The efficiency and safety of oxygen-supplemented accelerated transepithelial corneal cross-linking

Aydın, Emre; Aslan, Mehmet

doi:10.1007/s10792-021-01859-1

Cited by 8 publications

(19 citation statements)

References 45 publications

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“…4, conferring a refractive power to trans-epithelial customized accelerated CXL beyond ectasia stabilization. More recently the efficacy of trans-epithelial customized crosslinking with intraoperative oxygen supplement was also conformed after 12-months follow-up as reported in the literature [48,49].…”

Section: Customized Trans-epithelial CXL With Supplemental Oxygen: Surgical Techniquementioning

confidence: 60%

Enhanced Trans-Epithelial Accelerated Crosslinking Protocols: The Way Out of Future CXL

Mazzotta¹,

Barbara²,

Maggio³

et al. 2021

Keratoconus

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Section: Customized Trans-epithelial CXL With Supplemental Oxygen: Surgical Techniquementioning

confidence: 60%

Enhanced Trans-Epithelial Accelerated Crosslinking Protocols: The Way Out of Future CXL

Mazzotta¹,

Barbara²,

Maggio³

et al. 2021

Keratoconus

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“…Ex-vivo studies have shown that periocular oxygen supplementation provides significantly more corneal stiffening (Adler et al, 2019). A randomised, agesex-matched study by Aydın et al demonstrated that patients treated with periocular oxygen supplemented accelerated epithelium-on protocol experienced a larger decrease in maximum keratometry values (p-value 0.019) and had a significantly deeper demarcation line (320 ± 17 µm) when compared to the control group (269 ± 19 µm) (Aydın and Aslan, 2021). Additionally, post-procedural endothelial cell density was comparable between both groups.…”

Section: Oxygen Supplementationmentioning

confidence: 99%

Corneal Cross-Linking: The Evolution of Treatment for Corneal Diseases

Lim

et al. 2021

Front. Pharmacol.

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Corneal cross-linking (CXL) using riboflavin and ultraviolet A (UVA) light has become a useful treatment option for not only corneal ectasias, such as keratoconus, but also a number of other corneal diseases. Riboflavin is a photoactivated chromophore that plays an integral role in facilitating collagen crosslinking. Modifications to its formulation and administration have been proposed to overcome shortcomings of the original epithelium-off Dresden CXL protocol and increase its applicability across various clinical scenarios. Hypoosmolar riboflavin formulations have been used to artificially thicken thin corneas prior to cross-linking to mitigate safety concerns regarding the corneal endothelium, whereas hyperosmolar formulations have been used to reduce corneal oedema when treating bullous keratopathy. Transepithelial protocols incorporate supplementary topical medications such as tetracaine, benzalkonium chloride, ethylenediaminetetraacetic acid and trometamol to disrupt the corneal epithelium and improve corneal penetration of riboflavin. Further assistive techniques include use of iontophoresis and other wearable adjuncts to facilitate epithelium-on riboflavin administration. Recent advances include, Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) for treatment of infectious keratitis, customised protocols (CurV) utilising riboflavin coupled with customised UVA shapes to induce targeted stiffening have further induced interest in the field. This review aims to examine the latest advances in riboflavin and UVA administration, and their efficacy and safety in treating a range of corneal diseases. With such diverse riboflavin delivery options, CXL is well primed to complement the armamentarium of therapeutic options available for the treatment of a variety of corneal diseases.

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“…Each study was conducted in a different country (Italy, Iran, Turkey, China, France, Japan), which provided an international data set. There were 4 different methods used to increase the oxygen availability within the corneal stroma during CXL: goggles, 13,15,21 facemask, 30 eyelid speculum, 20 and pulsed illumination. 31 There were 5 of 6 studies that used epithelium- on (transepithelial) accelerated method of CXL included in the meta-analysis.…”

Section: Study Selectionmentioning

confidence: 99%

“…31 There were 5 of 6 studies that used epithelium- on (transepithelial) accelerated method of CXL included in the meta-analysis. One study had room air as a control 20 and another conventional and accelerated epithelium-off CXL methods without oxygen supplementation as controls. 30 Primary Outcomes…”

Section: Study Selectionmentioning

confidence: 99%

“…Moreover, oxygen supplementation has been demonstrated to increase the depth and strength of CXL in patients. 20 Oxygen availability in the stroma during CXL can be increased by reducing the rate of consumption through pulsed illumination or using supplemental oxygen. 15 Moreover, the use of pulsed illumination and supplemental oxygen during CXL have now entered clinical practice with a limited number of clinical studies reporting outcomes from the procedure.…”

mentioning

confidence: 99%

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Oxygen in Corneal Collagen Crosslinking to Treat Keratoconus: A Systematic Review and Meta-Analysis

Borchert

Watson

Kandel

2022

Asia-Pacific Journal of Ophthalmology

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Purpose: Keratoconus is a disorder that results in visual loss from increased corneal high-order aberrations and irregular astigmatism and reduces quality of life. The primary treatment for progressive keratoconus is crosslinking (CXL). Recently, it has been suggested that oxygen enhances the type II photodynamic reaction of CXL that is oxygen dependent. Our study investigated the effect of increased oxygen availability in epithelium-on CXL on visual acuity and corneal curvature. Methods: We searched PubMed, EMBASE, Medline, Web of Science, and Scopus databases on November 3, 2021. We included studies that reported increased oxygen availability during CXL in patients with keratoconus published within the last 10 years. A meta-analysis on the primary outcomes, maximum keratometry, and corrected distance visual acuity, was conducted. Results: The search yielded 108 publications which were screened and assessed for eligibility. Six studies were included in the systematic review and 5 studies were included in our meta-analysis of the outcomes of increased oxygen availability in accelerated CXL. The meta-analysis on data after 6 months of follow-up found a significant decrease in mean maximum keratometry of 1.2 diopter (95% confidence interval: 0.2–2.3; P=0.02) and an improvement in mean corrected distance visual acuity by 0.08 logMAR (95% confidence interval, 0.02–0.13; P=0.01). There were no serious adverse events reported. Conclusions: Increasing oxygen during epithelium-on CXL improved visual acuity and produced corneal flattening without any serious adverse events in patients with keratoconus. The demarcation line depth was significantly higher with oxygen compared to the control group. Further data are required with a control group and long-term follow-up across a range of CXL protocols for implementation into standard clinical practice.

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The efficiency and safety of oxygen-supplemented accelerated transepithelial corneal cross-linking

Cited by 8 publications

References 45 publications

Enhanced Trans-Epithelial Accelerated Crosslinking Protocols: The Way Out of Future CXL

Enhanced Trans-Epithelial Accelerated Crosslinking Protocols: The Way Out of Future CXL

Corneal Cross-Linking: The Evolution of Treatment for Corneal Diseases

Oxygen in Corneal Collagen Crosslinking to Treat Keratoconus: A Systematic Review and Meta-Analysis

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