Posterior Linear Stromal Haze Formation after Simultaneous Photorefractive Keratectomy followed by Corneal Collagen Cross-linking

Kymionis, George D.; Portaliou, Dimitra M.; Diakonis, Vasilios F.; Kontadakis, Georgios A.; Krasia, Maria S.; Papadiamantis, Anastasios G.; Coşkunseven, Efekan; Pallikaris, Aristofanis I.

doi:10.1167/iovs.09-5105

Cited by 52 publications

(32 citation statements)

References 13 publications

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“…It has been postulated that these structures represent new synthesized collagens possibly the product of activated keratocytes [17,22,24,25]. Gradual posterior to anterior relocation of these structures has been reported by Kymionis et al during sequential examinations [26]. Recent pathological studies suggested these particles related to transient fibroblast generation as opposed to myofibroblasts [5].…”

Section: Discussionmentioning

confidence: 93%

Comparison of corneal keratocytes before and after corneal collagen cross-linking in keratoconus patients

et al. 2015

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Keratoconus is a bilateral and asymmetric corneal ectasia. Cross-linking uses ultra-violate rays to enhance corneal tissue. The purpose of this study was to use in vivo confocal microscopy to quantitatively analyze microstructural changes over time, after corneal collagen cross-linking (CXL) in keratoconus patients. In this before-and-after study, a total of 45 keratoconic eyes were selected for cross-linking among patients referred to Al-Zahra ophthalmology clinic during 2013-2014. All patients underwent complete ophthalmologic examinations. Keratocytes and the present of activated keratocytes were calculated preoperatively and at 1, 3, 6, and 12 months postoperatively using confocal microscopy. One year after CXL, best corrected and best uncorrected visual acuity was increased significantly (p < 0.001). Spherical equivalent and spherical refractive errors reduced significantly (p < 0.001). The reduction in density of anterior and mid-stromal keratocytes was significant initially (p < 0.001). During follow-up, the density of keratocytes increased significantly in all layers reaching near normal values by 12 months. The percentage of activated keratocytes showed a significant increase 1 month after cross-linking (p < 0.001) albeit this percent reduced as the corneal healing proceeded by month 12. The endothelial cells showed no significant reduction during the follow-up. Collagen cross-linking-induced significant reduction in keratocyte density. The percent of activated keratocytes increased significantly after cross-linking which showed reduction with improvement of corneal healing. After collagen cross-linking, hyper-reflective structures were observed consistent with the stromal collagen structures. Further studies are needed to assess possible changes on corneal biomechanics. The consistency in corneal endothelium numbers proves the safety of this technique.

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Section: Discussionmentioning

confidence: 93%

Comparison of corneal keratocytes before and after corneal collagen cross-linking in keratoconus patients

et al. 2015

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“…In further report, Kymionis et al demonstrated mild linear haze in the posterior stroma as a complication of the simultaneous procedure. 17 According to this report, posterior haze developed after simultaneous PRK followed by CXL in the deep stroma in about half of the studied patients. In confocal microscopic evaluation, authors detected an area with high reflectance at the level of the posterior stroma characterized by spindle-shaped and linear structures.…”

Section: Further Evidence: Simultaneous T-prk Immediately Followed Bymentioning

confidence: 73%

Update on Simultaneous Topo-guided Photorefractive Keratectomy Immediately Followed by Corneal Collagen Cross-linking for Treatment of Progressive Keratoconus

Kymionis¹,

Yoo²,

Kankariya³

et al. 2012

International Journal of Keratoconus and Ectatic Corneal Diseases

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Corneal collagen cross-linking (CXL) is a safe and effective technique for the management of corneal ecstatic disorders. It has been proven that CXL is effectual in stopping the progression of keratoconus quasi 'freezing' the cornea and in many cases avoiding corneal transplantation. Nevertheless, patients' basic problem, which is the deterioration of their vision due to irregular astigmatism, remains. CXL combined with topography-guided photorefractive keratectomy (PRK) has been developed in order to achieve an important goal. To offer patients stability of their disorder and at the same time to assist them in achieving a functional vision by improving topographic outcomes. This article discusses update on this new combination therapy in the form of topo-guided PRK immediately followed by CXL as one-step procedure for treatment of progressive keratoconus.

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“…The timing of the ablation treatment and CXL as well as the interval between the two procedures has become topics of discussion. It was reported that patients who underwent both PRK and CXL procedures on the same day obtained better clinical and topographical results with a lower rate of corneal haze, compared to patients treated sequentially 94 . This may be related to the unpredictable refractive outcomes when excimer ablation is performed on cross-linked tissues.…”

Section: Combined Treatmentmentioning

confidence: 99%

Corneal Collagen Crosslinking with Riboflavin and Ultraviolet - A Irradiation in the Management of Progressive Ectatic Corneal Disorders. Review Article

Eldine

2017

Journal of Ophthalmology and Related Sciences

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Corneal crosslinking (CXL) has been proposed as a new modality to stop progression of keratoconus or secondary corneal ectasia, aiming to prevent progressive visual loss and to delay or avoid corneal transplantation. The possibility of strengthening corneal tissue by means of a photochemical reaction of corneal collagen by the combined action of riboflavin and ultraviolet-A irradiation (UVA), radically modified the conservative management of progressive corneal ectasia. This is a review of the state of the art of CXL. The paper describes basic principles, advantages and limitations of different CXL techniques and possible future evolution of the procedure.

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Posterior Linear Stromal Haze Formation after Simultaneous Photorefractive Keratectomy followed by Corneal Collagen Cross-linking

Abstract: Posterior linear stromal haze formation may appear after simultaneous PRK followed by CXL in patients with keratoconus. This finding seems to gradually become less dense and slowly moves toward the anterior stroma.

Cited by 52 publications

References 13 publications

Comparison of corneal keratocytes before and after corneal collagen cross-linking in keratoconus patients

Comparison of corneal keratocytes before and after corneal collagen cross-linking in keratoconus patients

Update on Simultaneous Topo-guided Photorefractive Keratectomy Immediately Followed by Corneal Collagen Cross-linking for Treatment of Progressive Keratoconus

Corneal Collagen Crosslinking with Riboflavin and Ultraviolet - A Irradiation in the Management of Progressive Ectatic Corneal Disorders. Review Article

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