Corneal Collagen Cross-linking

Xu, Kui; Chan, Tommy C Y; Vajpayee, Rasik B; Jhanji, Vishal

doi:10.1097/apo.0000000000000145

Cited by 10 publications

(4 citation statements)

References 93 publications

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“…Corneal collagen crosslinking (CXL) is an established treatment for slowing down or stopping disease progression in keratoconus and corneal ectasia. [ 10 ] While a majority of studies have reported outcomes of CXL in primary keratoconus, few publications have shown encouraging outcomes with CXL in post-refractive surgery keratectasia. [ 5 , 9 , 11 ] Unlike previous studies that used the epithelium-off protocol for CXL, we performed CXL in our patients with or without flap lift.…”

Section: Discussionmentioning

confidence: 99%

Crosslinking for post-laser-assisted in situ keratomileusis corneal ectasia

Zheng,

Yu,

Zhang

et al. 2023

Indian Journal of Ophthalmology

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Purpose: To evaluate the outcomes of transepithelial corneal collagen crosslinking (CXL) for management of corneal ectasia after laser-assisted in situ keratomileusis (LASIK). Methods: CXL was performed on 18 eyes of 16 patients either with LASIK flap lift ( n = 9; 365 nm, 30 mW/cm 2 , 4 minutes, pulse) or with transepithelial flap-on ( n = 9 eyes; 365 nm, 3 mW/cm 2 , 30 minutes) technique. Postoperative change in maximum keratometry (Kmax), anterior elevation, posterior elevation, spherical equivalent (SE), logMAR uncorrected distance visual acuity (UDVA), aberrations, and central corneal thickness (CCT) were evaluated at 12 months postoperatively. Results: A total of 18 eyes of 16 patients (11 males, 5 females) were included. Overall, Kmax flattened more after flap-on CXL ( P = 0.014) compared to flap-lift CXL. The endothelial cell density and posterior elevation were stable throughout the follow-up period. Index of vertical asymmetry (IVA), keratoconus index (KI), and central keratoconus index (CKI) decreased after flap-on CXL at 12 months, postoperatively ( P < 0.05), whereas there were no statistically significant changes in these parameters after flap-off CXL group. The spherical aberrations and total root mean square decreased after flap-lift CXL at 12 months, postoperatively ( P < 0.05). Conclusion: In our study, transepithelial collagen crosslinking was successfully used to halt disease progression in post-LASIK keratectasia. We recommend flap-on surgical technique for these cases.

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Section: Discussionmentioning

confidence: 99%

Crosslinking for post-laser-assisted in situ keratomileusis corneal ectasia

Zheng,

Yu,

Zhang

et al. 2023

Indian Journal of Ophthalmology

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“… 1 Overall, with rarely associated risks, the safety of corneal cross-linking is well established when performed within certain parameters. 2 Previously outlined contraindications for CXL include active infectious keratitis and pregnancy. 3 In addition to these conditions, a 400 µm minimum corneal thickness is a suggested criterion for determining procedure eligibility.…”

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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“… 11 Other risks include edema, infectious keratitis, corneal perforation, and corneal scarring. 12 An effective CXL procedure not requiring epithelial removal (epi-on CXL) would be safer and less disruptive for the patient.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Sodium Iodide on Stromal Loading, Distribution and Degradation of Riboflavin in a Rabbit Model of Transepithelial Corneal Crosslinking

Rubinfeld¹,

Gum²,

Talamo³

et al. 2021

OPTH

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Purpose: To evaluate effects of sodium iodide (NaI) on riboflavin concentration in corneal stroma before and during ultraviolet A (UVA) light exposure using a novel transepithelial corneal collagen crosslinking (CXL) procedure (EpiSmart CXL system, CXL Ophthalmics, Encinitas CA). Methods: Riboflavin solutions with NaI (Ribostat, CXL Ophthalmics, Encinitas CA) and without NaI were used for CXL in rabbits using EpiSmart. A pilot study determined sufficient riboflavin loading time. Four rabbits were dosed and monitored. Riboflavin fluorescence intensity was assessed from masked slit-lamp photos. A 12 min loading time was selected. Sixteen additional rabbits received the two formulae in contralateral eyes for CXL. Riboflavin uptake was assessed at 0, 10, 15, 20, 25, and 30 min of UVA exposure using a scale for riboflavin fluorescence previously validated against stromal concentration. Post sacrifice, corneal stromal samples were analyzed for concentrations of riboflavin and riboflavin 5ʹ-phosphate. Results: Eyes dosed with NaI riboflavin had higher riboflavin grades compared to eyes dosed with the NaI-free riboflavin formulation immediately after riboflavin loading and persisting throughout UVA exposure, with significantly higher (P < 0.01 to < 0.05) riboflavin grades from 15 through 25 min of UVA exposure. Riboflavin grades decreased more slowly in eyes dosed with NaI riboflavin through 25 minutes of UVA exposure. Minor conjunctival irritation was noted with or without NaI. Conclusion:The addition of NaI to riboflavin solution is associated with increased riboflavin concentration in corneal stroma throughout a clinically relevant time course of UVA exposure. This effect may be a combination of enhanced epithelial penetration and reduced riboflavin photodegradation and should enhance intrastromal crosslinking.

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Corneal Collagen Cross-linking

Cited by 10 publications

References 93 publications

Crosslinking for post-laser-assisted in situ keratomileusis corneal ectasia

Crosslinking for post-laser-assisted in situ keratomileusis corneal ectasia

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

The Effect of Sodium Iodide on Stromal Loading, Distribution and Degradation of Riboflavin in a Rabbit Model of Transepithelial Corneal Crosslinking

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