Accelerated Corneal Cross-linking in Pediatric Patients With Keratoconus: 24-Month Outcomes

Ozgurhan, Engin Bilge; Kara, Necip; Çankaya, Kadir İlker; Kurt, Tugba; Demirok, Ahmet

doi:10.3928/1081597x-20141120-01

Cited by 82 publications

(77 citation statements)

References 33 publications

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“…All sectors of the corneal epithelium were restored to preoperative levels at 1 month postoperative, which was consistent with the corneal epithelial regeneration period. Recent studies reported that postoperative corneal thickness initially decreased then returned to baseline values at 3–6 months after the “epithelium-off” accelerated CXL procedure2829. The recovery of corneal thickness in our study gradually returned the thickness to baseline values at postoperative 1 month, which was earlier than recovery times in previous studies.…”

Section: Discussionsupporting

confidence: 55%

One-year Outcomes of Pachymetry and Epithelium Thicknesses after Accelerated (45 mW/cm2) Transepithelial Corneal Collagen Cross-linking for Keratoconus Patients

Zhang

Sun

Chen

et al. 2016

Sci Rep

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The thickness of corneal pachymetry and the epithelium after accelerated (45 mW/cm 2 ) transepithelial corneal collagen cross-linking (CXL) for keratoconus were assessed in this prospective case series study. Twenty-eight patients were treated for keratoconus. The mean Kmax was 56.18 ± 7.90. The thinnest point, as assessed by optical coherence tomography (OCT), was 443.18 ± 39.75 μm. Accelerated transepithelial CXL was performed, and corrected distance visual acuity (CDVA), corneal topography, and OCT were recorded at 1 week postoperatively as well as at 1, 3, 6, and 12 months. The surgery was uneventful in all eyes. Postoperative epithelial edema was observed and faded in 3 days. The postoperative Kmax was 54.56 ± 8.81, 55.78 ± 8.11, 56.37 ± 8.71, 55.80 ± 7.92, and 55.47 ± 8.24 at 1 week, 1 month, 3 months, 6 months, and 12 months, respectively (all, P > 0.05). The thinnest postoperative corneal point, 439.04 ± 44.99 μm, was observed at 12 months (P = 0.109). The epithelial thickness decreased during the first postoperative week then showed a gradual recovery. Postoperative pachymetry thickness showed no significant changes for up to 12 months. Postoperative epithelial thickness decreased temporarily, then stabilized at month 12. Accelerated transepithelial CXL was shown to be effective and safe for the treatment of keratoconus.Keratoconus (KC) is a degenerative, bilateral, asymmetrical, non-inflammatory disease that induces biomechanical corneal weakening due to aberrant changes in organization and the structure of stromal corneal collagen fibers 1,2 , which is a serious ocular disorder that can cause severe loss of vision 3 . The recommended treatment is deep anterior lamellar keratoplasty or a penetrating corneal graft for patients in advanced stages that have contact lens intolerance and/or dense stromal scars 4 . Corneal collagen cross-linking (CXL) is used to treat keratoconus and keratectasia by strengthening corneal tissue through an interaction using a riboflavin photosensitizer and ultraviolet (UV) light. This treatment is based on an increase in covalent bonds within or between corneal collagen molecules that increases the biomechanical strength of the cornea 5,6 . This traditional protocol requires debridement of the corneal epithelium to promote diffusion of riboflavin into the corneal stroma 7 . Postoperative pain, infection, and even stromal haze are caused by the complex structural and physiological wound healing changes after CXL 4,8 . Long-term clinical studies showed the result of slowing, and in most cases blocking, keratoconus progression as well as improving refractive and topographic features [9][10][11][12] . Accelerated transepithelial or "epithelium-on" CXL is a technique performed without epithelial debridement by applying topical drugs to loosen the tight junctions of the corneal epithelial cells to facilitate riboflavin penetration through an intact epithelium. This technique was proposed to reduce the risk of complications caused by epithelial removal, such as postoperative pain an...

