Accelerated corneal cross-linking with hypo-osmolar riboflavin in thin keratoconic
            corneas: 2-year follow-up

Özek, Dilay; Karaca, Emine Esra; Kemer, Özlem Evren

doi:10.5935/0004-2749.20200049

Cited by 3 publications

(5 citation statements)

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“…Researchers have looked to design ways for thin corneas to safely undergo crosslinking. Hypo-osmolar 0.1% riboflavin solution has been used to successfully swell the stromal thickness to 400 μm prior to UV irradiation for both conventional and A-CXL [35,36 ▪ ]. These patients maintained corneal stability after treatment, comparable with CXL with standard riboflaxin [37 ▪ ].…”

Section: Thin Corneasmentioning

confidence: 99%

Update on corneal collagen crosslinking for ectasia

Pasha

Palazzolo²,

Prakash³

et al. 2021

Current Opinion in Ophthalmology

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Purpose of reviewCorneal collagen crosslinking (CXL) is a minimally invasive treatment that can stabilize corneal ectatic disorders including keratoconus, pellucid marginal degeneration, or postrefractive surgery ectasia. The benefits of CXL have been well documented. New research is focused on modifying current treatment protocols with the goals of maximizing corneal stability while also shortening overall procedure time. Recent findingsAccelerated CXL protocols have the goal of delivering the same ultraviolet A intensity as conventional protocols, but over a shorter time period. Accelerated protocols have shown success to date, but there are concerns for long-term corneal stability. Pulsed protocols may increase the long-term efficacy of the accelerated designs. In addition, transepithelial crosslinking protocols have been designed with the goal of reducing postoperative pain and lower the risk of infectious complications of epithelial-off conventional protocols. SummaryNewer CXL protocols attempt to make the procedure safer and more effective. Current research is promising, but long-term studies are essential to understand how the new protocols may affect corneal stability.

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Section: Thin Corneasmentioning

confidence: 99%

Update on corneal collagen crosslinking for ectasia

Pasha

Palazzolo²,

Prakash³

et al. 2021

Current Opinion in Ophthalmology

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“…Actualmente, la tendencia en el manejo del queratocono es detener su progresión lo más temprano posible para no tener que llegar a un trasplante de córnea. En los últimos años han surgido técnicas con esa finalidad, entre ellas el cross-linking, que con sus diferentes variantes [15][16][17] busca estabilizar el queratocono mediante la impregnación de riboflavina, seguida de la aplicación de radiación ultravioleta para que así el estroma de la córnea reaccione y genere puentes entrecruzados en las fibras de colágena de este [18][19][20][21] . En cuanto a la reducción del poder de las queratometrías, así como de la refracción, la técnica de cross-linking ha mostrado poco efecto 17 .…”

Section: Discussionunclassified

“…En los últimos años han surgido técnicas con esa finalidad, entre ellas el cross-linking, que con sus diferentes variantes [15][16][17] busca estabilizar el queratocono mediante la impregnación de riboflavina, seguida de la aplicación de radiación ultravioleta para que así el estroma de la córnea reaccione y genere puentes entrecruzados en las fibras de colágena de este [18][19][20][21] . En cuanto a la reducción del poder de las queratometrías, así como de la refracción, la técnica de cross-linking ha mostrado poco efecto 17 . Por otra parte, el uso de anillos intracorneales para el tratamiento del queratocono ha reportado tanto una estabilización en la progresión de la patología como una reducción amplia en el poder de las queratometrías, la refracción e incluso mejoría en la agudeza visual no corregida en el posoperatorio de estos pacientes [22][23][24] .…”

Section: Discussionunclassified

Resultados queratométricos y refractivos tempranos en pacientes con queratocono operados con anillos intracorneales

