Two-Year Corneal Cross-Linking Results in Patients Younger Than 18 Years With Documented Progressive Keratoconus

Vinciguerra, Paolo; Albè, Elena; Frueh, Béatrice E.; Trazza, Silvia; Epstein, David

doi:10.1016/j.ajo.2012.03.020

Cited by 200 publications

(213 citation statements)

References 39 publications

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“…Surprisingly, the initial topography changes are usually marked by a mild central steepening, whereas the onset of mild flattening occurs typically months after the CXL procedure. 18,41,42 This late onset flattening that has been attributed to the primary effect of CXL should instead be attributed to a healing response, as any chemically induced response from the concomitant UVA irradiation (as in CXL) would have occurred during the procedure itself, or shortly after. A similar central flattening with significant gain in corrected distance visual acuity occurs frequently after phototherapeutic keratectomy, even when shallow ablation with no refractive correction is performed, as for recurrent erosion syndrome.…”

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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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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“…[29][30] However, further monitoring suggests that despite initial improvement, pediatric patients may present long-term progression. 31 Additional studies are still needed and should focus on the development of appropriate techniques and protocol, not only to obtain lasting and effective results, but principally to ensure the safety of patients in pediatric age. Adequate advice to parents is essential in order for these to understand the disease's progressive nature and the necessity of intervention.…”

Section: Scientific Evidence Of Treatment Effectivenessmentioning

confidence: 99%

Corneal Crosslinking: The Standard Protocol

Santhiago¹

2017

Revista Brasileira De Oftalmologia

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RESUMOO objetivo desta revisão é de determinar as indicações e eficácia da cirurgia que promove novas ligações covalentes entre as fibras de colágeno da córnea, conhecida como Cross-Linking (CXL), assim como esclarecer seus objetivos. O ceratocone é uma doença ectasica da córnea, bilateral, assimétrica, que, principalmente, cursa com encurvamento e afinamentos progressivo, e se inicia em geral na segunda década de vida. O uso primário do CXL tem sido na interrupção da progressão do Ceratocone. Apesar do conhecido encurvamento no estroma da córnea ocorrer nesses pacientes, a fisiopatologia por trás do ceratocone ainda é desconhecida e parece ser multifatorial. Pela evidencia literária disponível até o momento, o CXL da córnea esta, portanto indicado nos pacientes com doença em progressão. Concluímos que existe evidencia suficiente para afirmar que o CXL da córnea é eficaz na estabilização da doença ectásica da cornea.Descritores: Córnea/fisiologia; Córnea/metabolismo; Cross-linking reagentes; Ceratocone/terapia; Riblflavina/administração & dosagem; Protocolos ABSTRACT The purpose of this review is to determine the indications and efficacy of the surgery that promotes new covalent bonds between the collagen fibers of the cornea, known as Cross-Linking (CXL), as well as to clarify its objectives. Keratoconus is a bilateral, asymmetric ectasic disease of the cornea that mainly courses with steepening and progressive thinning, and usually begins in the second decade of life.The primary use of CXL has been in discontinuing the progression of keratoconus. Although known corneal stromal remodeling occurs in these patients, the pathophysiology behind keratoconus is still unknown and appears to be multifactorial. By the literary evidence available to date, the CXL of the cornea is safely indicated in patients with progressing disease. We conclude that there is sufficient evidence to affirm that cornea CXL is effective in stabilizing corneal ectasic disease.

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“…Given the varying ages being studied (ranging from 8 to 19 years in the literature) [1][2][3][4][5][6] as well as the variety in potentially correct nomenclature (children, kids, adolescents, young, juvenile), which will only serve to confuse the issue as future studies arise, I recommend all of these studies be grouped under the generic heading "Pediatric CXL" to maximize the exchange of information by simplifying and thus facilitating complete literature searches. Timing of treatment, optimal treatment protocol, and long-term effi cacy are topics of active investigation.…”

Section: For Pediatric Keratoconusmentioning

confidence: 99%

Corneal Collagen Cross-linking: New and Expanding Applications

Randleman¹

2012

J Refract Surg

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Two-Year Corneal Cross-Linking Results in Patients Younger Than 18 Years With Documented Progressive Keratoconus

Cited by 200 publications

References 39 publications

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

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

Corneal Crosslinking: The Standard Protocol

Corneal Collagen Cross-linking: New and Expanding Applications

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