Corneal collagen cross‐linking following superficial keratectomy as treatment for corneal endothelial cell dystrophy in dogs: Preliminary clinical study

Kim, Jury; Ji, Dong-Beom; Takiyama, Naoaki; Bae, Jaehyun; Kim, Min Su

doi:10.1111/vop.12611

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…The investigation of veterinary patients with spontaneous corneal endothelial dysfunction may improve the predictive value of interventions for treating human patients and has the value added attribute of improving vision care for veterinary patients in need. Superficial keratectomy with conjunctival advancement hood flap (SKCAHF), thermokeratoplasty, and corneal collagen crosslinking procedures have been adapted by veterinary ophthalmologists from their physician-based colleagues as symptomatic therapy in client-owned dogs suffering from severe bullous keratopathy (138)(139)(140). EK is now being performed in dogs with endothelial dysfunction to improve visual function (141,142).…”

Section: Spontaneous Corneal Endothelial Dysfunction In Animalsmentioning

confidence: 99%

Animal models of corneal endothelial dysfunction to facilitate development of novel therapies

et al. 2021

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Progressive corneal endothelial disease eventually leads to corneal edema and vision loss due to the limited regenerative capacity of the corneal endothelium in vivo and is a major indication for corneal transplantation. Despite the relatively high success rate of corneal transplantation, there remains a pressing global clinical need to identify improved therapeutic strategies to address this debilitating condition. To evaluate the safety and efficacy of novel therapeutics, there is a growing demand for pre-clinical animal models of corneal endothelial dysfunction. In this review, experimentally induced, spontaneously occurring and genetically modified animal models of corneal endothelial dysfunction are described to assist researchers in making informed decisions regarding the selection of the most appropriate animal models to meet their research goals.

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Section: Spontaneous Corneal Endothelial Dysfunction In Animalsmentioning

confidence: 99%

Animal models of corneal endothelial dysfunction to facilitate development of novel therapies

et al. 2021

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“…Riboflavin delivery to the corneal stroma using iontophoresis and PCI was much quicker than with the Dresden protocol. 1,3,[7][8][9][10]13,14,20 In-vivo studies are needed to corroborate these findings and document any challenges of riboflavin administration in clinical patients. Rabbit samples were included in this study as a comparison to previous iontophoresis data collected in rabbits 21 and serve to validate our methodology.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the most common method of riboflavin administration for CXL involves use of riboflavin solution applied as eyedrops to the cornea every 2-5 minutes for at least 30 minutes after the corneal epithelium has been removed. 1,3,[7][8][9][10]13,14,20 This technique is commonly referred to as the Dresden Protocol. 5 The epithelium is removed because epithelium is a substantial barrier to stromal riboflavin penetration.…”

mentioning

confidence: 99%

“…21 This provides an efficient alternative to the Dresden protocol. 1,3,[7][8][9][10]13,14,20 However, there are significant interspecies differences in corneal epithelium and stromal thickness. [23][24][25] It is not clear whether iontophoresis could overcome the epithelial barrier in horses, or other species with thicker corneal epithelium, or reach the deeper corneal stroma in animals with a thicker cornea than rabbits.…”

mentioning

confidence: 99%

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Optimizing corneal riboflavin administration in ex vivo horse, dog, rabbit, and pig samples for use in corneal collagen cross‐linking

