Transepithelial Iontophoresis Versus Standard Corneal Collagen Cross-linking: 1-Year Results of a Prospective Clinical Study

Vinciguerra, Paolo; Romano, Vito; Rosetta, Pietro; Legrottaglie, Emanuela Filomena; Piscopo, Raffaele; Fabiani, Claudia; Azzolini, Claudio; Vinciguerra, Riccardo

doi:10.3928/1081597x-20160629-02

Cited by 52 publications

(51 citation statements)

References 24 publications

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“…The results are consistent with those reported by other studies, noting that our patients are followed up for a longer period of time (Bikbova & Bikbov ; Vinciguerra et al. ; Jouve et al. ).…”

Section: Discussionsupporting

confidence: 93%

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Iontophoretic collagen cross‐linking versus epithelium‐off collagen cross‐linking for early stage of progressive keratoconus – 3 years follow‐up study

Cantemir

Alexa

Galan

et al. 2017

Acta Ophthalmologica

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Section: Discussionsupporting

confidence: 93%

“…Recent clinical trials have shown that I ‐CXL is a valid method to halt the progression of keratoconus with an improvement of clinical and paraclinical parameters, but with a lower efficacy compared to standard cross‐linking (Bikbova & Bikbov ; Vinciguerra et al. ; Jouve et al. ).…”

Section: Discussionmentioning

confidence: 99%

Iontophoretic collagen cross‐linking versus epithelium‐off collagen cross‐linking for early stage of progressive keratoconus – 3 years follow‐up study

Cantemir

Alexa

Galan

et al. 2017

Acta Ophthalmologica

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“…Interestingly, the prevalent role of epithelium regrowth in the changes seen post-CXL is substantiated by the fact that the effects of transepithelial (epi on) CXL appear to be less pronounced than the effects of CXL with de-epithelialization (epi off) as described in the literature. 46,[48][49][50] It should be reasonable to conclude, therefore, that the variation in keratometric readings and visual quality observed after CXL may be non-biomechanical and instead be related to epithelial remodeling. We have conducted a study to further investigate the role of the corneal epithelium on the topography of the anterior surface of the cornea.…”

Section: Could Epithelial Wound Healing Account For Most Of the Changmentioning

confidence: 99%

Reevaluating the Effectiveness of Corneal Collagen Cross-linking and Its True Biomechanical Effect in Human Eyes

Gatinel¹

2017

International Journal of Keratoconus and Ectatic Corneal Diseases

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The induction of cross-links in corneal tissue appears to be a promising technique to increase its stiffness and this has been the basis of treatment of keratoconus (KC) and corneal ectatic disease. However, there exists a striking discrepancy between the reported biomechanical effects of corneal collagen cross-linking (CXL) in vitro compared to in vivo, and this has not received much attention in the literature. Despite the documentation of an increase in corneal stiffness in vitro by many investigators, reports that provide evidence of measurable and consistent biomechanical changes in corneal rigidity in vivo after CXL are lacking. Indeed, the absence of documented in vivo biomechanical improvement in CXL-treated corneas is a conundrum, which needs to be further explored. To explain this discrepancy, it has been postulated that biomechanical changes induced by CXL are too subtle to be measured by currently available diagnostic tools or have characteristics not discernible by these technologies. However, the dynamic bidirectional applanation device (Ocular Response Analyzer) and dynamic Scheimpflug analyzer instruments (Corvis ST) have demonstrated the ability to quantify even subtle biomechanical differences in untreated KC corneas of different ectatic degree, and document the reduction in corneal hysteresis (CH) and corneal resistance factor (CRF) in situations where the corneal stiffness is reduced, such as after laser in situ keratomileusis and surface ablation procedures. It has also been possible to demonstrate an altered CH and CRF in patients with diabetes, smoking habit, glaucoma, Fuchs’ dystrophy, and corneal edema. It is puzzling that these diagnostic tools could document subtle biomechanical changes in these situations, yet fail to measure the purported changes induced by CXL on corneas with progressive KC. This failure to document significant and consistent biomechanical changes in corneal rigidity could suggest that CXL does not induce a simple reversal of the particular biomechanical deficits that characterize KC, or make the cornea significantly more resistant to bending forces as has been widely postulated. The absence of measurable biomechanical change in living KC corneas after CXL could be a consequence of biomechanical strengthening which is insignificant compared to the marked weakening caused by preexisting alteration of the collagen structure, disorganization of collagen fiber intertwining, and compromised structural–mechanical homogeneity that are hallmarks of keratoconic disease, especially in corneas with progressive KC. The changes in the cornea induced by CXL that have been described in vivo may instead be driven by a wound healing process in response to the removal of the corneal epithelial layer and subsequent exposure to riboflavin and ultraviolet-A (UVA). This paper will present evidence that sustains this hypothesis. How to cite this article Gatinel D. Reevaluating the Effectiveness of Corneal Collagen Cross-linking and Its True Biomechanical Effect in Human Eyes. Int J Kerat Ect Cor Dis 2017;6(1):34-41.

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“…[14][15][16][17][18] To counteract this effect, it was proposed that corneal refractive surgery can be combined with corneal cross-linking (CXL), also labelled as "Xtra." [23][24][25][26] The purpose of this paper is to review the published results and findings on the indications, protocols and clinical outcomes of combined refractive surgery and CXL. [19][20][21][22] The surgery is expected to slow down or stop the progression of corneal ectasia.…”

Section: Introductionmentioning

confidence: 99%

“…There are standard, accelerated and pulsed protocols of CXL. [23][24][25][26] The purpose of this paper is to review the published results and findings on the indications, protocols and clinical outcomes of combined refractive surgery and CXL.…”

Section: Introductionmentioning

confidence: 99%

Corneal refractive surgery combined with simultaneous corneal cross‐linking: Indications, protocols and clinical outcomes—A review

Wang

Jhanji³

2019

Clinical Exper Ophthalmology

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Corneal refractive surgery is one of the most common approaches for correction of refractive errors. Combined corneal refractive surgery and corneal cross-linking (CXL) has been proposed as a method to achieve better refractive stability and to prevent iatrogenic corneal ectasia. However, there are concerns regarding its indications, surgical safety, standardization of protocols and long-term effect on corneal tissue. This review article aims to discuss the current knowledge and recent updates on combination of CXL and refractive surgery.cornea, corneal cross-linking, refractive surgery

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Transepithelial Iontophoresis Versus Standard Corneal Collagen Cross-linking: 1-Year Results of a Prospective Clinical Study

Abstract: The 1-year outcomes suggest that I-CXL might be comparable to S-CXL in stabilizing the progression of the degenerative ectatic disease. Additionally, quicker improvement of functional parameters was reported in the I-CXL group. [J Refract Surg. 2016;32(10):672-678.].

Cited by 52 publications

References 24 publications

Iontophoretic collagen cross‐linking versus epithelium‐off collagen cross‐linking for early stage of progressive keratoconus – 3 years follow‐up study

Iontophoretic collagen cross‐linking versus epithelium‐off collagen cross‐linking for early stage of progressive keratoconus – 3 years follow‐up study

Reevaluating the Effectiveness of Corneal Collagen Cross-linking and Its True Biomechanical Effect in Human Eyes

Corneal refractive surgery combined with simultaneous corneal cross‐linking: Indications, protocols and clinical outcomes—A review

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