Pulsed Light Accelerated Corneal Collagen Cross-Linking: 1-Year Results

Bowes, Oliver; Coutts, Sophie Joanna; Ismailjee, Aamir; Trocmé, Eric; Vilella, Albert J.; Perry, Hank; Barsam, Allon

doi:10.1097/ico.0000000000001187

Cited by 8 publications

(6 citation statements)

References 8 publications

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“…Particularly, the decrease >1.5D in K min , K max and K m (Tables 2 and 3) at 12 months observed for 30 mW/cm 2 was noteworthy when compared to the modest decrease in keratometric parameters observed in similar reports 4,11,25. Even when Bowes et al30 reported a similar behavior to our cohort in keratometries (decrease of 1.2D in K max at 12 months, range −5.6–+1.6 D) using a pulsed-light-accelerated CXL protocol (30 mW/cm 2 ), evidence with regard to high irradiance pulsed-light protocols refractive, topographic and visual outcomes are scarce and inconclusive. Another consideration about the reported topographic result in our study is the young age of the patients; our cohort included 17 patients aged 19 or younger (mean age 19.76±4.63), and as reported in previous experience with CXL in pediatric population, a different behavior is expected in the postoperative topographic profile (changes in K max , Average K) 31,32.…”

Section: Discussionmentioning

confidence: 56%

<p>Correlation between corneal stromal demarcation line depth and topographic outcomes after two pulsed-light-accelerated crosslinking protocols</p>

Hernández-Camarena

Graue-Hernández

Loya-García

et al. 2019

OPTH

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Purpose To report the visual and topographic outcomes of two pulsed-light-accelerated CXL (A-CXL) protocols at a 12-month follow-up and their correlation with the corneal stromal demarcation line (DL) depth. Patients and methods Retrospective comparative cohort of patients with documented progressive keratoconus were included. Two epi-off pulsed-light [1s on–1s off] A-CXL protocols were compared: irradiance 30*8 and 45*5:20 (fluence 7.2 J/cm 2 ). UDVA, CDVA, spherical equivalent (SE), topographic astigmatism, K min , K max , K m , central corneal thickness (CCT), thinnest pachymetry (TCT) and endothelial cell density (ECD) were measured preoperatively and months 1, 3, 6 and 12 postoperative. Corneal DL was measured 1 month postoperatively using anterior segment optical coherence tomography. Results Fifty eyes (27 patients): 22 eyes in group A-CXL (30*8), 28 eyes in group A-CXL (45*5:20). Mean age (years) was 19.04±4.71 and 20.32±4.57. DL depth (µm) at month 1 was 200.63±10.01 µm and 184.53±19.68 µm for group A-CXL (30*8) and group A-CXL (45*5:20), respectively ( p <0.001). Significant improvement in CDVA, topographic astigmatism, K min , K max and K m was observed in both groups (no significant difference between groups) and no significant changes were observed in CCT, TCT and ECD with regard to baseline. Over 85% of the eyes in both protocols achieved stabilization or improvement in maximum K at the end of the follow-up. No significant correlations between DL and any visual or topographic outcomes were observed at 12 months. Conclusion No correlation between DL depth and visual or topographic outcomes was observed on either protocol. Although significant improvement on CDVA, topographic astigmatism, K min , K max and K m was observed in both groups at 12 months, further research is needed to assure safety and effectiveness at stabilizing keratoconus progression.

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Section: Discussionmentioning

confidence: 56%

<p>Correlation between corneal stromal demarcation line depth and topographic outcomes after two pulsed-light-accelerated crosslinking protocols</p>

Hernández-Camarena

Graue-Hernández

Loya-García

et al. 2019

OPTH

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“…Acceptable efficacy of accelerated protocols has been shown in all these studies [24,25]. By the same token, early data on the use of pulsed, accelerated CXL show that the technique is safe and effective in the treatment of KC [26,27]. Analysis of different pulsed profiles can help clarify the structural outcomes of CXL and assess the most effective treatment protocol.…”

