Pachymetry and Elevation Back Map Changes in Keratoconus Patients After Crosslinking Procedure

Pjano, Melisa Ahmedbegović; Biščević, Alma; Grišević, Senad; Gabrić, Ivan; Salkica, Ajla Skopljak; Ziga, Nina

doi:10.5455/medarh.2020.74.105-108

Cited by 5 publications

(6 citation statements)

References 18 publications

(15 reference statements)

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“…The distributions of measurements at 6 and 12 months post-op exclude, with 95% confidence, any mean changes of greater than −2.8 or +3.7 microns. This contrasts with prior reports of epithelium-off CXL where mean corneal thinning was observed, 8–10 up to approximately 50 microns at 3-months, and with a mean of about 20 microns of thinning persisting at 12 months post-op. 8–10 Only the 3-month distribution of changes observed here differed from a normal distribution, corresponding to the 3-month peak in mean corneal thinning previously observed with epi-off techniques.…”

Section: Discussioncontrasting

confidence: 99%

“…This contrasts with prior reports of epithelium-off CXL where mean corneal thinning was observed, 8–10 up to approximately 50 microns at 3-months, and with a mean of about 20 microns of thinning persisting at 12 months post-op. 8–10 Only the 3-month distribution of changes observed here differed from a normal distribution, corresponding to the 3-month peak in mean corneal thinning previously observed with epi-off techniques. Further research is needed to elucidate the origin of these effects at 3-months, which may be technique-dependent physiological changes (ie, thinning due to epithelial removal) and/or optical changes (ie, optical density changes during epithelial healing).…”

Section: Discussioncontrasting

confidence: 99%

“…Previous reports of epi-off CXL have shown that pachymetry reaches its thinnest point approximately 3-months post-procedure. 8–10 We measured corneal thickness after a novel epithelium-on corneal cross-linking (EpiSmart) procedure. The procedure was previously tested in vivo to confirm adequate loading of riboflavin in corneal stroma, 20 which has been elusive with other transepithelial methods.…”

Section: Discussionmentioning

confidence: 99%

“…Corneal thinning is commonly seen in keratoconic eyes after epithelium-off crosslinking and is hypothesized to be due to either a direct effect of corneal crosslinking (CXL), secondary to keratocyte death, epithelial removal, and/or stromal loss secondary to inflammation. 1 , 6 , 7 Post epithelium-off CXL thinning, 8–10 however, can confound the evaluation of the procedure’s safety and efficacy during the healing period. This study assesses changes in corneal pachymetry one year after a novel epithelium-on CXL treatment.…”

Section: Introductionmentioning

confidence: 99%

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Pachymetric Assessment After EpiSmart® Epithelium-on Cross-Linking for Keratoconus and Post-Surgical Ectasia

Vaidya¹,

Daneshmand²,

Epstein³

et al. 2022

OPTH

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Purpose To assess the change in corneal pachymetry after a novel epithelium-on (EpiSmart ® ) corneal crosslinking procedure (CXL). Methods Eyes treated as part of the open-label, non-controlled arm of the study “Collagen Crosslinking with Ultraviolet-A in Asymmetric Corneas” (NCT01097447) were examined at baseline, 3-, 6- and 12-months post-CXL. Thinnest pachymetry readings based on Pentacam (OCULUS GmbH, Wetzlar, Germany) were recorded. Results A total of 101 eyes met the study inclusion criteria. Thinnest pachymetric readings at baseline averaged 451 ± 50 microns. The mean (± SD) minimum thickness was 450 ± 46 microns at 3 months, 452 ± 47 microns at 6 months, and 451 ± 48 microns at 12 months post-CXL. The changes from baseline (mean ± SE) at 3, 6, and 12 months post-CXL were −1.2 ± 1.5 microns, 0.5 ± 1.6 microns, and 0.4 ± 1.6 microns, respectively. Student’s t-tests showed no statistically significant change in pachymetry from baseline for any exam period. Conclusion This study demonstrated that, after EpiSmart ® epithelium-on CXL, there was no substantial corneal thinning observable on Scheimpflug tomography out to 12 months.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pachymetric Assessment After EpiSmart® Epithelium-on Cross-Linking for Keratoconus and Post-Surgical Ectasia

Vaidya¹,

Daneshmand²,

Epstein³

et al. 2022

OPTH

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“…Keďže hrúbka rohovky po CXL zákroku v mieste apexu už bola opakovane skúmaná [9,21,22], rozhodli sme sa zamerať na hrúbku rohovky v dvoch odlišných bodochv najtenšom mieste rohovky a v centre rohovky. Smadja et al poukázali na signifikantný rozdiel v hrúbke rohovky medzi zdravými rohovkami a tými, ktoré sú postihnuté keratokónusom [20].…”

Section: Diskusiaunclassified

Specific Corneal Parameters and Visual Acuity Changes After Corneal Crosslinking Treatment for Progressive Keratoconus

