence tomography, as well as visual acuity and corneal biomechanical parameters, were recorded in detail. Results In general, the overall cure rate was 93.85%; no corneal endothelial dysfunction was encountered in any patients. After 6 months of follow-up, the visual acuity of cured patients was significantly enhanced, while corneal thickness was significantly reduced. Hyphae growth of patients with fungal keratitis was completely inhibited at 1 month postoperatively. Furthermore, corneal biomechanical parameters (i.e., central corneal thickness, deformation amplitude, and pachymetry intraocular pressure) were significantly improved after surgery, compared with baseline measurements. Conclusion Accelerated CXL may be an effective adjuvant treatment for infectious keratitis.

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