Long-term results of accelerated and conventional corneal cross-linking

Marafon, Samara B; Kwitko, Sérgio; Marinho, Diane Ruschel

doi:10.1007/s10792-020-01462-w

Cited by 10 publications

(19 citation statements)

References 38 publications

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“…A number of long-term studies have demonstrated that, on average, epi-off CXL typically flattens the central cornea, improves visual quality and reduces cone progression [351][352][353]. As such, this surgical intervention is the first treatment of choice for progressive keratoconus patients [354], although clinical outcomes vary significantly from patient to patient [354][355][356][357]. This surgical procedure was found to be safe and effective for keratoconus in children and adolescents as evaluated post-operatively for periods ranging from 1 to 3 years [358][359][360][361], with similar initial efficacy as in adults [362], particularly in terms of improvement in visual and topographic outcomes following the first year of treatment [358].…”

Section: Severe Keratoconusmentioning

confidence: 99%

Keratoconus: An updated review

Santodomingo-Rubido

Carracedo

Suzaki

et al. 2022

Contact Lens and Anterior Eye

268

204

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Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20-to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal crosslinking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.

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Section: Severe Keratoconusmentioning

confidence: 99%

Keratoconus: An updated review

Santodomingo-Rubido

Carracedo

Suzaki

et al. 2022

Contact Lens and Anterior Eye

268

204

View full text Add to dashboard Cite

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“…This is consistent with previous studies evaluating the long-term outcomes of accelerated Epi-ON CXL. 20,[24][25][26][27][28][29][30][31] Specifically, in the current sample, there were no eyes worsening lines of CDVA, whereas half of the sample of eyes improved lines of CDVA. This improvement is mainly associated to the change in the level of corneal higher order corneal aberrations induced with the CXL treatment.…”

Section: Discussionmentioning

confidence: 53%

“…With the objective of raising the oxygen concentration, two different However, in the current sample, no significant changes were found in corneal curvature and symmetry data, as reported in previous studies. 27,[34][35][36][37][38] This may be explained by the significant variability observed in the outcomes achieved with this technique, with some samples including cases with ectatic cases of different severity. Indeed, some factors have been found to be related to a better effect with accelerated CXL.…”

Section: Discussionmentioning

confidence: 99%

Long-term Analysis of Epi-ON Corneal Collagen Cross-linking Outcomes in Corneal Ectasia

Melián¹,

Rodríguez²,

Carreras³

et al. 2022

International Journal of Keratoconus and Ectatic Corneal Diseases

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Aim and objective: To evaluate the 3-year follow-up clinical outcomes obtained in corneal ectasia using Epi-ON corneal collagen cross-linking (CXL). Materials and methods:This study is a retrospective study enrolling 46 eyes from 32 patients with progressive corneal ectasia and treated with Epi-ON CXL in the period from September 2012 to April 2016. Two groups were differentiated according to the type of corneal ectasia: ectasia post-LASIK group (EPL, 12 eyes) and primary ectasia group (34 eyes). Two different platforms were used for the surgical protocol: VEGA CBM X LINKER platform (CSO, Firenze, Italy) and KXL (Avedro, Waltham, Massachusetts, USA). Visual, refractive, and corneal tomographic outcomes were evaluated during a 3-year follow-up. Results: A statistically significant improvement in the logMAR corrected distance visual acuity (CDVA) was observed in the whole sample (p <0.001) during the follow-up, with half of the sample improving one or more lines of CDVA. Likewise, only significant changes were detected in steepest keratometry (p <0.001), corneal astigmatism (p = 0.012), and index of height asymmetry (p = 0.021), with a trend to increase. Regarding the comparison between groups, more significant improvement in CDVA was found in the EPL group compared to the primary ectasia group (−0.07 ± 0.09 vs −0.15 ± 0.14, p = 0.028). Likewise, a significant trend to more corneal thinning was observed in primary ectasia group (p = 0.034). Conclusion:Epi-ON CXL is efficacious for stabilizing the progression of primary and iatrogenic ectasias for most cases, with significant improvement of visual acuity associated.

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“…These findings were consistent with some previous reports [ 18 – 20 ]. Contrastingly, some studies have reported that different CXL procedures result in significantly improved visual acuity [ 21 , 22 ]. All of these results are influenced by interaction effects of various factors.…”

Section: Discussionmentioning

confidence: 99%

Independent-effect comparison of five crosslinking procedures for Progressive Keratoconus based on Keratometry and the ABCD Grading System using Generalized Estimating Equations (GEE)

et al. 2023

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Purpose Corneal collagen crosslinking (CXL) is an effective treatment for progressive keratoconus. Multiple CXL modalities are clinically available. The present study compared the 1 year outcomes of five types of CXL procedures for progressive keratoconus in a Chinese population using generalized estimating equations (GEE). Methods This retrospective study included 239 eyes in 171 patients with keratoconus who underwent CXL and were followed up for 1 year. Five CXL procedures were assessed, including Accelerated Transepithelial CXL, Iontophoresis CXL for 10 min, CXL plus phototherapeutic keratectomy (CXL-plus-PTK), High-Fluence Accelerated CXL, and Accelerated CXL. Patients treated with the Accelerated CXL procedure represented the reference group. Primary outcomes were visual acuity change, spherical equivalence, endothelial cell density, mean keratometry (Kmean), maximum keratometry (Kmax), minimum corneal thickness (MCT), and the ABCD Grading System, consisting of A (staging index for ARC; ARC = anterior radius of curvature), B (staging index for PRC, PRC = posterior radius of curvature), and C (staging index for MCT) values 1 year postoperatively compared to baseline. Secondary outcomes were corrected GEE comparisons from each procedure versus the Accelerated CXL group. Results The Accelerated Transepithelial CXL group had lower performance than the Accelerated CXL group according to Kmean and Kmax. The CXL-plus-PTK group performed significantly better than the reference group as reflected by Kmax (β = -0.935, P = 0.03). However, the CXL-plus-PTK group did not perform as well for B and C, and the Iontophoresis CXL group performed better for C. Conclusions The CXL-plus-PTK procedure was more effective than the Accelerated CXL procedure based on Kmax, and the Iontophoresis CXL procedure performed better on the C value based on the ABCD Grading System.

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Long-term results of accelerated and conventional corneal cross-linking

Cited by 10 publications

References 38 publications

Keratoconus: An updated review

Keratoconus: An updated review

Long-term Analysis of Epi-ON Corneal Collagen Cross-linking Outcomes in Corneal Ectasia

Independent-effect comparison of five crosslinking procedures for Progressive Keratoconus based on Keratometry and the ABCD Grading System using Generalized Estimating Equations (GEE)

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