Evaluation of the Effectiveness of Cross-Linking Combined With Photorefractive Keratectomy for Treatment of Keratoconus

Iqbal, Mohammed; Elmassry, Ahmed; Tawfik, Ahmed; Elgharieb, Mervat Elshabrawy; Nahrawy, Osama M El; Soliman, Ashraf; Saad, Hisham A; Elzembely, Hosam; Saeed, Ahmed; Mohammed, Osama Ali; Kamel, Ahmed Gad; Saman, Islam Saad El

doi:10.1097/ico.0000000000001663

Cited by 22 publications

(19 citation statements)

References 28 publications

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“…In comparison with other CXL protocols, SCXL has greater improvements in KC indices 9. Despite the superiority of SCXL in comparison with transepithelial CXL in halting KC progression,10,11 the combination procedures; sometimes called cross-linking plus (CXL Plus);12,13 have become popular procedures that include combination of CXL with a refractive procedure such as wavefront-guided photorefractive keratectomy (WFG PRK),14 refractive lens surgery (RLS)15 and intracorneal ring segments (ICRS) to correct the refractive status of the ectatic eyes 12,16…”

Section: Introductionmentioning

confidence: 99%

Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management

Iqbal¹,

Elmassry²,

Badawi³

et al. 2019

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PurposeTo analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management.Patients and methodsThis study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively.ResultsForty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by <1 D, 23 eyes (46.9%) improved from 1 D to <2 D and 7 eyes (14.3%) improved by ≥2 D. Both uncorrected distant visual acuity (UDVA) and corrected distant visual acuity (CDVA) showed statistically significant improvement from preoperative 1.34±0.29 (mean±SD) and 0.74±0.23 LogMAR to postoperative 0.99±0.32 and 0.50±0.22 LogMAR (P<0.0001) respectively. Both Kmax and SE refraction showed statistically significant and stable improvement from preoperative 51.95±1.90 and −7.90±3.14 D to postoperative 50.19±1.96 and −6.35±2.49 D (P<0.0001) respectively. Two eyes (4%) showed KC progression at the end of 5th follow-up year.ConclusionSCXL had good effectiveness and stability that halted KC progression over 5-year follow-up period. It had also unexpected improvement in the KC refractive components mainly the spherical and SE components.

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Section: Introductionmentioning

confidence: 99%

Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management

Iqbal¹,

Elmassry²,

Badawi³

et al. 2019

OPTH

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“…It aims to improve the intrinsic biomechanical characteristics of corneal stroma in order to stabilize progressive keratoconus. 15 Since visual rehabilitation for keratoconus eyes requires improvement in corneal aberrations, photoablation therapies in combination with CXL treatment have been proposed to not only arrest progression of the underlying disease but also to improve functional vision. 16 Promising results have been reported with topography-guided or wavefront-guided PRK with CXL in keratoconus eyes.…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Wavefront-Guided Photorefractive Keratectomy and Accelerated Corneal Crosslinking for Stabilization and Visual Rehabilitation of Keratoconus Eyes

Tamayo¹,

Castell²,

Vargas³

et al. 2020

OPTH

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Purpose: To evaluate the visual and refractive outcomes after high-resolution wavefrontguided (HRWG) surface ablation with corneal crosslinking (CXL) in keratoconus eyes. Patients and Methods: In this prospective, interventional case series, 47 eyes of 28 progressive keratoconus patients older than age 18 were enrolled. All patients underwent HRWG photorefractive keratectomy (PRK) with simultaneous accelerated CXL. The study parameters were manifest refraction spherical equivalent (MRSE), keratometric outcomes, uncorrected (UDVA) and corrected distance visual acuity (CDVA) at postoperative 6 and 12 months. Results: There was improvement in mean MRSE from −2.39±1.89 D preoperatively to −0.13 ± 0.68 D at 12 months, with corresponding improvement in UDVA from 0.77 ± 0.35 logMAR to 0.08 ± 0.12 logMAR and CDVA from 0.10 ± 0.11 logMAR to 0.02 ± 0.04 logMAR. Preoperative flat and steep keratometry (K) were 4wct 32.49 ± 1.67 D and 45.94 ± 2.10 D, respectively, and at postoperative 12 months were 41.36 ± 2.08 D and 42.65 ± 2.78 D, respectively. At postoperative 12 months, visual and refractive outcomes were maintained. Comparisons between preoperative and postoperative 12 month timepoints were statistically significant for all parameters. Conclusion: Simultaneous wavefront-guided PRK followed by CXL is a promising treatment for the visual rehabilitation of keratoconus patients.

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“…In particular, a precise characterization of collagen fibrils in the anterior part of corneal stroma is of great interest to understand the aetiology of rare conditions, such as keratoconus, or other dystrophies related to subtle morphological deformations. As an example, an early diagnosis of keratoconus may prevent the need for corneal transplantation and a contactless observation of collagen morpho-mechanics may help to follow treatments based on corneal collagen cross-linking (CXL) 47 , 48 or in tandem with laser in-situ keratomileusis (LASIK) as a tool to re-establish corneal biomechanics 49 – 51 .…”

Section: Discussionmentioning

confidence: 99%

Morpho-mechanics of human collagen superstructures revealed by all-optical correlative micro-spectroscopies

et al. 2019

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In every biological tissue, morphological and topological properties strongly affect its mechanical features and behaviour, so that ultrastructure, composition and mechanical parameters are intimately connected. Overall, it is their correct interplay that guarantees the tissue functionality. The development of experimental methods able to correlate these properties would open new opportunities both in the biological and the biomedical fields. Here, we report a correlative study intended to map supramolecular morphology, biochemical composition and viscoelastic parameters of collagen by all-optical microscopies. In particular, using human corneal tissue as a benchmark, we correlate Second-Harmonic Generation maps with mechanical and biochemical imaging obtained by Brillouin and Raman micro-spectroscopy. The study highlights how subtle variations in supramolecular organization originate the peculiar mechanical behavior of different subtypes of corneal lamellae. The presented methodology paves the way to the non-invasive assessment of tissue morpho-mechanics in biological as well as synthetic materials.

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Evaluation of the Effectiveness of Cross-Linking Combined With Photorefractive Keratectomy for Treatment of Keratoconus

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 22 publications

References 28 publications

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

<p>High-Resolution Wavefront-Guided Photorefractive Keratectomy and Accelerated Corneal Crosslinking for Stabilization and Visual Rehabilitation of Keratoconus Eyes</p>

Morpho-mechanics of human collagen superstructures revealed by all-optical correlative micro-spectroscopies

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