Patient selection for corneal collagen cross-linking: an updated review

Galvis, Virgilio; Tello, Alejandro; Ortiz, Alvaro I.; Escaf, Luis

doi:10.2147/opth.s101386

Cited by 30 publications

(22 citation statements)

References 118 publications

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“…Furthermore, all patients signed written consents before surgery approving the surgical procedures and approving the use of their medical data in scientific research work. Only cases with documented keratoconus progression were treated (Galvis et al 2017).…”

Section: Patientsmentioning

confidence: 99%

Standard cross‐linking versus photorefractive keratectomy combined with accelerated cross‐linking for keratoconus management: a comparative study

Iqbal

Elmassry

Tawfik

et al. 2018

Acta Ophthalmologica

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Purpose To compare the safety and efficacy of standard 30 min epithelium‐off cross‐linking ( CXL ) versus photorefractive keratectomy ( PRK ) combined with accelerated epithelium‐off cross‐linking ( AXL ) for the treatment of progressive keratoconus ( CXL ‐Plus). Methods This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL . Group B included 67 eyes treated with combined PRK and AXL . The recorded data included UDVA , CDVA , subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow‐up. Results In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (Log MAR ± SD ). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (Log MAR ± SD ). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D. Conclusion Surprisingly, standard CXL showed close results to CXL ‐Plus at the 24th follow‐up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL ‐Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long‐term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL .

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Section: Patientsmentioning

confidence: 99%

Standard cross‐linking versus photorefractive keratectomy combined with accelerated cross‐linking for keratoconus management: a comparative study

Iqbal

Elmassry

Tawfik

et al. 2018

Acta Ophthalmologica

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“…Unfortunately, failures and progression of keratectasia have also been reported, as a result of CXL. The best candidates for CXL are patients with progressive KC, but that is not the only criteria [ 38 ]. Candidates for CXL should also be between the ages 16 and 40 years, with a minimum corneal thickness of 400 microns, maximal keratometry <60 D (Pentacam), and have no other known corneal disease.…”

Section: Discussionmentioning

confidence: 99%

Collagen cross-linking impact on keratoconus extracellular matrix

2018

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BackgroundKeratoconus (KC) is a common multifactorial ectatic corneal disease with unknown onset. KC most commonly appears in adolescence and affects approximately 1:400 people worldwide. Treatment options, for advanced KC cases, are collagen cross-linking (CXL) and corneal transplants. CXL is a new KC treatment that helps arrest the disease. Unfortunately, only a fraction of KC patients will qualify for CXL treatment. Our goal, in this study, was to begin to understand how CXL affects the corneal microenvironment and pave the way towards a more patient-driven CXL treatment.MethodsPrimary human corneal fibroblasts from healthy and KC donors were plated on transwell polycarbonate membranes and stimulated by a stable vitamin C. At 4 weeks, riboflavin was added followed by UVA irradiation. Transmission Electron Microscopy (TEM) and western blots were used to assess the effect of CXL on the extracellular matrix (ECM) and the resident cells, pre- and post CXL.ResultsData shows CXL improved lamellar organization showing more organized collagen fibrils decorated with proteoglycans (PGs). The distribution of the collagen fibrils and interfibrillar spacing was also visibly improved, post-CXL. Lumican, mimecan, and decorin were the dominant PGs and were significantly upregulated in post-CXL cultures. ECM degradation proteins, matrix metalloproteinases (MMPs), MMP-1, -3, and -9, but not MMP-2, were significantly downregulated post-CXL. TIMP-1 and -2 were not modulated by CXL.ConclusionThe unknown effects of CXL on the human corneal microenvironment have hampered our ability to make CXL available to all KC patients. Our current study provides a deeper understanding on CXL activity, using our unique 3D in vitro model.

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“…CXL, intended to create a stiffening of the cornea, has been an accepted therapeutic intervention to stabilize corneal ectasia for patients with more than 400 μm of central corneal thickness [ 6 , 10 – 12 ]. However, this case was not suitable for CXL due to a corneal thickness under 400 μm.…”

Section: Discussionmentioning

confidence: 99%

“…1 a&b). As the patient’s corneal thickness was exceedingly thin at less than 400 μm, a CXL procedure was not recommended [ 12 ]. A lenticule addition procedure was approved by the Ethics Committee of the Fudan University EENT Hospital Review Board.…”

Section: Case Presentationmentioning

confidence: 99%

Thirty-month results after the treatment of post-LASIK ectasia with allogenic lenticule addition and corneal cross-linking: a case report

Yang

Zhao

et al. 2018

BMC Ophthalmol

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BackgroundTo report a first case of lenticule addition and corneal cross-linking for post-LASIK ectasia with associated corneal thinning.Case presentationLenticule addition followed by corneal cross-linking was performed on the left eye of a patient with post-LASIK ectasia. Postoperatively, the corneal power and elevation were stable with a remarkable improvement in corneal thickness, and the lenticule had merged with the adjacent corneal stroma at 30 months follow-up. The patient’s corrected distance visual acuity gained two lines.ConclusionsThis case provides a potential treatment option for patients with keratectasia and keratoconus in association with thin corneal thickness (less than 400 μm) and may provide the benefit of delaying or avoiding the need for keratoplasty, which has its own associated complications and is limited by the availability of donor corneas.

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Patient selection for corneal collagen cross-linking: an updated review

Cited by 30 publications

References 118 publications

Standard cross‐linking versus photorefractive keratectomy combined with accelerated cross‐linking for keratoconus management: a comparative study

Standard cross‐linking versus photorefractive keratectomy combined with accelerated cross‐linking for keratoconus management: a comparative study

Collagen cross-linking impact on keratoconus extracellular matrix

Thirty-month results after the treatment of post-LASIK ectasia with allogenic lenticule addition and corneal cross-linking: a case report

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