Effect Of Accelerated Corneal Collagen Cross Linking (CXL) On Corneal Endothelium

Bh, Vipul; ari,; Lohia, Meenal; Reddy, Jagdeesh Kumar; Haritha,

doi:10.15406/aovs.2015.03.00074

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…The statistically significant changes in endothelial cell count and coefficient of variance were persistent until the end of 1-year follow-up. 24 In contrast, other studies had assumed that accelerated CXL had inconsiderable impacts on the value of ECD and 6-month follow-up of 23 patients with progressive KC treated by accelerated CXL (9 mW/cm 2 for 10 minutes) revealed insignificant endothelial cell changes ( P =0.082). 25 Another comparative study between standard CXL (3 mW/cm 2 for 30 minutes) in one eye of 21 patients and accelerated CXL (7 mW/cm 2 for 15 minutes) in the fellow eye provided a similar result on the safety of both accelerated and standard CXL on the corneal endothelium.…”

Section: Discussionmentioning

confidence: 87%

“…The substantial obvious changes were observed at the first week and the first month, and then, corneal endothelial count returned to the baseline values at 6 months, whereas 6A and CV returned to their base values only at 3 months. 23 The second study 24 used more intensive UVA irradiance (30 mW/cm 2 for 3 minutes) and reported that changes did not return to its base value. The statistically significant changes in endothelial cell count and coefficient of variance were persistent until the end of 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Corneal endothelial changes after accelerated corneal collagen cross-linking in keratoconus and postLASIK ectasia

Badawi¹

2016

OPTH

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PurposeThe purpose of this study was to evaluate the effects of accelerated cross-linking (CXL) on corneal endothelium in keratoconus and postlaser-assisted in situ keratomileusis (LASIK) ectasia.DesignThis study is a prospective nonrandomized controlled study.SettingThis study was conducted in Mansoura Ophthalmic Center (Mansoura University) and Al-Mostakbal Ophthalmic Center, Mansoura, Egypt.MethodsIn total, 40 eyes with progressive keratoconus and 10 eyes with postLASIK ectasia were subjected to an accelerated CXL (10 mW/cm2 for 9 minutes). Qualitative and quantitative analyses of the corneal endothelial cells were conducted before CXL and 3, 6, and 12 months after CXL by using a specular microscope (Tomy EM-3000).ResultsThere was a significant reduction in endothelial cell count particularly at 3 and 6 months postCXL. In addition, the coefficient of variance was also statistically significantly higher at 3 and 6 months postoperatively than the preCXL value. There was a slight change in the percentage of hexagonal cells.ConclusionThe use of accelerated CXL (10 mW/cm2 for 9 minutes) has a transient negative impact on endothelial cell density and/or endothelial morphology.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Corneal endothelial changes after accelerated corneal collagen cross-linking in keratoconus and postLASIK ectasia

Badawi¹

2016

OPTH

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“…The assessment of endothelial cell density (ECD) loss in standard and accelerated and transepithelial CXL protocols in the pediatric group has not produced a statistically significant decrease in ECD after the procedure [ 21 , 23 , 56 , 58 , 61 , 69 , 70 , 76 , 80 , 82 , 96 , 97 ]; however, other studies reported that, depending on the protocol and carrier used, there is damage to endothelial cell density [ 68 , 98 – 100 ]. In a retrospective SCXL study developed by Barbisan et al in 2020, involving 105 eyes, a statistically significant reduction in ECD was observed, as well as corneal thinning after 1 year of follow-up, evidencing the potential impact of CXL on anatomy and corneal physiology [ 68 ].…”

