Customized corneal crosslinking for treatment of progressive keratoconus: Clinical and OCT outcomes using a transepithelial approach with supplemental oxygen

Mazzotta, Cosimo; Sgheri, Arianna; Bagaglia, Simone Alex; Rechichi, Miguel; Maggio, Alessandro Di

doi:10.1097/j.jcrs.0000000000000347

Cited by 39 publications

(80 citation statements)

References 28 publications

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“…Neuropathic pain post-treatment is very rare. [50][51][52][53][54][55][56][57] Fixed Costs $ 500,000 $ 500,000 $ 500,000 $ 500,000…”

Section: Outcomes and Patient Satisfaction After Lvcmentioning

confidence: 99%

The 25th Anniversary of Laser Vision Correction in the United States

Joffe¹

2021

OPTH

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Laser Vision Correction (LVC) is an elective, self-pay and safe surgical procedure to correct myopia and hyperopia. Since FDA approval 25 years ago, there have been a progression of technological improvements leading to better outcomes and LVC is now one of the safest surgical procedures. With a potential pool of 50 million patients, 6000 trained ophthalmic surgeons regularly treating in over 1000 centers of which 65% are physician owned. Treatments remain low from an earlier peak of 1.4 million to less than 800,000 over last 10 years. The factors preventing patients undergoing surgery have not changed and include the cost of $2000 ± $1000 per eye and fear of laser surgery on their eyes. The latter is overcome by word of mouth referrals and positive social media messaging. In addition, press misinformation and lack of optometrists participating in co-management have not helped grow LVC procedures despite the positive results of the FDA's Patient Reported Outcomes with LASIK studies known as PROWL. The surgery is quick, and patients can be "in and out" in less than two hours with a rapid recovery, minimal postoperative restrictions and within 24 hours have 20/20 vision. Volume and price drives center and physician profitability with a scheduling capacity of two to four patients' treatments per hour. Laser vision correction and especially LASIK, remains the treatment of choice for myopic and hyperopic patients wanting to remove their dependency on glasses and contact lenses.

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“…Neuropathic pain post-treatment is very rare. [50][51][52][53][54][55][56][57] Fixed Costs $ 500,000 $ 500,000 $ 500,000 $ 500,000…”

Section: Outcomes and Patient Satisfaction After Lvcmentioning

confidence: 99%

The 25th Anniversary of Laser Vision Correction in the United States

Joffe¹

2021

OPTH

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“…In an ex vivo model of porcine eyes, Hill and colleagues 44 were able to demonstrate that aerobic conditions could be obtained by providing supplemental oxygen in an epi-on pulsed high-irradiance protocol, suggesting that optimization of oxygen may be beneficial in accelerated epi-on protocols. To test this clinically, Mazzotta and colleagues 45 have used oxygen delivery goggles to provide supplemental oxygen during an accelerated epi-on protocol and have reported meaningful improvements in visual acuity and corneal curvature with no significant adverse effects after 6 months of follow-up.…”

Section: Advances In Treatmentmentioning

confidence: 99%

“…The precise location to treat can be determined using tomography-driven finite-element models, 62 maximum tomographic posterior float, 63 – 65 and thinnest pachymetry. 45 , 66 Such approaches, however, rely on the geometric surrogates of biomechanical weakening and hence not the cause but the effect. With the advances in spatially resolved in vivo biomechanical imaging of the cornea either with Brillouin spectroscopy 7 or optical coherence elastography, 67 biomechanics-guided C-CXL may be possible soon.…”

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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“…Mazzotta et al recently investigated the utility of high-irradiance epithelium-on customised CXL with supplemental oxygen ( Mazzotta et al, 2020b ). A total of 27 eyes were included in this study.…”

Section: Maximising Pharmacokinetic Properties Of Riboflavin/ultraviolet-a In the Treatment Of Keratoconusmentioning

confidence: 99%

Corneal Cross-Linking: The Evolution of Treatment for Corneal Diseases

Lim

et al. 2021

Front. Pharmacol.

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Corneal cross-linking (CXL) using riboflavin and ultraviolet A (UVA) light has become a useful treatment option for not only corneal ectasias, such as keratoconus, but also a number of other corneal diseases. Riboflavin is a photoactivated chromophore that plays an integral role in facilitating collagen crosslinking. Modifications to its formulation and administration have been proposed to overcome shortcomings of the original epithelium-off Dresden CXL protocol and increase its applicability across various clinical scenarios. Hypoosmolar riboflavin formulations have been used to artificially thicken thin corneas prior to cross-linking to mitigate safety concerns regarding the corneal endothelium, whereas hyperosmolar formulations have been used to reduce corneal oedema when treating bullous keratopathy. Transepithelial protocols incorporate supplementary topical medications such as tetracaine, benzalkonium chloride, ethylenediaminetetraacetic acid and trometamol to disrupt the corneal epithelium and improve corneal penetration of riboflavin. Further assistive techniques include use of iontophoresis and other wearable adjuncts to facilitate epithelium-on riboflavin administration. Recent advances include, Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) for treatment of infectious keratitis, customised protocols (CurV) utilising riboflavin coupled with customised UVA shapes to induce targeted stiffening have further induced interest in the field. This review aims to examine the latest advances in riboflavin and UVA administration, and their efficacy and safety in treating a range of corneal diseases. With such diverse riboflavin delivery options, CXL is well primed to complement the armamentarium of therapeutic options available for the treatment of a variety of corneal diseases.

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Customized corneal crosslinking for treatment of progressive keratoconus: Clinical and OCT outcomes using a transepithelial approach with supplemental oxygen

Cited by 39 publications

References 28 publications

The 25th Anniversary of Laser Vision Correction in the United States

The 25th Anniversary of Laser Vision Correction in the United States

Advances in the diagnosis and treatment of keratoconus

Corneal Cross-Linking: The Evolution of Treatment for Corneal Diseases

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