scholarly journals Clinical Outcomes of Accelerated Corneal Cross-Linking for Pediatric Keratoconus

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Abdelrahman Salman ◽  
Taym Darwish ◽  
Marwan Ghabra ◽  
Obeda Kailani ◽  
Hussam Khalil ◽  
...  

Aim. To assess the efficacy and safety of accelerated corneal cross-linking in the treatment of pediatric keratoconus. Method. In this retrospective case series, 29 eyes of 20 pediatric patients with keratoconus underwent accelerated corneal cross-linking. Treatment was delivered at 10 mW/cm2 for 9 minutes with a total dose of 5.4 J/cm2. Clinical evaluation included visual acuities and refractive and Scheimpflug corneal tomography assessments. All patients with a minimum follow-up duration of 24 months were included in the study. Results. Mean ± standard deviation age was 15.41 ± 2.13 years (range: 8 to 18 years). Uncorrected distance visual acuity improved significantly from 0.56 ± 0.28 to 0.42 ± 0.29 logMAR P = 0.0003 , and corrected distance visual acuity improved significantly from 0.34 ± 0.23 to 0.28 ± 0.22 logMAR P = 0.014 . The mean manifest refraction spherical equivalent value was significantly reduced (−0.59 ± 0.95 D, P = 0.0024 ). While mean flat keratometry and steep keratometry values were not significantly altered ( P > 0.05 for both), the mean maximum keratometry value was significantly decreased from 56.97 ± 5.24 D preoperatively to 55.84 ± 5.37 D at 24 months postoperatively P = 0.003 . Maximum keratometry had progressed by >1 D in two eyes (6.89%). Permanent corneal haze was reported in one case (3.44%). Conclusion. Our 24-month follow-up demonstrated that accelerated corneal cross-linking appears to halt the progression of keratoconus in pediatric patients without apparent complications. Uncorrected and corrected distance visual acuities were also improved.

2021 ◽  
pp. 112067212110206
Author(s):  
Iliya Simantov ◽  
Lior Or ◽  
Inbal Gazit ◽  
Biana Dubinsky-Pertzov ◽  
David Zadok ◽  
...  

Background: Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes. Methods: Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography. Results: Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years; p = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years; p = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D); p < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm ( p = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D ( p = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL. Conclusion: CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.


2018 ◽  
Vol 30 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Guilherme Andrade do Nascimento Rocha ◽  
Paulo Ferrara de Almeida Cunha ◽  
Leonardo Torquetti Costa ◽  
Luciene Barbosa de Sousa

Importance: This study shows that a newer long-arc length intrastromal corneal ring segment is efficient and safe for keratoconus treatment. Background: To evaluate visual, tomographic results and complications of a 320-degree intrastromal corneal ring segment implantation with the femtosecond laser for keratoconus treatment. Design: A prospective, nonrandomized, and interventional study. Participants: A total of 34 eyes of 31 patients diagnosed with keratoconus were enrolled. Methods: Patients were divided into two groups based on the strategy used for 320-degree intrastromal corneal ring segment thickness selection. In one group, this selection was based on spherical equivalent (SE group) and in the other on the mean asphericity (Q group). The uncorrected and corrected distance visual acuities, spherical equivalent, K1, K2, Km, Kmax, and mean asphericity ( Q) on corneal tomography were evaluated preoperatively and at 3 and 6 months postoperatively. For astigmatism improvement, we analyzed the corneal tomographic vectorial astigmatism change preoperatively and at 6 months postoperatively. The mean follow-up period was 6.63 ± 0.96 months. Results: The mean uncorrected distance visual acuity and corrected distance visual acuity improved with a significant spherical equivalent improvement ( p < 0.05), with no differences between the 320-degree intrastromal corneal ring segment groups. All corneal tomographic parameters improved significantly ( p < 0.05) between the preoperative and postoperative intervals, with a significant better performance when we used spherical equivalent for the 320-degree intrastromal corneal ring segment thickness selection. Finally, the mean vectorial corneal tomographic astigmatism significantly improved after 6 months, again with no differences between groups. Conclusion: This study suggests that implanting a 320-degree intrastromal corneal ring segment is a safe and effective procedure for treating patients with keratoconus. It also suggests that for thickness selection spherical equivalent is the better strategy.