Section: Resultsmentioning

confidence: 99%

Pediatric Crosslinking: Current Protocols and Approach

et al. 2022

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Keratoconus (KC) is likely to be more aggressive in the pediatric population, with a higher risk of progression and visual loss. Several techniques have been proposed for corneal crosslinking (CXL) so far. The standard CXL (SCXL) technique, or the Dresden Protocol, originally developed by Wollensak et al., has been shown to be safe and effective in the pediatric KC group. With similar efficacy to the conventional method, the accelerated CXL (ACXL) protocols proposed a reduced UVA exposure time by increasing the intensity of UVA irradiation. Transepithelial CXL (TCXL), considered an “epithelium-on” method, emerged as a strategy to improve safety and reduce postoperative complications and discomfort. For thinner corneas, we can highlight the use of hypoosmolar riboflavin and new studies, such as contact lens-assisted CXL (CACXL), the epithelial-island CXL (EI-CXL), and the Sub400 protocol. In addition to the different protocols used, another factor that changes CXL results is the type of carrier used: dextran-based or hydroxypropyl methylcellulose-based (HPMC) riboflavin solutions. There are several ways to perform a CXL surgery, and it is still unclear which method is the safest and most effective in the pediatric group. This review of the literature in English, available in PubMed, provides an update on corneal CXL in the pediatric KC group, exploring the data on the techniques currently used and under investigation, including their advantages, efficacy, safety profiles, risks, and cost analyses.

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“…The higher mean preoperative endothelial cell count in our study is another possible factor interpreting the safer outcome. Bhandari et al [ 22 ] documented that the changes in endothelial cell count and coefficient of variance were statistically significant and persisted until the end of the 12-month follow-up period following cl-ACXL with intensive UVA irradiance of 30 mW/cm 2 for 3 min. A possible interpretation of their findings is the use of more intense UVA irradiance (30 mW/cm 2 ) in a continuous mode.…”

Section: Discussionmentioning

confidence: 99%

The effect of accelerated pulsed high-fluence corneal cross-linking on corneal endothelium; a prospective specular microscopy study

et al. 2023

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Background Corneal collagen cross-linking (CXL) is a procedure utilized for halting keratoconus progression with different approved protocols. The current study aimed to assess the corneal endothelial changes following the relatively new accelerated pulsed high-fluence protocol of epithelium-off corneal cross-linking for the treatment of mild to moderate keratoconus. Methods This prospective case series study enrolled 45 eyes of 27 patients with mild to moderate progressive keratoconus who underwent accelerated pulsed high-fluence CXL (pl-ACXL, 30 mW/ cm2 UVA at 365 nm wavelength, 8 min pulsed mode 1 s on / 1 s off with a total energy of 7.2 J/ cm2). The main outcome measures were corneal endothelial changes assessed by specular microscopy at 3 and 6 months postoperatively including endothelial cell density (ECD), coefficient of variation, percentage of hexagonal cells, average, minimum and maximum endothelial cell sizes. Demarcation line depth was assessed 1 month following surgery. Results The mean age of the studied sample was 24.89 ± 7.21. The mean preoperative ECD (2944.6 ± 247.41 cell/mm2) showed non-significant reduction at 3 and 6 months postoperatively (2931.03 ± 253.82 and 2924.7 ± 224.88 cell/mm2, respectively, P-value = 0.361). There were no significant changes in the mean coefficient of variation, percentage of hexagonal cells, average, minimum and maximum endothelial cell sizes at 3 and 6 months following pl-ACXL (P-value > 0.05). The mean demarcation line depth 1 month after pl-ACXL was 214 ± 17.43 μm. Conclusions Corneal endothelial changes following accelerated pulsed high-fluence CXL were minimal with stability of endothelial cell count and non-significant morphological changes. Trial Registration Clinicaltrials.gov: NCT04160338 (13/11/2019).

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Effect Of Accelerated Corneal Collagen Cross Linking (CXL) On Corneal Endothelium

Cited by 4 publications

References 15 publications

Corneal endothelial changes after accelerated corneal collagen cross-linking in keratoconus and postLASIK ectasia

Corneal endothelial changes after accelerated corneal collagen cross-linking in keratoconus and postLASIK ectasia

Pediatric Crosslinking: Current Protocols and Approach

The effect of accelerated pulsed high-fluence corneal cross-linking on corneal endothelium; a prospective specular microscopy study

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