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Section: Discussionsupporting

confidence: 55%

One-year Outcomes of Pachymetry and Epithelium Thicknesses after Accelerated (45 mW/cm2) Transepithelial Corneal Collagen Cross-linking for Keratoconus Patients

Zhang

Sun

Chen

et al. 2016

Sci Rep

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“…On further analysis of the treatment methods used in the two accelerated protocol papers, they were found to be heterogenous, with one study applying UVA irradiance at 30 mW/cm 2 over 4 minutes (Ozgurhan et al. ) and the other applying UVA irradiance at 9 mW/cm 2 over 10 min (Shetty et al. ).…”

Section: Resultsmentioning

confidence: 99%

Cross‐linking in children with keratoconus: a systematic review and meta‐analysis

McAnena

Doyle

O’Keefe

2016

Acta Ophthalmologica

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Keratoconus can behave more aggressively in pediatric than in adult patients. We systematically reviewed the literature to determine the effectiveness of corneal collagen cross‐linking (CXL) in children. For this study, MEDLINE® and Cochrane databases were searched for all studies examining the effects of standard, trans‐epithelial or accelerated CXL protocols in patients age 18 years or younger. Primary outcomes were; uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) and secondary outcomes were; best‐corrected visual acuity (BCVA), mean refractive spherical equivalent (MRSE), central corneal thickness (CCT) and endothelial cell density (ECD). Standardized mean differences (SMD) and 95% confidence intervals were calculated, comparing baseline values with those at 6, 12 and 24 months. A total of 13 papers, published between May 2011 and December 2014 examining 490 eyes of 401 patients with a mean age of 15.25 (±1.5) years, were included in the qualitative analysis in this review. Nine papers were included in the meta‐analysis, showing significant improvement in UCVA and BCVA and stable Kmax at 12 months, and stable UCVA, improved BCVA and improved Kmax at 24 months in the standard protocol group UCVA, BCVA and KMax were stable at 12 months in the trans‐epithelial group. Mean refractive spherical equivalent (MRSE), CCT and ECD remained stable in both groups. In conclusion it was found that standard CXL may be effective in halting progression of keratoconus in pediatric patients at 1 year. However, larger, more long‐term studies are required to ascertain its effectiveness.

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“…Corneal collagen cross-linking (CXL), either epi-on or epi-off, is a promising treatment to actually delay and potentially halt the progression of many ectasias, including KC, pellucid marginal degeneration, and PLEs [41][42][43][44] by strengthening the collagen lamellae of the cornea. 44 In a retrospective case series study, Yildirim 47 The under-flap technique involves lifting the existing LASIK flap, followed by ultrasound pachymetry performed on the stromal bed.…”

Section: Cross-linkingmentioning

confidence: 99%

Post Laser-assisted in situ Keratomileusis Ectasia: A Systematic Review

Barbara¹,

Busool²

2017

International Journal of Keratoconus and Ectatic Corneal Diseases

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Purpose: To provide a comprehensive overview of ectasia development following laser-assisted in situ keratomileusis (LASIK). Materials and methods:Literature review of relevant studies dealing with corneal ectasia associated with refractive surgery, keratoconus (KC), and cross-linking.Results: Post Laser-assisted (PLE) involves histopathologic, clinical, and topographic characteristics similar to KC. Several risk screening indices were developed to enhance the detection of KC suspect and mild KC cases prior to the laser procedure. A grading system of PLE was developed, based on risk factors for the severity of ectasia, primarily measured by visual loss. The aims of the treatment are halting ectasia progression and restoring visual acuity. Conclusion:Familiarity with the highly sensitive and specific indices for ectasia screening, in addition to procedure parameters that increase the likelihood of ectasia development following the refractive procedure, is essential for minimizing the risk of PLE. However, when ectasia develops, early recognition and proper management are essential to prevent progression and improve visual rehabilitation.

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Accelerated Corneal Cross-linking in Pediatric Patients With Keratoconus: 24-Month Outcomes

Abstract: The findings revealed that accelerated corneal cross-linking halted the keratoconus progression without relevant side effects in pediatric patients over a 24-month follow-up period. Visual acuity, keratometric values, and corneal aberrations also improved.

Cited by 82 publications

References 33 publications

One-year Outcomes of Pachymetry and Epithelium Thicknesses after Accelerated (45 mW/cm2) Transepithelial Corneal Collagen Cross-linking for Keratoconus Patients

One-year Outcomes of Pachymetry and Epithelium Thicknesses after Accelerated (45 mW/cm2) Transepithelial Corneal Collagen Cross-linking for Keratoconus Patients

Cross‐linking in children with keratoconus: a systematic review and meta‐analysis

Post Laser-assisted in situ Keratomileusis Ectasia: A Systematic Review

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