2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ercüment Bozkurt ◽  
Engin Bilge Ozgurhan ◽  
Betul Ilkay Sezgin Akcay ◽  
Tugba Kurt ◽  
Yusuf Yildirim ◽  
...  

Purpose. To report the visual, refractive, and corneal topography and wavefront aberration results of accelerated corneal cross-linking (CXL) during a 24-month follow-up.Methods. Forty-seven eyes underwent riboflavin-ultraviolet A-induced accelerated CXL treatment (30 mW/cm2with a total dose of 7.2 joules/cm2). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical values, keratometry (K) measurements (Ksteep,Kflat,Kavg, andKapex), central corneal thickness, and anterior corneal aberrometric analyses including total wavefront error (WFE), total high order aberration (HOA), astigmatism, trefoil, coma, quadrafoil, secondary astigmatism, and spherical aberration were evaluated.Results. The mean UDVA and CDVA were significantly improved at 1 (p=0.003andp=0.004, resp.) and 2 years after treatment (p=0.001andp=0.001, resp.). The meanKsteep,Kflat,Kaverage, andKapexvalues were significantly lower than baseline at 12 months (p=0.008,p=0.024,p=0.001, andp=0.014, resp.) and 24 months (p=0.014,p=0.017,p=0.001, andp=0.012, resp.). Corneal thickness showed a significant decrease at 1 month. Total HOA and coma decreased significantly at the 12-month (p=0.001andp=0.009, resp.) and 24-month visits (p=0.001andp=0.007, resp.).Conclusion. Accelerated CXL (30 mW/cm2) was found to be effective in improving UDVA, CDVA, corneal topography readings, total HOA, and coma aberrations during the 24-month follow-up.


2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Rafic Antonios ◽  
Ali Dirani ◽  
Ali Fadlallah ◽  
Elias Chelala ◽  
Adib Hamade ◽  
...  

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.


1970 ◽  
Vol 6 (4) ◽  
pp. 466-471 ◽  
Author(s):  
R Thapa ◽  
MK Shrestha ◽  
R Gurung ◽  
S Ruit ◽  
G Paudyal

Background: Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment. Aim: This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility. Study design: This was a retrospective- prospective, interventional case series. Materials and methods: All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study. Results: A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of < 6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexafluoride and Perfluoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure. Conclusion: The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon's time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce. Key words: Rhegmatogenous retinal detachment, retinal break, pneumatic retinopexy, Nepal   doi: 10.3126/kumj.v6i4.1737   Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 466-471  


2021 ◽  
Vol 25 (6) ◽  
pp. 1-68
Author(s):  
Alexander C Day ◽  
Jennifer M Burr ◽  
Kate Bennett ◽  
Rachael Hunter ◽  
Catey Bunce ◽  
...  

