Treatment of Progressive Keratoconus by Riboflavin-UVA-Induced Cross-Linking of Corneal Collagen

Mazzotta, Cosimo; Balestrazzi, Angelo; Traversi, Claudio; Baiocchi, Stefano; Caporossi, Tomaso; Tommasi, C; Caporossi, Aldo

doi:10.1097/ico.0b013e318030df5a

Cited by 323 publications

(119 citation statements)

References 19 publications

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“…Because we had also investigated corneal sensitivity in our patients pre- and postoperatively, and because sensitivity was clearly reduced in all patients after treatment compared with preoperative baseline findings, it is likely that the subbasal nerve plexus in the treated area is destroyed as a result of therapy. The research team led by Mazzotta also arrived at this conclusion [34]. Nevertheless, it is still unclear whether complete nerve fiber destruction occurs as a result of mechanical epithelial abrasion and of riboflavin/UVA treatment, or whether the nerve plexus simply cannot be visualized on confocal microscopy during the initial postoperative months.…”

Section: Discussionmentioning

confidence: 98%

Results of Confocal Microscopy Examinations after Collagen Cross-Linking with Riboflavin and UVA Light in Patients with Progressive Keratoconus

et al. 2010

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Purpose: Keratoconus is a predominantly bilateral form of corneal degeneration that is associated with central thinning and cone-shaped bulging of the cornea usually accompanied by a progressive reduction in visual acuity. A recent therapeutic option is cross-linking, a procedure designed to prevent the progression of keratoconus by the photochemical cross-linkage of collagen fibers. Patients and Methods: Eight eyes in 8 patients with progressive keratoconus were treated by the photochemical cross-linking method using riboflavin and UVA light. In addition to the usual ophthalmological examinations, patients were examined pre- and postoperatively by confocal in vivo laser scanning microscopy. Follow-up examinations were performed at 2 weeks and at 2, 4, 6 and 12 months postoperatively. Results: Complete regeneration of corneal epithelium was detected by 2 weeks after therapy at the latest. The sub-basal nerve plexus could not be visualized by confocal microscopy after treatment. Immediately after treatment, the anterior corneal stroma had a honeycombed appearance but without the typical hyperreflective keratocyte nuclei. At about 6 months postoperatively, the corneal stroma had virtually regained its normal configuration. After therapy, confocal microscopy revealed that corneal endothelium was normal in terms of cell density and morphology at every time point. Conclusions: Confocal in vivo laser scanning microscopy is an investigative technique that permits reproducible visualization of structural changes in the cornea (epithelium, stroma and endothelium) following collagen cross-linking with riboflavin and UVA light. Once epithelial healing is complete, the epithelium and endothelium appear to be unaffected by the treatment. The most noteworthy structural changes, which are detected on confocal microscopy shortly after treatment, involve the anterior and middle corneal stroma. Over the course of time, up to 12 months postoperatively, these changes show a definite tendency to regress.

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Section: Discussionmentioning

confidence: 98%

Results of Confocal Microscopy Examinations after Collagen Cross-Linking with Riboflavin and UVA Light in Patients with Progressive Keratoconus

et al. 2010

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“…Both objective (14,15) and subjective (16) improvements were reported in eyes with keratoconus after CXL treatment, even in subjects under 18 (17). As collagen bonds are established at a depth of 250-350 µm in the anterior stroma, called the treatment zone (5,(18)(19)(20)(21), and for the protection of the endothelium, a minimum of 400 µm stromal thickness is suggested (5,22). However, according to other publications, a minimum of 330 µm of initial thickness is also sufficient for CXL after corneal swelling (23).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative and Postoperative Corneal Thickness Change after Collagen Crosslinking Therapy

Hassan

Módis

Szalai

et al. 2014

European Journal of Ophthalmology

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Purpose: To assess intraoperative and postoperative changes in corneal thickness subsequent to riboflavin-UVA (collagen crosslinking [CXL]) treatment. Methods: Forty-one eyes of 41 patients (mean age 27.97 ± 6.97 years) were treated with CXL technique. During treatment, isotonic riboflavin was instilled and corneal thickness measurements were obtained at the cornea apex, the thinnest point, and the pupil center at 15 and 30 minutes, then 3 days, 1 week, and 1, 3, 6, and 12 months after surgery using Pentacam HR and an ultrasound pachymeter. Results: A decrease in corneal thickness was detected 15 minutes intraoperatively with a value of 108.95 ± 48.6 μm, and 112.35 ± 47.3 μm at 30 minutes (p<0.001). Three days after the operation, no deviation was found from the initial values (p = 0.17). No further changes were detected during the follow-up period. Conclusions: Isotonic riboflavin solution used during CXL treatment resulted in a significant decrease in corneal thickness, but its effect had disappeared by postoperative day 3.

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“…In the older Group, reduction in thinnest pachymetry was lesser in magnitude (mean change −38.72 µm, p < 0.0001; and −31.0 µm, p < 0.0001 at three and six months respectively) but statistically significant. This reduction in thinnest pachymetry can be attributed to measurement artifact as it has been shown that optical pachymetry is affected negatively by the non-homogen- ous optical changes seen in crosslinked corneas (due to corneal haze/demarcation line/stromal edema) [23] [24]. The Siena Study group [17] compared pachymetric results of the optical Obrscan IIz with ultrasound pachymetry and confocal pachymetric examinations and found a significant underestimation (−120 µm in the first six months) of corneal thickness with the Orbscan IIz.…”

Section: Discussionmentioning

confidence: 99%

Corneal Cross Linking with Riboflavin for Progressive Keratoconus in Paediatric Eyes

Nawani¹,

Jain²,

Singh³

2014

OJOph

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Purpose: To report visual, refractive and topographic outcomes after corneal collagen crosslinking (CXL) for progressive keratoconus in paediatric eyes. Methods: In this prospective interventional study, twenty eyes of eighteen patients with progressive keratoconus were included. All eyes underwent CXL with riboflavin after documented progression of the disease. Informed, written consent was taken from the parents of the patients. The patients were followed up for 6 mon-

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Treatment of Progressive Keratoconus by Riboflavin-UVA-Induced Cross-Linking of Corneal Collagen

Abstract: Reduction in anterior and intermediate stromal keratocytes followed by gradual repopulation has been confirmed directly in vivo in humans by HRT II-RCM confocal microscopy after riboflavin-UVA-induced corneal collagen cross-linking.

Cited by 323 publications

References 19 publications

Results of Confocal Microscopy Examinations after Collagen Cross-Linking with Riboflavin and UVA Light in Patients with Progressive Keratoconus

Results of Confocal Microscopy Examinations after Collagen Cross-Linking with Riboflavin and UVA Light in Patients with Progressive Keratoconus

Intraoperative and Postoperative Corneal Thickness Change after Collagen Crosslinking Therapy

Corneal Cross Linking with Riboflavin for Progressive Keratoconus in Paediatric Eyes

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