Veselý¹,

Vesely²,

Combová³

et al. 2021

CSO

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Aim: To evaluate the effect of crosslinking (CXL) therapy on the change in the quality of visual acuity and the change in the topographic properties of the cornea – curvature, pachymetry, and change of astigmatism, coma abberation and CLMIaa (Cone Localisation and Magnitude Index). Methods: A retrospective analytical study included 29 eyes of 24 patients who had progressed in the last 12 months and were suitable candidates for CXL surgery. The monitored parameters were the steepest, flatest and mean anterior instantaneous curvature (AICS, AICF, AICM) and the steepest, flatest and mean posterior instantaneous curvature (PICS, PICF, PICM) of the cornea, corneal thickness in the centre of the cornea (PACHC) and in the thinnest point of the cornea (PACHT), corneal astigmatism (ASTIG). coma (COMA), Cone Localization and Magnitude Index (CLMIaa) and uncorrected distance visual acuity (UDVA) with corrected distance visual acuity (CDVA). Data were analysed before surgery and 12 months after surgery. The AIC, COMA, CLMIaa and ASTIG parameters were analysed by paired t test. As the parameters of UDVA, CDVA, PIC and PACH did not meet the conditions of normal distribution, the Wilcoxon test was used to investigate the change in these parameters after CXL. Results: Twelve months after the procedure, we recorded an improvement in UDVA (p = 0.371) and CDVA (p = 0.825), an increase in PICS, PICF and PICM (p = 0.902; p = 0.87 and p = 0.555), a decrease in PACHCC (p = 0.294) and a decrease in CLMIaa (p = 0.113) that did not reach statistical significance. The decrease in PACHT (p = 0.027), decrease in COMA (p = 0.037) and decrease in anterior corneal curvature of AICS, AICF and AICM were statistically significant (p = 0.019; p = 0.010 and p = 0.005). The decrease in the value of astigmatism did not show statistical significance, as p = 0.297. Conclusion: CXL corneal therapy has been shown to be an effective method to stabilize the cornea in progressive keratoconus, and to improve the higher order of coma. This contributes to the possible improvement of UDVA and CDVA.

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Could Automated Objective Measurements Acquired at the Preoperative Stage Estimate the Corrected Distance Visual Acuity after Corneal Cross-Linking in Keratoconus?

Gilevska,

Biscevic,

Bohac

et al. 2024

Ophthalmol Ther

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Introduction Objective markers describing corneal optical density (COD), thinnest corneal thickness (TCT), and anterior (ARC) and posterior (PRC) surface radii over the 3 mm thinnest region of the cornea were investigated to provide a model for estimating corrected distance visual acuity (CDVA) after corneal cross-linking (CXL) in keratoconus. Methods CDVA, COD, TCT, ARC, and PRC were monitored (using Pentacam™) over 1 year in patients with (1) keratoconus treated with routine CXL (2) relatively stable untreated keratoconus, and (3) age/gender-matched controls. Results In group 1 ( n = 77), the median logMAR CDVA (mode, interquartile range) improved significantly ( p < 0.01) from 0.26 (0.22, 0.12–0.65) to 0.07 (0.00, 0.02–0.21). The mean (± standard deviation, 95% confidence interval) COD (in 0–100 grey scale units) in the 0–2 mm central anterior corneal region (0–2 ant), TCT (µm), ARC (mm), and PRC (mm) changed significantly ( p < 0.01), from 21.2 (± 3.70, 20.4–22.0), 454 (± 40.0, 446–462), 6.49 (± 0.71, 6.33–6.65), and 4.81 (± 0.65, 4.66–4.96) to 31.5 (± 9.19, 29.5–33.6), 423 (± 49.3, 412–434), 6.78 (± 0.80, 6.60–6.98), and 4.74 (± 0.64, 4.59–4.88), respectively, but remained stable in groups 2 ( n = 23) and 3 ( n = 24). Significant relationships ( p < 0.01) were uncovered between postop CDVA and preop values of COD, TCT, ARC, and PRC. Multilinear regression revealed significant correlations between CDVA at 1 year and preop COD, TCT, ARC, and PRC ( r 2 = 0.533, r 2 0-2ant = 0.126, r 2 TCT = 0.321, r 2 ARC = 0.506, r 2 PRC = 0.467). Including preop CDVA further enhanced this correlation ( r 2 = 0.637, r 2 LogMAR CDVApreop = 0.566). Conclusion CXL improved CDVA, increased COD and ARC, and reduced TCT and PRC. The chance of correctly estimating the CDVA at 1 year after CXL using preoperative markers of COD, TCT, ARC, and PRC is 53%, improving to 64% with the inclusion of preoperative CDVA. Objective measurements taken at the preoperative screening stage may be useful to estimate the likely postoperative CDVA when preoperative CDVA measures are unreliable or unobtainable. Trial Registration ClinicalTrials.gov identifier, NCT06522789.

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Pachymetry and Elevation Back Map Changes in Keratoconus Patients After Crosslinking Procedure

Cited by 5 publications

References 18 publications

Pachymetric Assessment After EpiSmart® Epithelium-on Cross-Linking for Keratoconus and Post-Surgical Ectasia

Pachymetric Assessment After EpiSmart® Epithelium-on Cross-Linking for Keratoconus and Post-Surgical Ectasia

Specific Corneal Parameters and Visual Acuity Changes After Corneal Crosslinking Treatment for Progressive Keratoconus

Could Automated Objective Measurements Acquired at the Preoperative Stage Estimate the Corrected Distance Visual Acuity after Corneal Cross-Linking in Keratoconus?

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