Background Cataract surgery is one of the most common operations. Femtosecond laser-assisted cataract surgery (FLACS) is a technique that automates a number of operative steps. Objectives To compare FLACS with phacoemulsification cataract surgery (PCS). Design Multicentre, outcome-masked, randomised controlled non-inferiority trial. Setting Three collaborating NHS hospitals. Participants A total of 785 patients with age-related cataract in one or both eyes were randomised between May 2015 and September 2017. Intervention FLACS (n = 392 participants) or PCS (n = 393 participants). Main outcome measures The primary outcome was uncorrected distance visual acuity in the study eye after 3 months, expressed as the logarithm of the minimum angle of resolution (logMAR): 0.00 logMAR (or 6/6 if expressed in Snellen) is normal (good visual acuity). Secondary outcomes included corrected distance visual acuity, refractive outcomes (within 0.5 dioptre and 1.0 dioptre of target), safety and patient-reported outcome measures at 3 and 12 months, and resource use. All trial follow-ups were performed by optometrists who were masked to the trial intervention. Results A total of 353 (90%) participants allocated to the FLACS arm and 317 (81%) participants allocated to the PCS arm attended follow-up at 3 months. The mean uncorrected distance visual acuity was similar in both treatment arms [0.13 logMAR, standard deviation 0.23 logMAR, for FLACS, vs. 0.14 logMAR, standard deviation 0.27 logMAR, for PCS, with a difference of –0.01 logMAR (95% confidence interval –0.05 to 0.03 logMAR; p = 0.63)]. The mean corrected distance visual acuity values were again similar in both treatment arms (–0.01 logMAR, standard deviation 0.19 logMAR FLACS vs. 0.01 logMAR, standard deviation 0.21 logMAR PCS; p = 0.34). There were two posterior capsule tears in the PCS arm. There were no significant differences between the treatment arms for any secondary outcome at 3 months. At 12 months, the mean uncorrected distance visual acuity was 0.14 logMAR (standard deviation 0.22 logMAR) for FLACS and 0.17 logMAR (standard deviation 0.25 logMAR) for PCS, with a difference between the treatment arms of –0.03 logMAR (95% confidence interval –0.06 to 0.01 logMAR; p = 0.17). The mean corrected distance visual acuity was 0.003 logMAR (standard deviation 0.18 logMAR) for FLACS and 0.03 logMAR (standard deviation 0.23 logMAR) for PCS, with a difference of –0.03 logMAR (95% confidence interval –0.06 to 0.01 logMAR; p = 0.11). There were no significant differences between the arms for any other outcomes, with the exception of the mean binocular corrected distance visual acuity with a difference of –0.02 logMAR (95% confidence interval –0.05 to 0.00 logMAR) (p = 0.036), which favoured FLACS. There were no significant differences between the arms for any health, social care or societal costs. For the economic evaluation, the mean cost difference was £167.62 per patient higher for FLACS (95% of iterations between –£14.12 and £341.67) than for PCS. The mean QALY difference (FLACS minus PCS) was 0.001 (95% of iterations between –0.011 and 0.015), which equates to an incremental cost-effectiveness ratio (cost difference divided by QALY difference) of £167,620. Limitations Although the measurement of outcomes was carried out by optometrists who were masked to the treatment arm, the participants were not masked. Conclusions The evidence suggests that FLACS is not inferior to PCS in terms of vision after 3 months’ follow-up, and there were no significant differences in patient-reported health and safety outcomes after 12 months’ follow-up. In addition, the statistically significant difference in binocular corrected distance visual acuity was not clinically significant. FLACS is not cost-effective. Future work To explore the possible differences in vision in patients without ocular co-pathology. Trial registration Current Controlled Trials ISRCTN77602616. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 6. See the NIHR Journals Library website for further project information. Moorfields Eye Charity (grant references GR000233 and GR000449 for the endothelial cell counter and femtosecond laser used).


2016 ◽  
Vol 8 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Lalit Agarwal ◽  
Nisha Agarwal ◽  
Rajya Laxmi Gurung ◽  
Rahul Chaubey ◽  
Bhaskar Kumar Jha ◽  
...  

Introduction: In the absence of capsular support, anterior chamber intraocular lens (IOL), iris fixated IOL and sutured scleral fixated intraocular lens (SFIOL) implantation have been performed for many years. Recently sutureless glued SFIOL have been used as a primary or secondary procedure to correct aphakia. In this study we have used sutureless and glueless technique of SFIOL implantation. Methodology: An interventional case series was conducted. Aphakic patients without capsular support, sub-luxated lens (>180°), dislocated lens and dislocated IOL were the inclusion criteria. The patients with hazy cornea, non-dilating pupil, macular scar and glaucoma were not enrolled in the study. Results: Of 62 eyes who completed 1 month follow- up, 48 were men and 14 women. There was a significant improvement in uncorrected distance visual acuity after surgery (p<0.001). One month postoperative best corrected distance visual acuity was 6/18 or better in 45 eyes (72.6%). The common early postoperative complications were hypotony, corneal edema. No serious complications such as endophthalmitis and retinal detachment were seen. Conclusion: Our technique of sutureless and glueless SFIOL implantation showed good visual outcome in the absence of serious complications. SFIOL will be the only choice in eyes that have anatomic contraindications like non constricting pupil, large sectoral iridectomy and peripheral anterior synechia in which other types of lens are not suitable.Nepal J Ophthalmol 2016; 8(15): 41-46 