Ramírez¹,

Manzanillo²,

Estrada³

et al. 2022

CIRU

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Objetivo: Evaluar los resultados queratométricos y refractivos tempranos de pacientes con queratocono operados con anillos intracorneales. Método: Se evaluaron 50 ojos de 25 pacientes con queratocono de grado 2 o 3, posoperados con colocación de anillos intracorneales mediante el uso de láser de femtosegundos, al mes del posoperatorio, comparando las queratometrías y las refracciones antes y después de la operación. Resultados: El promedio preoperatorio de las queratometrías planas fue de 48.8 ± 3.65 D y en el posoperatorio fue de 46.44 ± 3.65 D (p < 0.005). El promedio preoperatorio de las queratometrías curvas fue de 53.92 ± 4.50 y en el posoperatorio fue de 49.65 ± 4.15 (p < 0.005). El equivalente esférico preoperatorio fue de −7.39 ± 2.42 D y en el posoperatorio fue de −3.48 ± 2.47 D (p < 0.005). El promedio del cilindro preoperatorio fue de −5.65 ± 2.02 D y en el posoperatorio fue de −3.48 ± 2.47 D (p < 0.005). Conclusiones: La colocación de anillos intracorneales reduce de forma significativa tanto las queratometrías como los equivalentes esféricos y el astigmatismo en pacientes con queratocono en forma temprana.

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“…4,5 Multiple recent studies have reported favorable outcomes following CXL in corneas with corneal thickness measurements <400 μm. [6][7][8] These 2 journals.sagepub.com/home/oed…”

Section: Introductionmentioning

confidence: 99%

“…Multiple recent studies have reported favorable outcomes following CXL in corneas with corneal thickness measurements <400 μm. 6–8 These studies suggest that the minimum corneal thickness recommendation may be too conservative. Recent work has led to groups proposing new minimal requirements including a paper by Hafenzi and colleagues suggesting a minimal corneal thickness of 330 µm, based on the lack of adverse outcomes in their subjects with thin corneas.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the safety and efficacy of epi-off corneal cross-linking in patients with thin corneas due to keratectasia

Nieuwsma,

Vander Zee,

Berdahl

et al. 2023

Ophthalmol Eye Dis

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Background: Corneal cross-linking (CXL) is a safe and effective procedure for slowing keratectasia progression in eyes with a corneal thickness of at least 400 µm. Limited research has evaluated the safety and efficacy of epi-off CXL in corneas thinner than 400 µm. Objective: To evaluate the safety and efficacy of CXL to slow keratectasia progression in eyes with <400 µm preoperative corneal thickness. Design: Retrospective chart review. Methods: This retrospective chart review included 37 eyes who underwent epi-off, iso-osmolar riboflavin corneal CXL with a preoperative thinnest point of the cornea <400 µm and had at least 6–12 months of follow-up. Preoperative and postoperative uncorrected visual acuity, best-corrected visual acuity (BCVA), thinnest point of the cornea, flat keratometry, steep keratometry, maximum keratometry (Kmax), need for penetrating keratoplasty, and cases of endothelial failure were recorded. Data were collected at baseline and months 3, 6, 9, and 12 post-CXL. Results: Following cross-linking, 18 eyes (47%) had improved BCVA, 13 (35%) had an unchanged BCVA, and 6 eyes (16%) had a worse BCVA ( p = 0.05). The mean postoperative BCVA was 20/81 (0.61 LogMAR) compared to 20/121 (0.78 LogMAR) preoperatively ( p = 0.06). Kmax decreased an average of 1.1 D at 3-month ( p = 0.53) and 3.4 D at the furthest follow-up ( p = 0.10). At the farthest follow-up, 22.7% of eyes had >1 D of Kmax steepening. No patients required keratoplasty and there were no cases of endothelial failure in the follow-up period. Conclusion: This research supports the safety and efficacy of epi-off, iso-osmolar CXL in eyes with <400 μm baseline corneal thickness with no patients requiring penetrating or endothelial keratoplasty, a trend toward improvement in BCVA, and Kmax flattening. In the future, prospective studies would be helpful to confirm these findings.

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Accelerated corneal cross-linking with hypo-osmolar riboflavin in thin keratoconic corneas: 2-year follow-up

Cited by 3 publications

References 0 publications

Update on corneal collagen crosslinking for ectasia

Update on corneal collagen crosslinking for ectasia

Resultados queratométricos y refractivos tempranos en pacientes con queratocono operados con anillos intracorneales

Evaluating the safety and efficacy of epi-off corneal cross-linking in patients with thin corneas due to keratectasia

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