Zibura

Cullen

Rutledge

et al. 2020

Veterinary Ophthalmology

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Purpose Determine optimal iontophoresis times for riboflavin delivery to the corneal stroma across different species and compare these to corneal injection. Methods Ex vivo horse, dog, rabbit, and pig globes were treated with riboflavin administered with either iontophoresis for 2.5‐20 minutes with or without corneal epithelium; or with purpose‐designed precise corneal injection (PCI) application with intact epithelium. Immediately following riboflavin administration, samples were harvested, frozen, and sectioned. Riboflavin penetration was imaged using fluorescence microscopy. Results Horse samples processed with iontophoresis without epithelium for 2.5, 5, and 7.5 minutes, and processed with intact epithelium for 20 minutes, had mean percent stromal penetration (%SPmean) of 63.4%, 93.8%, 100.0%, and 0.0% (respectively). Dog samples processed with iontophoresis without epithelium for 2.5 and 5 minutes, had %SPmean of 60.7% and 82.1% (respectively). Pig samples processed with iontophoresis for 5 minutes without and with epithelium had %SPmean of 63.3% and 35.1% (respectively). Rabbit samples processed with iontophoresis without epithelium for 2.5 and 5 minutes, had %SPmean of 81.8% and 100.0% (respectively). For all injected volumes, riboflavin was observed spanning throughout the corneal stroma, and lamellar separation was noted surrounding all sites of injection. Conclusions Both iontophoresis and injection via PCI needles provide efficient and effective means of riboflavin administration in ex vivo horse, dog, rabbit, and pig corneas. Epithelial debridement is required for stromal delivery of riboflavin using iontophoresis in horses. Following epithelial removal, riboflavin penetrated through the horse corneal stroma faster than all other species tested.

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“…23 Collagen cross-linking combined with superficial keratectomy has also been evaluated, showing no added benefit of CXL to the SK procedure, resulting in comfortable eyes but poor results in terms of long-lasting improvement of corneal transparency. 24 Keratoleptynsis and partial coverage of the corneal surface with a thin fornix based conjunctival flap sutured over the cornea following lamellar keratectomy has also been described. This functions as a drainage sink for the edematous fluid in the stroma resulting in decrease of the corneal thickness.…”

Section: Introductionmentioning

confidence: 99%

A modified technique of keratoleptynsis (“letter‐box”) for treatment of canine corneal edema associated with endothelial dysfunction

Giannikaki¹,

Escanilla²,

Sturgess³

et al. 2020

Veterinary Ophthalmology

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To describe a modified keratoleptynsis procedure, as a method of preserving central corneal function, and evaluate the outcome in vision, reduction of corneal thickness and treatment of epithelial corneal ulcers in cases with endothelial cell dysfunction. Methods: Forty-four dogs (72 eyes) were affected by progressive corneal edema, with or without ulcerative keratitis. All patients were treated with a dorsal and ventral superficial keratectomy followed by conjunctival flaps, maintaining a clear central cornea. Corneal thickness measurements were obtained via ultrasound biomicroscopy. Results: All eyes showed resolution of ocular discomfort postoperatively, with a median time to resolution of 35 days. Two years post-surgery, vision had been lost in 2 of 29 eyes (7%). From the initial population, 23 dogs (39 eyes) had follow-up evaluations of corneal thickness. The mean central corneal thickness was 1359 ± 251 μm prior to surgery. Thickening of the central cornea was observed one week after surgery to 1559 ± 263 μm. Decreased corneal thickness was reported, at 1 month, 4 months, 10 months and 2 years postoperatively (1285 ± 267 μm, 1102 ± 150 μm, 1121 ± 288 μm, 1193 ± 283 μm, respectively). All eyes showed a similar trend of increasing and then decreasing corneal thickness. Conclusions: This surgical technique provided statistically significant reduction in central corneal thickness and sustained relief of ocular pain. Reduction in corneal thickness appeared to be maintained 2 years post-surgery, and all patients remained comfortable. Superficial corneal pigmentation and fibrosis resulted in vision loss in two eyes.

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Corneal collagen cross‐linking following superficial keratectomy as treatment for corneal endothelial cell dystrophy in dogs: Preliminary clinical study

Cited by 8 publications

References 27 publications

Animal models of corneal endothelial dysfunction to facilitate development of novel therapies

Animal models of corneal endothelial dysfunction to facilitate development of novel therapies

Optimizing corneal riboflavin administration in ex vivo horse, dog, rabbit, and pig samples for use in corneal collagen cross‐linking

A modified technique of keratoleptynsis (“letter‐box”) for treatment of canine corneal edema associated with endothelial dysfunction

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