Author(s):  
Guillermo Rocha ◽  
Victor Penner ◽  
Kylee Lewis

ABSTRACT Purpose To demonstrate clinical outcomes of epithelium-off corneal cross-linking (CXL) in combination with wavefront-guided photorefractive keratectomy (PRK) for the treatment of keratoconuns. Materials and methods Total, 28 keratoconic eyes of 21 patients were included. The Sirius Wavefront Analyzer (SCHWIND eye-tech-solutions GmbH and Co. KG) was used to evaluate the high-order aberrations (HOAs). The coupled Amaris 750S excimer laser then performed a PRK of no more than 40 μm using the measured HOA. The CXL was then carried out respecting the standard of 400 μm of corneal thickness. Results The average age was 32 (15—48) years. Uncorrected distance visual acuity (UDVA) improved from 0.58 to 0.31 logMAR (p < 0.001), with best corrected distance visual acuity (CDVA) improving from 0.03 to 0.02 logMAR (p = 0.7). On manifest refraction, the average spherical component decreased from –1.87 to –1.40 D (0.47 ± 2.12, p = 0.4). Cylinder decreased from 2.18 to 0.87 D (1.31 ± 1.14 D, p < 0.001). All HOAs decreased: total HO 0.94 to 0.58 (0.36 ± 0.42, p = 0.05); spherical aberration: 0.142 to –0.018 (0.160 ± 0.160, p < 0.001); secondary astigmatism: 0.21 to 0.11 (0.10 ± 0.11, p = 0.02); coma: 0.80 to 0.42 (0.38 ± 0.47, p = 0.03); trefoil: 0.33 to 0.29 (0.04 ± 0.17, p = 0.7). Conclusion Utilizing HOA to guide the laser treatment in combination with CXL resulted in a significant decrease of HOA at 6 months postprocedure. This is a small case series, but demonstrates a promising trend of improved HOA. Considering that keratoconic eyes have very irregular surfaces with significant HOA, reducing these aberrations should improve best corrected quality of vision. Having longer follow-up and greater numbers may demonstrate a clearer improvement. How to cite this article Penner V, Lewis K, Rocha G. Reduced High-order Aberrations using Wavefront-guided Partial Photorefractive Keratectomy and Accelerated Epithelium-off Corneal Cross-linking for Keratoconus. Int J Kerat Ect Cor Dis 2017;6(2):73-77.


2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Sherif A. Eissa ◽  
Nashwa Badr Eldin ◽  
Ashraf Ahmed Nossair ◽  
Wael Ahmed Ewais

Purpose. To evaluate corneal transparency following accelerated collagen cross-linking (ACXL) in pediatric keratoconus.Design. A prospective interventional case series.Methods. This study included 47 eyes (25 patients), aged 9–14 years, with documented progressive keratoconus. After applying 0.1% riboflavin drops, ACXL was performed. Assessment included corrected distance visual acuity (CDVA), uncorrected visual acuity (UCVA), corneal haze, and corneal densitometry in grayscale units (GSU).Result. The mean baseline and corneal densitometry peaked at 3 months post-ACXL while central and posterior densitometry showed a statistically significant increase (P<0.05) and peaked at 8 months postoperatively. By 12 months, densitometry in all corneal layers (P≥0.99) and concentric zones (P≥0.97) reached near baseline values. Slit-lamp graded haze peaked at 1 month to 1.82 ± 0.65 (P<0.05) and declined to near baseline at 12 months (0.39 ± 0.58). There was a statistically significant increase in the mean UCVA and CDVA at 12 months.Conclusion. Total and anterior corneal densitometry peaked after 3 months, while central and posterior densitometry peaked after 8 months. Maximum haze was at 1 month post-ACXL. All corneal layers, concentric zone densitometry and haze reached near baseline values after 1 year. Scheimpflug densitometry showed weak correlation with CDVA over the 12-month follow-up period (r=−0.193).


Sign in / Sign up

Export Citation Format

Share Document