Optical Coherence Tomography and Confocal Microscopy Following Three Different Protocols of Corneal Collagen-Crosslinking in Keratoconus

Bouheraoua, Nacim; Jouve, Lea; Sanharawi, Mohamed El; Sandali, Otman; Temstet, Cyril; Loriaut, Patrick; Basli, Elena; Laroche, L.

doi:10.1167/iovs.14-15662

Cited by 87 publications

(78 citation statements)

References 40 publications

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“…The question of whether a greater amount of CXL can result in a greater enhancement in visual acuity and greater reduction of keratometry remains the subject of studies with longer postoperative follow-up. In addition, regarding the mean anterior stromal keratocyte density count on IVCM, a significant reduction was observed during the first 6 months, with normalization at 12 months with C-CXL and A-CXL, and at 6 months with I-CXL [22][23][24] . Consequently, varying microstructural corneal changes appear dependent on the type of collagen cross-linking protocol used.…”

Section: Discussionmentioning

confidence: 90%

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

Bouheraoua

Jouve

Borderie

et al. 2015

JoVE

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Keratoconus is a bilateral and progressive corneal ectasia. In order to slow down its progression, corneal collagen cross-linking (CXL) has recently been introduced as an efficient treatment option. In biological and chemical sciences, crosslinking refers to new chemical bonds formed between reactive molecules. Hence, the aim of corneal collagen CXL is to synthetically increase the formation of crosslinks between collagen fibrils in the corneal stroma. Despite the fact that the efficiency of the conventional CXL (C-CXL) protocol has already been shown in several clinical studies, it might benefit from improvements in duration of the procedure and removal of corneal epithelium. Hence, in order to provide a coherent evaluation of two new and optimized CXL protocols, we studied keratoconus patients who had undergone one of the three CXL treatments: iontophoresis (I-CXL), accelerated CXL (A-CXL), and conventional CXL (C-CXL). A-CXL is a 6 time faster CXL procedure using a ten time higher UVA irradiance but still including an epithelium removal. Iontophoresis is a transepithelial non-invasive technique in which a small electric current is applied to improve riboflavin penetration throughout the cornea. Using anterior segment optical coherence tomography (AS OCT) and in vivo confocal microscopy (IVCM), we conclude that regarding the depth of treatment penetration, conventional CXL protocol remains the standard for treating progressive keratoconus. Accelerated CXL seems to be a quick, effective and safe alternative to treat thin corneas. The use of iontophoresis is still being investigated and should be considered with greater caution. Video LinkThe video component of this article can be found at

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Section: Discussionmentioning

confidence: 90%

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

Bouheraoua

Jouve

Borderie

et al. 2015

JoVE

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“…The demarcation line appears not to be related to alteration in visual acuity or maximum keratometry. (36) Laboratory studies provide objective data which confirm that CXL is in fact effective, through the visualization, with electronic microscopy, of the increase in collagen fiber diameter. (37) Apart from greater resistance to enzymatic digestion, there is an increase in biomechanical rigidity, indicated by the increase in Young's modulus (2) identified through imaging modalities such as atomic force microscopy (38) and second-harmonic generation microscopy.…”

Section: Evaluating Treatment Effectivenessmentioning

confidence: 79%

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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“…при использовании стандартного протокола CXL фиксировали наличие демаркационной линии в среднем на глубине 303 мкм стромы по сравне-нию с тем, что имеет место при проведении кросслин-кинга по акселерированному протоколу при облучении мощностью 30 мВт/см 2 в течение 3 минут. При этом де-маркационная линия выявлялась в 212 мкм от поверхно-сти роговицы [18]. В противоположность этому, Tomita и соавт.…”

Section: Discussionunclassified

Topographic Localization of the Demarcation Line after UV Corneal Crosslinking in Progressive Keratoconus

Бикбов¹,

Суркова²,

Khalimov³

et al. 2018

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Optical Coherence Tomography and Confocal Microscopy Following Three Different Protocols of Corneal Collagen-Crosslinking in Keratoconus

Abstract: Iontophoresis was associated with weaker damage of corneal sub-basal nerves and anterior keratocytes compared to conventional procedures, but the demarcation line was present in less than 50% of cases and was more superficial than with the traditional procedure.

Cited by 87 publications

References 40 publications

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

Corneal Crosslinking: The Standard Protocol

Topographic Localization of the Demarcation Line after UV Corneal Crosslinking in Progressive Keratoconus

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