Customized Topography-Guided Corneal Collagen Cross-linking for Keratoconus

Cassagne, Myriam; Pierné, Kévin; Galiacy, Stéphane; Asfaux-Marfaing, Marie Pierre; Fournié, Pierre; Malecaze, François

doi:10.3928/1081597x-20170201-02

Cited by 52 publications

(40 citation statements)

References 26 publications

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“…The customized UVA treatment pattern consisted of a graded pattern of three concentric ellipses of decreasing energy dose from center to periphery. Maximum energy dose applied was 15 J/cm 2 , consistent with previous studies of customized cross-linking using 30 mW/cm 2 irradiance in patients with keratoconus [ 6 , 7 , 9 , 11 ]. The treatment pattern was centered on the location of the posterior float identified on corneal tomography, with the diameter of the treatment ellipses customized to cover the cone area, according the method previously described by Seiler et al [ 10 ].…”

Section: Methodssupporting

confidence: 84%

“…The treatment is applied using a programmable UVA delivery device with integrated eye tracking to selectively activate the riboflavin photosensitizer in the targeted areas of the cornea [ 8 ]. Several controlled clinical studies have demonstrated greater corneal regularization in eyes treated with epi-off customized cross-linking as compared to conventional broad beam CXL, with greater flattening in the areas of steepest corneal curvature, compensatory steepening in the untreated surrounding cornea, and resultant gains in visual function [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus

Kamiya

Kanayama

Takahashi

et al. 2020

JCM

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Customized cross-linking has been proposed as an alternative to conventional cross-linking in patients with progressive keratoconus, targeting greater flattening of the cone region and improved visual function. Epithelium-on cross-linking aims to reduce complications associated with epithelial removal, while the addition of oxygen aims to maintain treatment effect. Our study evaluates the combination of these novel treatment strategies to achieve a minimally invasive treatment targeting maximal functional outcomes. This prospective study included 42 eyes undergoing epithelium-on, accelerated, oxygen-supplemented, customized corneal cross-linking for progressive keratoconus. Outcome measures, including refraction, visual acuity, and corneal tomography were obtained at baseline and at 1, 3, and 6 months, and 1 year postoperatively. Logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity was significantly improved, from 0.87 ± 0.53 preoperatively, to 0.78 ± 0.56 1 year postoperatively (Wilcoxon rank sum test, p = 0.016). LogMAR best spectacle-corrected visual acuity was also significantly improved, from 0.19 ± 0.36 preoperatively, to 0.11 ± 0.33 postoperatively (p = 0.004). Manifest refractive cylinder was significantly decreased, from 4.50 ± 2.96 D preoperatively, to 3.27 ± 2.61 D postoperatively (p = 0.004). The baseline maximum keratometry (Kmax) was 53.04 ± 7.91 D, significantly flattening to 52.25 ± 7.31 D by 1 month, and remaining relatively stable at 1 year postoperatively (52.31 ± 7.50 D) (p < 0.001). No significant adverse events occurred in any eye. Epithelium-on, accelerated, oxygen-supplemented, customized corneal cross-linking is a promising new treatment approach, with reduced maximum keratometry, reduced astigmatism, and improved visual acuity at 1 year, with a favorable safety and patient comfort profile.

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Section: Methodssupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus

Kamiya

Kanayama

Takahashi

et al. 2020

JCM

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“…The Mosaic delivery system (KXL II, Avedro Inc.,Waltham, MA, USA) offers customised cross-linking (photorefractive intrastromal cross-linking- PiXL). Initial studies on customised cross-liking report greater corneal regularisation and reduction in maximum keratometry than conventional cross-linking [ 95 - 97 ].…”

Section: Customised Cross-linkingmentioning

confidence: 99%

A Review of Corneal Collagen Cross-linking – Current Trends in Practice Applications

Lim¹,

Lim²

2018

TOOPHTJ

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Objective:To review the literature on current applications of corneal Collagen Cross-Linking (CXL).Methods:A review of publications on corneal cross-linking was conducted. This included systemic reviews, randomized controlled clinical trials, cohort studies, case-controlled studies and case series. A summary of the publications is tabulated.Results:The original indication of riboflavin – Ultraviolet-A (UVA) induced corneal collagen cross-linking is to arrest the progression of keratoconus. Studies show that it is effective in arresting the progression of keratoconus and post-LASIK ectasia with the standard Dresden protocol (epithelium-off). There are also improvements in visual, keratometric and topographic measurements over time. Severe complications of cross-linking are rare. The epithelium-on techniques have less efficacy than the Dresden protocol. Accelerated protocols have variable results, with some studies reporting comparable outcomes to the Dresden protocol while other studies reporting less efficacious outcomes. Cross-linking combined with refractive procedures provide better visual outcome but long term studies are warranted. Cross-linking for the treatment of infective keratitis is a promising new treatment modality. Initial studies show that it is more effective for superficial rather than deep infections and for bacterial rather than fungal infections.Conclusions:Corneal cross-linking is a procedure with an expanding list of indications from the treatment of corneal ectasias to infective keratitis. While the standard Dresden protocol is established as the gold standard treatment for progressive keratoconus, the more recent protocols may require further refinements, investigative and long-term studies.

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“…Various other studies have been published since demonstrating the results of the customized approach. [ 71 72 73 74 ] The use of varying treatment patterns including customized toric, asymmetric arcuates, and concentric circles has been described. An important aspect is to determine the localization of the irradiation patterns.…”

Section: Customized Corneal Collagen Cross-linking For Keratoconus: Imentioning

confidence: 99%

Recent advances in corneal collagen cross-linking

Sachdev

2017

Indian J Ophthalmol

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Corneal collagen cross-linking has become the preferred modality of treatment for corneal ectasia since its inception in late 1990s. Numerous studies have demonstrated the safety and efficacy of the conventional protocol. Our understanding of the cross-linking process is ever evolving, with its wide implications in the form of accelerated and pulsed protocols. Newer advancements in technology include various riboflavin formulations and the ability to deliver higher fluence protocols with customised irradiation patterns. A greater degree of customisation is likely the path forward, which will aim at achieving refractive improvements along with disease stability. The use of cross-linking for myopic correction is another avenue under exploration. Combination of half fluence cross-linking with refractive correction for high errors to prevent post LASIK regression is gaining interest. This review aims to highlight the various advancements in the cross-linking technology and its clinical applications.

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Customized Topography-Guided Corneal Collagen Cross-linking for Keratoconus

Cited by 52 publications

References 26 publications

Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus

Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus

A Review of Corneal Collagen Cross-linking – Current Trends in Practice Applications

Recent advances in corneal collagen cross-linking

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