Predictive Factors of the Standard Cross-linking Outcomes in Adult Keratoconus: One-Year Follow-Up

Badawi, Amani E; Samra, Waleed Abou; Ghafar, Ayman Abd El

doi:10.1155/2017/4109208

Cited by 16 publications

(16 citation statements)

References 27 publications

(38 reference statements)

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“…However, patients in whom CXL failed had a thinner cornea (p < 0.01 * ) when failure was defined as the presence of one or both criteria. Studies in the literature contradict one another concerning pachymetry; findings of Godefrooij et al are comparable with ours [21], Badawi et alshowed in their study that thinner corneas were good predictors for postoperative CDVA improvement only without any effect on keratometry [18] while Toprak et al stated that thinner corneas exhibited more flattening post-CXL [26].…”

Section: Discussionsupporting

confidence: 68%

“…Additionally, the mean TP showed a significant reduction than the baseline values (p < 0.01 * ). Other studies reported the same results, suggesting that the postoperative thinning may be due to compression of collagen fibrils, changes in corneal hydration and edema, and keratocyte apoptosis [15,18,19]. On the contrary, corneal thickness remained unchanged in other series [11].…”

Section: Discussionmentioning

confidence: 54%

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Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus

Farhat

Ghannam

Azar

et al. 2020

Journal of Ophthalmology

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Purpose. To report predictive factors of outcome of conventional epithelium-off corneal crosslinking (CXL) in the treatment of progressive keratoconus. Methods. This is a monocentric observational retrospective study conducted at Eye and Ear International Hospital, Lebanon. All patients with progressive keratoconus who underwent CXL between January 2008 and January 2016, with minimal 3-years follow-up were included. Primary treatment outcomes were maximum keratometry (K max), best-corrected distance visual acuity (CDVA), and failure. Failure was defined as an increase of 1.00 diopters (D) or more in K max and/or an increase of 0.1 logMAR or more in CDVA and conversion to corneal transplantation. Statistical analysis was done to identify predictors of treatment success. Univariate and multivariate analyses were performed to determine the correlations between baseline parameters and outcomes, and an equation for predicting K max and CDVA was created. Results. 156 eyes of 102 patients were enrolled. The mean age was 23.85 ± 6.52 years. Failure occurred in 31 eyes (19.87%). Gender and thinnest pachymetry did not have any impact on postoperative outcomes. Concerning the CDVA outcome, multivariate analysis showed that a better preoperative CDVA was associated with higher improvement in CDVA, and higher baseline K max and higher posterior mean K were associated with a worse outcome CDVA. Regarding postoperative K max, a higher baseline K max, a worse baseline CDVA, and a younger age were associated with less flattening postoperatively. Conclusion. CXL is a safe and effective method in treating progressive keratoconus. However, the clinical benefits can differ among patients, and in our series, a nonnegligible number of cases show a continued progression of their ectasia. Further studies to identify predictors of postoperative progression prior to the procedure could help sort out good responders to treatment.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 54%

Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus

Farhat

Ghannam

Azar

et al. 2020

Journal of Ophthalmology

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“…The two most significant indicators of improvement in vision after corneal CXL were the preoperative values of low CDVA (≤ 20/40) and high K-max values (≥ 55 D). 1 , 8 , 20 , 21 In the current study, the central KCs exhibited lower average values for the preoperative CDVA, with higher K-max values (0.25 ± 0.04 log MAR and 56.6 D) compared to paracentral KC (0.1 ± 0.2 log MAR and 53.84 D), which could explain these results. The greater improvement in the CDVA in the central cones is in accordance with what has been published by other authors, 22 , 23 and this may be due to the fact that the central area is closer to the radiation of the CXL, so the intensity of radiation is higher than in the paracentral region, plus the depth does not appear to be homogeneous within the treatment area, exhibiting a decrease towards the periphery of the cornea.…”

Section: Discussionsupporting

confidence: 41%

Epithelium-Off vs. transepithelial corneal collagen crosslinking in progressive keratoconus: 3 years of follow-up