Section: Discussionmentioning

confidence: 99%

Accelerated, Pulsed Collagen Cross-Linking versus the Dresden Protocol in Keratoconus: A Case Series

Dervenis

Dragoumis

et al. 2020

Med Princ Pract

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Purpose: The aim of our study was to compare the depth of the demarcation line developing in the cornea after the standard Dresden protocol versus the accelerated, pulsed, epithelium-off corneal collagen cross-linking (CXL). Methods: This was a nonrandomized, retrospective case series. Patients with progressive keratoconus were treated with either the standard Dresden protocol (Group 1) or accelerated, epithelium-off CXL using the Avedro (Waltham, MA, USA) device (Group 2). The accelerated CXL protocol involved 18 min of pulsed ultraviolet-A (20 mW/cm², 7.2 J/cm², pulsed pro-file: 1 s on, 2 s off). The depth of the demarcation line was measured about 3 months postoperatively. Results: Fifty-nine eyes of 35 subjects were included in the analysis. Group 1 consisted of 19 eyes, and Group 2 of 40 eyes. The mean age of the participants was 22.21 years in Group 1 and 26.55 years in Group 2 (p = 0.184). The mean preoperative K value was 44.89 D in Group 1 and 45.20 D in Group 2 (p = 0.768). The depth of the demarcation line was 322.50 μm in Group 1 and 319.95 μm in Group 2 (p = 0.937). Conclusions: The demarcation line depth was not statistically significantly different between the two protocols. The significance of the demarcation line depth has not been fully clarified in the literature. Our results support the contention that these two techniques may have similar structural outcomes and efficacies in the treatment of keratoconus.

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“…• CDVA improved by 0.11 logMAR at 6 months [49] • BCVA improved by 0.2 logMAR at 1 year [92] • BSCVA improved by 0.17 logMAR at 2 years [46] • Corneal astigmatism increased by 0.3 D at 1 year [92] • Kmax reduced by 1.2D at 1 year [92] • Flattening of Kmean and Kmax by 0.58 and 0.75 D at 2 years [46] • Thinnest corneal pachymetry reduced by 7-16 μm at 1-2 years [46,92] • CCT reduced by 6 μm at 2 years • UDVA 20/50 to 20/100 [18] • BCVA 20/30 to 20/40 [18] • Average astigmatism 3…”

Section: Intrastromal Corneal Ring Segments (Icrs)mentioning

confidence: 98%

Keratoconus Treatment Toolbox: An Update

Roongpoovapatr¹,

Shousha²,

Charukamnoetkanok³

2020

Eyesight and Medical Image Cognition - Recent Advances and New Perspectives [Working Title]

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Keratoconus is a bilateral, asymmetric, progressive disease of the cornea which can lead to visual impairment and blindness as irregular astigmatism increases and corneal scar occurs. Currently, many methods are available for a treatment of keratoconus. The treatment can help enhance visual rehabilitation and prevent progression in keratoconus patients. The treatment options included non-surgical and surgical managements. This review offers a summary of the current and emerging treatment options for keratoconus- eyeglasses, contact lens, corneal collagen cross-linking (CXL), CXL Plus, intrastromal corneal ring segment (ICRS), Corneal Allogenic Intrastromal Ring Segments (CAIRS), Penetrating Keratoplasty (PK), Deep Anterior Lamellar Keratoplasty (DALK), Bowman layer transplantation (BL transplantation) and gene therapy.

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Pulsed Light Accelerated Corneal Collagen Cross-Linking: 1-Year Results

Cited by 8 publications

References 8 publications

<p>Correlation between corneal stromal demarcation line depth and topographic outcomes after two pulsed-light-accelerated crosslinking protocols</p>

<p>Correlation between corneal stromal demarcation line depth and topographic outcomes after two pulsed-light-accelerated crosslinking protocols</p>

Accelerated, Pulsed Collagen Cross-Linking versus the Dresden Protocol in Keratoconus: A Case Series

Keratoconus Treatment Toolbox: An Update

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