Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: Scheimpflug and biomicroscopic analysis

Greenstein, Steven A.; Fry, K. L.; Bhatt, Jalpa; Hersh, Peter S.

doi:10.1016/j.jcrs.2010.06.067

Cited by 248 publications

(228 citation statements)

References 29 publications

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“…All adverse events were due to stromal haze formation, which induced a Effects and adverse events after CXL for keratoconus are independent of age PB Baenninger et al loss of BCVA, except for one case in a young patient where a contact lens-induced epithelial problem was the reason for vision deterioration at the 12-month followup. Taking into account that stromal haze formation is a common finding after CXL 15 and, because none of the patients experienced a severe complication, we still regard CXL as a relatively safe procedure in all age groups. A limitation of our study is that the failure rate (7.9-16.5%), defined as increase of K max Z1 Dpt after CXL, was somewhat higher than the failure rate reported in the literature (0-7.6%).…”

Section: Resultsmentioning

confidence: 99%

Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

Baenninger

Bachmann

Wienecke

et al. 2014

Eye

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Purpose To compare the effect, failure rate and the risks of corneal cross-linking (CXL) in keratoconus patients aged Z35 years to patients o35 years. Methods In 141 eyes of 116 keratoconus patients we compared the changes in best phoropter-corrected visual acuity (BCVA) and maximum keratometry values (K max ) before and 12 months after CLX in patients aged Z35 years (n ¼ 34, 38 eyes) to the cohort of patients below 35 years of age. Results Overall, CXL significantly improved BCVA from 0.487 logMAR (95% confidence interval (CI) 0.426-0.548) by À 0.197 logMAR (95% CI À 0.243 to À 0.150; Po0.001) and reduced K max from 48.96 diopter (Dpt) by À 1.33 Dpt (95% CI À 1.85 to À 0.81: Po0.001). Age Z35 years had no effect on the changes of BCVA ( À 0.02 (95% CI À 0.13 to 0.09); P ¼ 0.757) or K max (0.58 (95%CI À 0.51 to 1.68); P ¼ 0.294) as compared with younger patients. In 54 patients (55 eyes, 38.5%) aged o35 years and in 18 patients (18 eyes, 47.4%) aged Z35 years, BCVA increased by Z2 Snellen lines. Failure (increase in K max Z1 Dpt) was observed in 17 eyes (16.5%) of patients aged o35 years and in 3 eyes (7.9%) of patients aged Z35 years during the 12-month follow-up period. Adverse outcomes (loss of Z2 Snellen lines) occurred in 4 (3.9%) eyes of patients aged o35 years and 1 (2.6%) eye of a patient aged Z35 years. Conclusion Effects and adverse events of CXL treatment do not seem to differ between subjects younger or older than 35 years.

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Section: Resultsmentioning

confidence: 99%

Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

Baenninger

Bachmann

Wienecke

et al. 2014

Eye

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“…Crosslinking studies with long-term follow-up have shown that corneal thickness as well as central keratometry follows a dynamic curve over the first 6 months. 7,8 Although complete epithelial healing is achieved in the first few days postoperatively, epithelium remodeling is an acceptable explanation for the continuous changes seen over several months. Avoidance of contact lens corneal bearing and mechanical trauma to the center of the cornea seems to be crucial for undisrupted epithelium remodeling and normal corneal nerve proliferation after CXL.…”

Section: Discussionmentioning

confidence: 99%

Silicone Hydrogel Miniscleral Contact Lenses after Corneal Collagen Crosslinking for Post-LASIK Keratoectasia

