Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results

Nordström, Maria; Schiller, Maria; Fredriksson, Anneli; Behndig, Anders

doi:10.1136/bjophthalmol-2016-309210

Cited by 44 publications

(37 citation statements)

References 18 publications

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“…A modified version of CXL, photorefractive intrastromal CXL (PiXL) is designed to deliver tailored UVA patterns and intensities. This customization allows for localized, non-ablative strengthening and thereby, potentially, flattening of the cornea (Kanellopoulos 2012(Kanellopoulos , 2014Nordstrom et al 2017;Schedin et al 2017). Early clinical results support the ability of PiXL to predictably flatten a myopic cornea without significant changes to the endothelial cell count (ECC) or corneal clarity Nordstrom et al 2017).…”

Section: Introductionmentioning

confidence: 82%

“…This customization allows for localized, non‐ablative strengthening and thereby, potentially, flattening of the cornea (Kanellopoulos , ; Nordstrom et al. ; Schedin et al. ).…”

Section: Introductionmentioning

confidence: 99%

“…This customization allows for localized, non-ablative strengthening and thereby, potentially, flattening of the cornea (Kanellopoulos 2012(Kanellopoulos , 2014Nordstrom et al 2017;Schedin et al 2017). Early clinical results support the ability of PiXL to predictably flatten a myopic cornea without significant changes to the endothelial cell count (ECC) or corneal clarity Nordstrom et al 2017). Lim et al (2017) followed eight subjects after PiXL in healthy myopic eyes, reporting a mean improvement of 0.25 LogMAR (2.5 Snellen lines) in uncorrected distance visual acuity at 1-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

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A prospective evaluation of photorefractive intrastromal cross‐linking for the treatment of low‐grade myopia

Fredriksson

Näslund

Behndig

2019

Acta Ophthalmologica

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Purpose To evaluate photorefractive intrastromal cross‐linking (PiXL) treatment for low‐grade myopia, comparing three treatment protocols. Methods Healthy individuals, 25.6 ± 3.6 years of age, with low‐grade myopia underwent epi‐on PiXL with either: 4‐mm zone treated in high oxygen environment (4 mm‐HIGH; n = 15), 4‐mm/room air (4‐mm LOW; n = 6), or 6‐mm/high oxygen (6‐mm HIGH; n = 6). Efficacy was determined by change in uncorrected visual acuity (UCVA), manifest refractive spherical equivalent (MRSE) and corneal curvature (Kmean) over a 12‐month follow‐up. Safety was determined by best spectacle corrected visual acuity (BSCVA), corneal endothelial cell loss and registration of side‐effects. Results Twenty‐seven subjects were included. Due to insufficient effect with the 4‐mm LOW treatment and an unacceptable degree of initial light sensitivity/ocular irritation in the 6‐mm HIGH group, the inclusions to these treatments were stopped after inclusion of 6 patients in each group. The 4‐mm HIGH treatment showed a significantly larger improvement in UCVA (−0.45 ± 0.27 LogMAR) and MRSE (+0.99 ± 0.44 D) at 1, 6 and 12 months compared with the 4‐mm LOW treatment (p < 0.05). At 12 months posttreatment, endothelial cell count and BSCVA were unaltered. More initial side‐effects were noted with the 6‐mm HIGH treatment, compared with the 4‐mm HIGH treatment (p < 0.05). Conclusion Epi‐on PiXL may become a safe and effective non‐ablative treatment for low‐grade myopia. The effect is augmented by high oxygen environment and remains stable for 12 months. The initial ocular irritation is acceptable with a 4‐mm treatment zone. The present results justify further clinical studies on PiXL, including refinements of the technique and long‐term results.

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Section: Introductionmentioning

confidence: 82%

“…This customization allows for localized, non‐ablative strengthening and thereby, potentially, flattening of the cornea (Kanellopoulos , ; Nordstrom et al. ; Schedin et al. ).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A prospective evaluation of photorefractive intrastromal cross‐linking for the treatment of low‐grade myopia

Fredriksson

Näslund

Behndig

2019

Acta Ophthalmologica

Self Cite

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“…47,50 Significant CXL side effects are unlikely to occur with a double fluence protocol since topography-guided CXL protocols with regional fluences ranging from 7.2 to 15 J/ cm 2 have been used for human keratoconus patients without detrimental effects. 61 Also, no negative effects on the corneal endothelium or retina were reported following the use of 15-20 J/cm 2 fluences in preclinical studies on nonhuman primates and 10-15 J/cm 2 fluences in a clinical safety study on blind human eyes. 62 Optical coherence tomography is a valuable diagnostic tool in PMD patients and was helpful to determine epithelial integrity and the exact remaining corneal thickness as stromal loss was slightly overestimated via slit lamp examination.…”

Section: Discussionmentioning

confidence: 93%

“…Significant CXL side effects are unlikely to occur with a double fluence protocol since topography‐guided CXL protocols with regional fluences ranging from 7.2 to 15 J/cm 2 have been used for human keratoconus patients without detrimental effects . Also, no negative effects on the corneal endothelium or retina were reported following the use of 15‐20 J/cm 2 fluences in preclinical studies on nonhuman primates and 10‐15 J/cm 2 fluences in a clinical safety study on blind human eyes…”

Section: Discussionmentioning

confidence: 99%