Transepithelial Cross-Linking in Keratoconus Patients

Filippello, Massimo; Stagni, Edoardo; Buccoliero, Donato; Bonfiglio, Vincenza; Avitabile, Teresio

doi:10.1097/opx.0b013e318269c8e5

Cited by 20 publications

(18 citation statements)

References 21 publications

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“…To date, the efficacy of CXL treatment can be monitored only indirectly by postoperative follow-up observations, such as with a Scheimpflug camera,12 or with corneal confocal microscopy 13…”

Section: Introductionmentioning

confidence: 99%

Introduction of quantitative and qualitative cornea optical coherence tomography findings induced by collagen cross-linking for keratoconus: a novel effect measurement benchmark

Kanellopoulos¹,

Asimellis²

2013

OPTH

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PurposeTo introduce a novel, noninvasive technique to determine the depth and extent of anterior corneal stroma changes induced by collagen cross-linking (CXL) using quantitative analysis of high-resolution anterior-segment optical coherence tomography (OCT) post-operative images.SettingPrivate clinical ophthalmology practice.Patients and methodsTwo groups of corneal cross-sectional images obtained with the OptoVue RTVue anterior-segment OCT system were studied: group A (control) consisted of unoperated, healthy corneas, with the exception of possible refractive errors. The second group consisted of keratoconic corneas with CXL that were previously operated on. The two groups were investigated for possible quantitative evidence of changes induced by the CXL, and specifically, the depth, horizontal extent, as well as the cross-sectional area of intrastromal hyper-reflective areas (defined in our study as the area consisting of pixels with luminosity greater than the mean +2 × standard deviation of the entire stromal cross section) within the corneal stroma.ResultsIn all images of the second group (keratoconus patients treated with CXL) there was evidence of intrastromal hyper-reflective areas. The hyper-reflective areas ranged from 0.2% to 8.8% of the cross-sectional area (mean ± standard deviation; 3.46% ± 1.92%). The extent of the horizontal hyper-reflective area ranged from 4.42% to 99.2% (56.2% ± 23.35%) of the cornea image, while the axial extent (the vertical extent in the image) ranged from 40.00% to 86.67% (70.98% ± 7.85%). There was significant statistical difference (P < 0.02) in these values compared to the control group, in which, by application of the same criteria, the same hyper-reflective area (owing to signal noise) ranged from 0.00% to 2.51% (0.74% ± 0.63%).ConclusionHerein, we introduce a novel, noninvasive, quantitative technique utilizing anterior segment OCT images to quantitatively assess the depth and cross-sectional area of CXL in the corneal stroma based on digital image analysis. Mean cross-sectional area showing evidence of CXL was 3.46% ± 1.92% of a 6 mm long segment.

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Section: Introductionmentioning

confidence: 99%

Introduction of quantitative and qualitative cornea optical coherence tomography findings induced by collagen cross-linking for keratoconus: a novel effect measurement benchmark

Kanellopoulos¹,

Asimellis²

2013

OPTH

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“…Transepithelial cross-linking also provides an opportunity to subject thinner cornea to CXL, which projects range of CCT less than 400 μm [27]. It has been observed that the subbasal nerve plexus in epithelium-on technique patients can be preserved, as compared to the patients treated with a conventional method [28].…”

Section: Discussionmentioning

confidence: 99%

Transepithelial versus Epithelium off Crosslinking for Treating Keratoconus among Jordanians

Zubi¹,

Albakar²,

Nasser³

2019

TOOPHTJ

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Background: The progression of keratoconus is stabilized with the help of corneal collagen cross-linking (CXL) supported through photosynthesized riboflavin. Objective: This study aims to compare the effectiveness of the transepithelial procedure and epithelium off procedure of corneal collagen crosslinking among keratoconus patients in Jordan. Methods: The study recruited 80 patients suffering from progressive keratoconus, from a tertiary care setting in Jordan. These participants were randomly divided into two groups; group 1 with 40 participants subjected to transepithelial (Corneal collagen cross-linking) CXL; and 40 participants in group 2 received conventional epithelium off CXL. Results: Improvement was observed in the mean contact lens, which corrected distance visual acuity (CDVA) from logMAR 0.332 ± 0.09 (group 1), 0.35 ± 0.09 (group 2) to 0.241 ± 0.07 (group 1), 0.21 ± 0.07 (group 2), respectively at the end of follow-up (12 months). The mean pachymetry improved from 429.81 ± 18.96 μm (group 1), 430.08 ± 17.05 μm (group 2) to 436.5 ± 15.49 μm (group 1), 436.44 ± 12.53 μm (group 2), respectively, after twelve months. Additionally, the mean Sim K astigmatism declined from 7.0 ± 2.0 (group 1), 6.73 ± 1.98 (group 2) to 5.97 ± 1.88 (group 1), 5.53 ± 0.08 (group 2) respectively at twelve months post-treatment. Majority of the patients in group 2 experienced more pain as compared to group 1 participants. Conclusion: The effectiveness of a cross-linking procedure related to keratometry readings and corneal thickness showed that conventional (epithelium off) CXL method is more effective than transepithelial CXL.

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“…In humans and rabbits, regeneration of nerve fibres is complete after about 6 months and plexus structure after 1 year . Corneal sensitivity recovers quickly and is completely normal six months to one year after treatment …”

Section: Safetymentioning

confidence: 99%

Corneal cross‐linking – a review

Meek

Hayes

2013

Ophthalmic Physiologic Optic

112

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Purpose: To review cross-linking the cornea using riboflavin and ultraviolet A light, which has been widely adopted, refined and applied in a range of corneal surgeries and pathologies where the strength of the cornea might be compromised. Recent findings: A large number of clinical trials have been carried out, most of which have demonstrated that standard cross-linking is a successful method to halt the progression of keratoconus or even aid regression. Summary: This review describes our current understanding of the technique, focussing on how cross-linking works, how the treatment is being optimised, the clinical results that have been reported to date and the potential use of the therapy in the treatment of other corneal disorders.

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Transepithelial Cross-Linking in Keratoconus Patients

Cited by 20 publications

References 21 publications

Introduction of quantitative and qualitative cornea optical coherence tomography findings induced by collagen cross-linking for keratoconus: a novel effect measurement benchmark

Introduction of quantitative and qualitative cornea optical coherence tomography findings induced by collagen cross-linking for keratoconus: a novel effect measurement benchmark

Transepithelial versus Epithelium off Crosslinking for Treating Keratoconus among Jordanians

Corneal cross‐linking – a review

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