Parasurgical therapy for keratoconus by riboflavin–ultraviolet type A rays induced cross-linking of corneal collagen

Caporossi, Aldo; Baiocchi, Stefano; Mazzotta, Cosimo; Traversi, Claudio; Caporossi, Tomaso

doi:10.1016/j.jcrs.2006.01.091

Cited by 405 publications

(365 citation statements)

References 15 publications

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“…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%). 9,11,12,16 Arguably, the rate depends on the inclusion criteria, and further investigations are needed to define factors predicting the risk of failure. Including patients with high K max values could be one reason for the higher rate of failures.…”

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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“…The therapeutic potential of CXL to treat progressive keratoconus was demonstrated in a clinical pilot study, 3 as well as in controlled prospective studies and in case reports and case series of patients with iatrogenic keratectasia after refractive laser surgery. [7][8][9][10] Before the first application in humans in 1999, 3 the parameters of the method (riboflavin concentration, intensity and wavelength of UVA light, and duration of treatment) were established in a series of time-and dose-response assays in animal models over several years. [2][3][4][11][12][13][14] To protect the corneal endothelium and deeper ocular structures, the currently used treatment parameters are set so the anterior 250 to 350 mm of corneal stroma are treated.…”

mentioning

confidence: 99%

Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas

Hafezi¹,

Mrochen²,

Iseli³

et al. 2009

Journal of Cataract and Refractive Surgery

311

230

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Corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light is a method for treating progressive keratectasia. The currently accepted treatment parameters induce collagen crosslinking in the anterior 250 to 350 mm of corneal stroma. To protect the endothelium, CXL inclusion criteria require a minimum corneal thickness of 400 mm after removal of the epithelium. In advanced keratoconus, however, progressive corneal thinning often leads to a remaining stromal thickness of less than 400 mm. We have therefore modified the current treatment protocol by preoperatively swelling thin corneas to a stromal thickness of at least 400 mm using hypoosmolar riboflavin solution. This treatment protocol was performed in a case series of 20 patients, and no complications were observed. Preoperative swelling of the cornea safely broadens the spectrum of CXL indications to thin corneas that would otherwise not be eligible for treatment.

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“…Conforme previsto em trabalhos anteriores, a irradiação da riboflavina por fonte luminosa foi capaz de causar alterações biomecânicas no estroma corneano (2)(3)(4)(5)(6) . De acordo com trabalhos relacionados com a bioquímica de alimentos, a luz visível não ultravioleta é capaz de degradar a riboflavina e subprodutos com a geração de radicais livres oxidantes (8,10) .…”

Section: Discussionunclassified

“…O processo de "cross-linking" já é conhecido dos bioquímicos através da glicolização das fibrilas de colágeno, fato este que corrobora a ausência de casos de ceratocone em pacientes previamente diabéticos. Devido aos altos níveis de glicose, ocorre a glicolização das fibrilas de colágeno (5) .…”

Section: Introductionunclassified

Alterações biomecânicas da córnea porcina com riboflavina fotossensibilizada por luz não-ultravioleta

Grottone

Suga

Matsuda

et al. 2008

Rev. bras.oftalmol.

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RESUMOObjetivo: Demonstrar a possibilidade de alterar a plasticidade do estroma corneano através da utilização do agente fotossensível riboflavina associado ao uso de iluminação não-ultravioleta. Métodos: Experimento prospectivo duplo cego. Vinte e cinco olhos de porcos enucleados até 24 horas antes do experimento, foram divididos nos seguintes grupos: Grupo RB01+L-Riboflavina 0,1% com irradiação de luz azul; Grupo RB01-Riboflavina 0,1% sem irradiação de luz azul; Grupo RB05+L-Riboflavina 0,5% com irradiação de luz azul; Grupo RB05-Riboflavina 0,5% sem irradiação; Grupo L-Solução salina balanceada e irradiação de luz azul. Resultados: Após o tratamento das informações dos grupos estudados, obtivemos diferenças estatisticamente significantes no grupos RB01+L e RB05+L(p<0,05). Os grupos sem irradiação de luz azul e o grupo somente com irradiação da luz azul sem riboflavina, não apresentaram diferenças estatisticamente significantes. Conclusão: A utilização de riboflavina para efetuar o processo de aumento de ligações covalentes entre as fibrilas colágenas pode ser uma das chaves para o controle de doenças da córnea como o ceratocone. Nas concentrações estudadas e doses de irradiância concebidas, o processo de aumento das características biomecânicas da córnea foram obtidas com sucesso.

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Parasurgical therapy for keratoconus by riboflavin–ultraviolet type A rays induced cross-linking of corneal collagen

Abstract: Refractive results showed a reduction of about 2.5 D in the mean spherical equivalent, topographically confirmed by the reduction in mean K. Results of surface aberrometric analysis showed improvement in morphologic symmetry with a significant reduction in comatic aberrations.

Cited by 405 publications

References 15 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

Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas

Alterações biomecânicas da córnea porcina com riboflavina fotossensibilizada por luz não-ultravioleta

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