Arance-Gil

Villa-Collar

Pérez-Sánchez

et al. 2021

Journal of Optometry

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Purpose To compare the efficacy of epithelium-off corneal collagen crosslinking (CXL) with transepithelial CXL in patients with progressive keratoconus with a follow-up of 3 years, taking into account the patients’ age and the location of the corneal ectasia. Methods In this prospective study participated 64 eyes with progressive keratoconus were included in this long-term study, of which 31 eyes were treated by epithelium-off CXL and 33 by transepithelial CXL. All of the patients with a follow-up of 36 months were evaluated for visual variables (corrected distance visual acuity (CDVA), corneal aberrations, and corneal densitometry), structure variables (astigmatism, keratometry, corneal asphericity, maximum posterior elevation, corneal thickness, and corneal volume), and keratoconus index variables. Results After corneal CXL, CDVA improved significantly in both central and paracentral keratoconus, with greater improvement in the centrals (p = 0.001), asphericity at 6 mm improved in central keratoconus (p = 0.047). In the epi-off group, there was a significant improvement in coma-like (p = 0.038), higher-order aberrations (p = 0.036), asphericity at 8 mm (p = 0.049), asphericity at 10 mm (p = 0.049), and index of surface variance (p = 0.049). Conclusion Although both techniques halted and stabilized the progression of keratoconus, epithelium-off CXL was more effective. In addition, after the corneal CXL, there was a greater degree of regularization of the corneal surface and, therefore, a greater improvement in the CDVA with central keratoconus than with paracentral keratoconus.

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“…Some authors have reported significant improvement of BCDVA [ 15 , 40 , 41 ], while others did not support that [ 12 , 14 , 31 ]. According to some recently available data [ 42 – 44 ], preoperative keratometry has a significant impact on postoperative outcome in terms of visual acuity, i.e. patients with higher preoperative keratometry values are likely to show more improvement in BCDVA.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing haze formation and corneal flattening, and the impact of haze on visual acuity after conventional collagen cross-linking: a 12-month retrospective study

et al. 2021

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Background Our aim was to determine associations of pachymetry, keratometry, and their changes with haze formation and corneal flattening after collagen cross-linking, and to analyse the relationship between postoperative haze and visual outcome. Methods Retrospective analysis was performed on 47 eyes of 47 patients with keratoconus using the Pentacam HR Scheimpflug camera before and 1, 3, 6 and 12 months after cross-linking. Corneal backscattered light values in grey scale unit were recorded in the anterior, center and posterior corneal layers and in four concentric rings. Surface area- and thickness-corrected grey scale unit values were assessed with an additional calculation. Friedman test with post hoc Wilcoxon signed-rank test was used to analyse changes in visual acuity, pachymetry, keratometry and densitometry. Spearman’s rank correlation test was used to detect correlations of haze formation and corneal flattening with pachymetry, keratometry and their postoperative change. Generalized estimating equations analysis was used to investigate the influence of densitometry values on postoperative visual acuity after controlling for the effect of preoperative keratometry. Results One year after treatment, significant flattening was observed in maximum and mean keratometry readings (p < 0.001). Significantly increased densitometry values were observed in three central rings compared to baseline (post hoc p < 0.0125). According to receiver operating characteristic curve, densitometry value of the anterior layer of 0–2 mm ring was the most characteristic parameter of densitometry changes after cross-linking (area under the curve = 0.936). Changes in haze significantly correlated with preoperative maximum keratometry (R = 0.303, p = 0.038) and with the changes in maximum keratometry (R = -0.412, p = 0.004). Changes in maximum keratometry correlated with preoperative maximum keratometry (R = -0.302, p = 0.038). Postoperative haze had a significant impact on uncorrected and best corrected distance visual acuity (β coefficient = 0.006, p = 0.041 and β coefficient = 0.003, p = 0.039, respectively). Conclusions Our findings indicate that in more advanced keratoconus more significant corneal flattening effect parallel with haze formation can be observed after cross-linking. Despite significant reduction of keratometry, postoperative corneal haze may limit final visual acuity.

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Predictive Factors of the Standard Cross-linking Outcomes in Adult Keratoconus: One-Year Follow-Up

Cited by 16 publications

References 27 publications

Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus

Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus

Epithelium-Off vs. transepithelial corneal collagen crosslinking in progressive keratoconus: 3 years of follow-up

Factors influencing haze formation and corneal flattening, and the impact of haze on visual acuity after conventional collagen cross-linking: a 12-month retrospective study

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