Theoretical Basis, Laboratory Evidence, and Clinical Research of Chemical Surgery of the Cornea: Cross-Linking

Paz, Amanda C. da; Bersanetti, Patrícia Alessandra; Salomão, Marcella Q.; Ambrósio, Renato; Schor, Paulo

doi:10.1155/2014/890823

Cited by 10 publications

(6 citation statements)

References 87 publications

(113 reference statements)

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“…These cases typically have from less optimal to poor results after LVC and are at very high risk for iatrogenic ectasia development after the surgical procedure [12,13]. Furthermore, the advent of collagen crosslinking and other treatment modalities such as intracorneal ring segments (ICRS) has made relevant the identification of milder or subclinical forms of ectatic corneal diseases along with monitoring the disease progression [14,15].…”

Section: Introductionmentioning

confidence: 99%

The Role of Corneal Biomechanics for the Evaluation of Ectasia Patients

Salomão

Hofling-Lima

Esporcatte

et al. 2020

IJERPH

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Purpose: To review the role of corneal biomechanics for the clinical evaluation of patients with ectatic corneal diseases. Methods: A total of 1295 eyes were included for analysis in this study. The normal healthy group (group N) included one eye randomly selected from 736 patients with healthy corneas, the keratoconus group (group KC) included one eye randomly selected from 321 patients with keratoconus. The 113 nonoperated ectatic eyes from 125 patients with very asymmetric ectasia (group VAE-E), whose fellow eyes presented relatively normal topography (group VAE-NT), were also included. The parameters from corneal tomography and biomechanics were obtained using the Pentacam HR and Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany). The accuracies of the tested variables for distinguishing all cases (KC, VAE-E, and VAE-NT), for detecting clinical ectasia (KC + VAE-E) and for identifying abnormalities among the VAE-NT, were investigated. A comparison was performed considering the areas under the receiver operating characteristic curve (AUC; DeLong’s method). Results: Considering all cases (KC, VAE-E, and VAE-NT), the AUC of the tomographic-biomechanical parameter (TBI) was 0.992, which was statistically higher than all individual parameters (DeLong’s; p < 0.05): PRFI- Pentacam Random Forest Index (0.982), BAD-D- Belin -Ambrosio D value (0.959), CBI -corneal biomechanical index (0.91), and IS Abs- Inferior-superior value (0.91). The AUC of the TBI for detecting clinical ectasia (KC + VAE-E) was 0.999, and this was again statistically higher than all parameters (DeLong’s; p < 0.05): PRFI (0.996), BAD-D (0.995), CBI (0.949), and IS Abs (0.977). Considering the VAE-NT group, the AUC of the TBI was 0.966, which was also statistically higher than all parameters (DeLong’s; p < 0.05): PRFI (0.934), BAD- D (0.834), CBI (0.774), and IS Abs (0.677). Conclusions: Corneal biomechanical data enhances the evaluation of patients with corneal ectasia and meaningfully adds to the multimodal diagnostic armamentarium. The integration of biomechanical data and corneal tomography with artificial intelligence data augments the sensitivity and specificity for screening and enhancing early diagnosis. Besides, corneal biomechanics may be relevant for determining the prognosis and staging the disease.

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Section: Introductionmentioning

confidence: 99%

The Role of Corneal Biomechanics for the Evaluation of Ectasia Patients

Salomão

Hofling-Lima

Esporcatte

et al. 2020

IJERPH

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“…treatment penetration) that may have significant biomechanical and clinical implications in terms of long-term ectasia stabilization and treatments functional outcomes. [31,32] IVCM and corneal optical coherence tomography (OCT) data, verifying the postoperative cells apoptosis, nerves disappearance and the demarcation lines induced by A-CXL, showed a mean treatment penetration of 150 µm (range 140-200 µm measured from epithelial surface) after 30 mW/cm 2 continuous light A-CXL and 220 µm (range 200-250 µm measured from the epithelial surface) after fractionated or pulsed light A-CXL. [18,27] Transepithelial CXL and A-CXL showed a limited and uneven cell apoptosis confined in the anterior stroma under the Bowman's lamina at a mean depth of 80 µm (range 50-100 µm) with no evidences of demarcation lines both at IVCM and at spectral domain corneal OCT. [18,33] A limited biomechanical transfer was documented after transepithelial CXL by Brillouin microscopy [34] testing and an insufficient (short-term) ectasia stabilization was demonstrated in over 2 year follow-up clinical studies, especially in pediatric patients 18 years and under with faster keratoconus progression.…”

Section: Expert Reviewmentioning

confidence: 77%

Slowing the Progression of Keratoconus - Turning to Corneal Crosslinking

Mazzotta

Rechichi²,

Traversi

et al. 2016

Expert Review of Ophthalmology

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Riboflavin UV-A Corneal Crosslinking was developed in the 1990s to treat progressive keratoconus. Its indication was rapidly extended to iatrogenic corneal ectasias. Conventional 3mW/cm2 CXL represents the gold standard therapy in multiple Countries around the World to halt the progression of early stages corneal ectasia demonstrating good long-term visual results and low complications. Early diagnosis, slowing the progression of keratoconus turning to native corneal crosslinking spirit: stabilizing ectasia progression preventing corneal shape modification, is the key. Conventional and Accelerated CXL protocols demonstrated a medium-long term improvement in visual and topo-aberrometric parameters. New conservative approaches such as topography-guided CXL and CXL-plus corneal reshaping techniques are under investigation for patients with poor spectacles corrected visual acuity and contact lenses intolerance before keratoplasty

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“…23 Some complications were observed in eyes subjected to CXL, such as corneal haze, postoperative infection or ulcer, peripheral infiltrates, and treatment failure with keratoconus progression. 24 Thus, different alternatives to the Dresden protocol have been proposed in the literature, 25,26 such as transepithelial CXL. Raiskup et al 27 verified that the transepithelial riboflavin solution should contain no dextran, but it should include 0.01% benzalconium chloride and 0.44% NaCl to promote the permeability of riboflavin through the epithelium, resulting in a sufficient concentration in the corneal stroma.…”

Section: Discussionmentioning

confidence: 99%