Combined Protocols for Corneal Collagen Cross-Linking with Photorefractive Surgery for Refractive Management of Keratoconus: Update on Techniques and Review of Literature

Zhu, Angela Y.; Jun, Albert S.; Soiberman, Uri

doi:10.1007/s40123-019-00210-3

Cited by 34 publications

(24 citation statements)

References 89 publications

(86 reference statements)

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“…Zeraid et al have published simultaneous employment of collagen cross-linking along with intracorneal rings implantation 10. Whereas Zhu et al 11 in their recent review of literature have suggested that not enough large studies with extended follow-up have been conducted to fully determine the ideal technical protocol and long-term outcomes for combined ICRS with CXL. We do not follow simultaneous employment of collagen cross-linking along with intracorneal rings implantation due to lack of established evidence.…”

Section: Discussionmentioning

confidence: 99%

Novel technique of fixing intracorneal rings segments after migration

Agarwal

Subudhi

Mithal³

2020

BMJ Case Rep

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A 38-year-old patient with a history of non-progressive keratoconus in the left eye presented to us with an uncorrected visual acuity of 20/400, which improved to 20/60 with pinhole. We planned for intracorneal rings segment in the left eye. Postoperatively uncorrected visual acuity improved to 20/30. The patient presented 2 weeks later with severely decreased vision to 20/100 and migration of intracorneal rings were noted with both the rings riding side by side. The patient gave history of vigorous eye rubbing. The rings were repositioned with the help of Sinskey hooks and superior ring was anchored with 10-nylon suture passed through the ring hole to the corneal stroma. Two more sutures were placed radial to the circumference of inferior ring to prevent its migration. The sutures were removed after 1 month and the patient was followed up with stable position of the rings for the next 6 months . The uncorrected visual acuity improved to 20/40.

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Section: Discussionmentioning

confidence: 99%

Novel technique of fixing intracorneal rings segments after migration

Agarwal

Subudhi

Mithal³

2020

BMJ Case Rep

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“…[6] Evaluations of the difference of the outcomes between S-CXL and A-CXL and their impact on the anterior corneal flattening, hyperopic shift, astigmatism, and corneal thinning have gained a particular importance for the refractive surgeons in choosing the CXL protocol to combine with other refractive surgery procedure. [7][8][9] In this study, we aimed to compare the visual outcomes, topographic parameters, and corneal higher-order aberrations (HOAs) values (anterior and posterior) of an A-CXL 10 mW/cm 2 , 9 min and the standard CXL protocol using 3 mW/cm 2 , 30 min.…”

Section: Introductionmentioning

confidence: 99%

Accelerated versus Standard Corneal Cross-linking for Progressive Keratoconus in Syria

Salman

Darwish

Haddad

et al. 2021

JOVR

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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/cm2, 9 min) and 36 eyes in group two were treated with the standard method (3 mW/cm2, 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/cm2 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.

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“…However, for patients with significant loss of CDVA due to corneal ectasia, an evolving area of research involves combining CXL with an adjunctive refractive procedure to improve CDVA as well as stabilize the ectatic cornea. 5 CXL is generally very effective at stopping progressive ectatic vision loss. Small improvements in mean vision upon treatment have been seen in epi-off CXL 6 and in an epi-on procedure.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Conductive Keratoplasty Combined with Corneal Crosslinking in Advanced Ectatic Corneal Disease

Sinjab¹,

Rubinfeld²,

Wagner³

et al. 2021

OPTH

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Purpose: To assess the effectiveness of a novel treatment for patients with advanced corneal ectasia and loss of visual acuity (VA). Conductive keratoplasty (CK) is performed to improve VA followed by epithelium-on (epi-on) corneal crosslinking (CXL) to stabilize the cornea after CK. Methods: Retrospective, exploratory cohort study. Patients with keratoconus or postsurgical ectasia and best spectacle-corrected distance VA (CDVA) ≤ 20/40 were included. Conductive keratoplasty was performed (ViewPoint CK System, Refractec, Inc., Bloomington, MN); followed a day later by epi-on CXL (CXLUSA/CXLO, Bethesda, MD/CXLO Encinitas, CA). Measures included uncorrected distance visual acuity (UDVA) and CDVA, as well as refractive and tomographic measures and tomographic indices. Results: Data from 50 eyes of 45 patients were analyzed. Mean follow-up was 15.1 ± 12.2 months (range: 2 to 51). Overall, UDVA and CDVA improved postoperatively. Subjective refraction and tomographic metrics did not show consistent changes, but changes in tomographic indices were associated with treatment follow-up time. At the 1-year visit, mean UDVA significantly improved over baseline (P = 0.009) by approximately 3 lines; mean CDVA improved significantly (P = 10 −5 ) by approximately 2 lines. No eye lost lines of CDVA. Change in the Index of Surface Variance (ISV) was associated with treatment, and the D-Index trended over follow-up time. Conclusion:Conductive keratoplasty with a proprietary epi-on CXL treatment improved vision in patients with advanced ectasia This CK/epi-on CXL treatment offers the possibility of improved VA for patients with compromised vision due to ectasia.

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Combined Protocols for Corneal Collagen Cross-Linking with Photorefractive Surgery for Refractive Management of Keratoconus: Update on Techniques and Review of Literature

Cited by 34 publications

References 89 publications

Novel technique of fixing intracorneal rings segments after migration

Novel technique of fixing intracorneal rings segments after migration

Accelerated versus Standard Corneal Cross-linking for Progressive Keratoconus in Syria

Outcomes of Conductive Keratoplasty Combined with Corneal Crosslinking in Advanced Ectatic Corneal Disease

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