Accelerated Epi-On Versus Standard Epi-Off Corneal Collagen Cross-Linking for Progressive Keratoconus in Pediatric Patients: Five Years of Follow-Up

Henríquez, María A; Hernandez-Sahagun, Gustavo; Camargo, Jorge; Izquierdo, Luis

doi:10.1097/ico.0000000000002463

Cited by 20 publications

(32 citation statements)

References 21 publications

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“…Buzzonetti, in a study of the efficacy of TCXL in pediatric KC, with an average age group of 14.4 years (± 3.7 years), with an 18-month follow-up, observed worsening of K max, concluding that this method does not effectively reduce the progression of KC compared to SCXL [ 79 ]. In a comparative study, Henriquez et al showed that although both procedures halted the progression of KC at 5 years of follow-up, SCXL was able to halt it at a significantly higher level and with a higher flattening effect than TCXL [ 84 ]. Compared with SCXL, I-CXL could stop KC progression as much as 12 months, as disease progression was found in 50% of cases at a 24-month follow-up [ 40 ].…”

Section: Resultsmentioning

confidence: 99%

Pediatric Crosslinking: Current Protocols and Approach

et al. 2022

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Keratoconus (KC) is likely to be more aggressive in the pediatric population, with a higher risk of progression and visual loss. Several techniques have been proposed for corneal crosslinking (CXL) so far. The standard CXL (SCXL) technique, or the Dresden Protocol, originally developed by Wollensak et al., has been shown to be safe and effective in the pediatric KC group. With similar efficacy to the conventional method, the accelerated CXL (ACXL) protocols proposed a reduced UVA exposure time by increasing the intensity of UVA irradiation. Transepithelial CXL (TCXL), considered an “epithelium-on” method, emerged as a strategy to improve safety and reduce postoperative complications and discomfort. For thinner corneas, we can highlight the use of hypoosmolar riboflavin and new studies, such as contact lens-assisted CXL (CACXL), the epithelial-island CXL (EI-CXL), and the Sub400 protocol. In addition to the different protocols used, another factor that changes CXL results is the type of carrier used: dextran-based or hydroxypropyl methylcellulose-based (HPMC) riboflavin solutions. There are several ways to perform a CXL surgery, and it is still unclear which method is the safest and most effective in the pediatric group. This review of the literature in English, available in PubMed, provides an update on corneal CXL in the pediatric KC group, exploring the data on the techniques currently used and under investigation, including their advantages, efficacy, safety profiles, risks, and cost analyses.

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Section: Resultsmentioning

confidence: 99%

Pediatric Crosslinking: Current Protocols and Approach

et al. 2022

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“… 2019 ; Henriquez et al. 2020 ). Several studies show outcomes after epi‐on treatment similar to the standard CXL procedures (Magli et al.…”

Section: Discussionmentioning

confidence: 99%

“…Keeping the epithelium intact during CXL could reduce pain and complications, such as delayed reepithelialization, haze formation and microbial keratitis. It is, therefore, that many studies have focused on delivering RF to the corneal stroma without the removal of the epithelium, known as 'epi-on' CXL, by addition of penetration enhancers, alteration of the riboflavin formulation or by the use of iontophoresis(Beckman et al 2019;Henriquez et al 2020). Several studies show outcomes after epi-on treatment similar to the standard CXL procedures(Magli et al 2013;Stojanovic, Zhou & Utheim 2014;Nawaz et al 2015;Rossi et al 2015;Stulting et al 2018).…”

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confidence: 99%

Excimer laser‐assisted corneal epithelial pattern ablation for corneal cross‐linking