Severinsky¹

2014

International Journal of Keratoconus and Ectatic Corneal Diseases

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Purpose: To report successful visual rehabilitation of post refractive surgery keratoectasia shortly after corneal collage crosslinking (CXL) procedure achieved with silicone hydrogel mini-scleral (SHmS) contact lens. Materials and methods:A 29-year-old woman attended to our clinic with complaints on decreased vision in her left eye. Twelve years earlier she underwent bilateral laser-assisted in situ keratomileusis (LASIK) procedure for myopia correction. Corneal topography revealed bilateral central keratoectasia with maximal keratometry values of 55.4 Diopter (D) for her right eye and 59.7 D for the left, corneal thicknesses were 422 and 443 respectively. The patient underwent an uneventful CXL procedure in her left eye and was fitted with SHmS lens 5 weeks later. The lens was designed to rest over the patients' sclera and perilimbal cornea and vault the central cornea with minimal support over it.Results: SHmS lens fitting resulted in significant subjective improvement in visual acuity (from 20/200, unaided to 20/25, contact lens corrected). The patient was able to wear the lens upto 10 hours a day with stable contact lens corrected vision. No contact lens related complications, such as edema or neovascularization were observed during 3 months follow-up period. As a result of successful restoration of vision in the CXL-treated eye, the patient was scheduled for the procedure in her other eye.Conclusion: SHmS contact lens should be considered as an option for the visual rehabilitation of corneas shortly after collagen corneal crosslinking procedure. This novel contact lens modality made from flexible and highly gas permeable material minimizes contact lens influence on corneal recovery after CXL and provides an excellent visual outcome.

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“…Other studies suggest that keratocyte apoptosis could be used as an indicator of CXL success. (44)(45) …”

Section: Safety Parameters and Potential Complicationsmentioning

confidence: 99%

Corneal Crosslinking: The Standard Protocol

Santhiago¹

2017

Revista Brasileira De Oftalmologia

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RESUMOO objetivo desta revisão é de determinar as indicações e eficácia da cirurgia que promove novas ligações covalentes entre as fibras de colágeno da córnea, conhecida como Cross-Linking (CXL), assim como esclarecer seus objetivos. O ceratocone é uma doença ectasica da córnea, bilateral, assimétrica, que, principalmente, cursa com encurvamento e afinamentos progressivo, e se inicia em geral na segunda década de vida. O uso primário do CXL tem sido na interrupção da progressão do Ceratocone. Apesar do conhecido encurvamento no estroma da córnea ocorrer nesses pacientes, a fisiopatologia por trás do ceratocone ainda é desconhecida e parece ser multifatorial. Pela evidencia literária disponível até o momento, o CXL da córnea esta, portanto indicado nos pacientes com doença em progressão. Concluímos que existe evidencia suficiente para afirmar que o CXL da córnea é eficaz na estabilização da doença ectásica da cornea.Descritores: Córnea/fisiologia; Córnea/metabolismo; Cross-linking reagentes; Ceratocone/terapia; Riblflavina/administração & dosagem; Protocolos ABSTRACT The purpose of this review is to determine the indications and efficacy of the surgery that promotes new covalent bonds between the collagen fibers of the cornea, known as Cross-Linking (CXL), as well as to clarify its objectives. Keratoconus is a bilateral, asymmetric ectasic disease of the cornea that mainly courses with steepening and progressive thinning, and usually begins in the second decade of life.The primary use of CXL has been in discontinuing the progression of keratoconus. Although known corneal stromal remodeling occurs in these patients, the pathophysiology behind keratoconus is still unknown and appears to be multifactorial. By the literary evidence available to date, the CXL of the cornea is safely indicated in patients with progressing disease. We conclude that there is sufficient evidence to affirm that cornea CXL is effective in stabilizing corneal ectasic disease.

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Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: Scheimpflug and biomicroscopic analysis

Abstract: The time course of corneal haze after CXL was objectively quantified; it was greatest at 1 month, plateaued at 3 months, and was significantly decreased between 3 months and 12 months. Changes in haze did not correlate with postoperative clinical outcomes.

Cited by 248 publications

References 29 publications

Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

Silicone Hydrogel Miniscleral Contact Lenses after Corneal Collagen Crosslinking for Post-LASIK Keratoectasia

Corneal Crosslinking: The Standard Protocol

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