Brekelmans

Dickman

Verma

et al. 2021

Acta Ophthalmologica

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Purpose To determine corneal cross‐linking (CXL) efficacy and chromophore penetration after excimer laser‐assisted patterned de‐epithelialization. Methods Two‐hundred‐twenty porcine eyes were de‐epithelialized ex vivo, either fully (mechanical; n = 88) or patterned (excimer laser; n = 132). Consecutively, corneas were impregnated with hypo‐ or hyperosmolar riboflavin (RF; n = 20, RF‐D; n = 40, respectively) or water‐soluble taurine (WST11; n = 40, and WST‐D; n = 40, respectively), or kept unimpregnated (n = 80). Sixty corneas were subsequently irradiated, inducing CXL, with paired contralateral eyes serving as controls. Outcome measurements included strip extensiometry to assess CXL efficacy, and spectrophotometry and fluorescence microscopy to determine stromal chromophore penetration. Results All tested chromophores induced significant CXL (p < 0.001), ranging from 7.6% to 14.6%, with similar stiffening for all formulations (p = 0.60) and both de‐epithelialization methods (p = 0.56). Light transmittance was significantly lower (p < 0.001) after full compared with patterned de‐epithelialization. Stromal chromophore penetration was comparable between fully and patterned de‐epithelialized samples, with full penetration in RD and RF‐D samples and penetration depths measuring 591.7 ± 42.8 µm and 592.9 ± 63.5 µm for WST11 (p = 0.963) and 504.2 ± 43.2 µm and 488.8 ± 93.1 µm for WST‐D (p = 0.669), respectively. Conclusions Excimer laser‐assisted patterned de‐epithelialization allows for effective CXL. Stromal chromophore concentration is, however, reduced, which may have safety implications given the need for sufficient UVA attenuation in RF/UVA CXL. The different safety profile of near‐infrared (NIR) may allow safe WST11/NIR CXL even with reduced stromal chromophore concentration values. In vivo studies are needed to evaluate the benefits and further assess safety of excimer laser‐assisted patterned de‐epithelialization for corneal CXL.

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“…As such, it is more accepted and preferred all over the world as being a safer and more effective method in the long term. 93 , 94 …”

Section: Advances In Treatmentmentioning

confidence: 99%

“…As such, it is more accepted and preferred all over the world as being a safer and more effective method in the long term. 93,94 New keratoplasty procedures The last two decades have seen a paradigm shift in keratoplasty moving from the insertion of fullthickness grafts to lamellar grafts. A lamellar approach not only decreases the likelihood of immune rejection but also offers less-induced astigmatism and better visual outcomes particularly in the case of endothelial transplants.…”

Section: Advances In Treatmentmentioning

confidence: 99%

Advances in the diagnosis and treatment of keratoconus

2021

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Keratoconus had traditionally been considered a rare disease at a time when the imaging technology was inept in detecting subtle manifestations, resulting in more severe disease at presentation. The increased demand for refractive surgery in recent years also made it essential to more effectively detect keratoconus before attempting any ablative procedure. Consequently, the armamentarium of tools that can be used to diagnose and treat keratoconus has significantly expanded. The advances in imaging technology have allowed clinicians and researchers alike to visualize the cornea layer by layer looking for any early changes that might be indicative of keratoconus. In addition to the conventional geometrical evaluation, efforts are also underway to enable spatially resolved corneal biomechanical evaluation. Artificial intelligence has been exploited in a multitude of ways to enhance diagnostic efficiency and to guide treatment. As for treatment, corneal cross-linking treatment remains the mainstay preventive approach, yet the current main focus of research is on increasing oxygen availability and developing new strategies to improve riboflavin permeability during the procedure. Some new combined protocols are being proposed to simultaneously halt keratoconus progression and correct refractive error. Bowman layer transplantation and additive keratoplasty are newly emerging alternatives to conventional keratoplasty techniques that are used in keratoconus surgery. Advances in tissue engineering and regenerative therapy might bring new perspectives for treatment at the cellular level and hence obviate the need for invasive surgeries. In this review, we describe the advances in the diagnosis and treatment of keratoconus primarily focusing on newly emerging approaches and strategies.

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Accelerated Epi-On Versus Standard Epi-Off Corneal Collagen Cross-Linking for Progressive Keratoconus in Pediatric Patients: Five Years of Follow-Up

Cited by 20 publications

References 21 publications

Pediatric Crosslinking: Current Protocols and Approach

Pediatric Crosslinking: Current Protocols and Approach

Excimer laser‐assisted corneal epithelial pattern ablation for corneal cross‐linking

Advances in the diagnosis and treatment of keratoconus

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