Analysis of pseudoprogression after corneal cross‐linking in children with progressive keratoconus

Schuerch, Kaspar; Tappeiner, Christoph; Frueh, Béatrice E.

doi:10.1111/aos.13060

Cited by 14 publications

(8 citation statements)

References 30 publications

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“…Above-mentioned studies did not have data for 36-month follow-up. In Schuerch et al 6 study, 5 cases of 33 (15.15%) eyes in a follow-up period of 37.5 months had an increase of 1 D or more of Kmax. Chatzis and Hafezi 18 investigated at 1, 2 and 3 years after C-CXL, Kmax readings were increased by 1 D or more in 11%, 13% and 55% of eyes.…”

Section: Discussionmentioning

confidence: 88%

“…Corneal cross-linking (CXL) can increase the biomechanical strength and stability of the cornea by an interaction of ultraviolet (UV) light and riboflavin, which is used to halt or decelerate the progression of keratoconus. 5 Previous studies 6–10 have reported that conventional corneal collagen cross-linking (C-CXL; epithelium-off procedure with 3 mW/cm 2 UVA radiation for 30 min) is an effective and safe procedure to treat adult and paediatric keratoconus. Only a few studies 11 12 have investigated the use of accelerated transepithelial (ATE) CXL (ATE-CXL; epithelium-on procedure with 45 mW/cm 2 UVA radiation in the pulsed mode for 320 s) for the treatment of paediatric keratoconus.…”

Section: Introductionmentioning

confidence: 99%

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Three-year follow-up of accelerated transepithelial corneal cross-linking for progressive paediatric keratoconus

et al. 2020

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PurposeTo investigate the long-term safety and efficacy of accelerated transepithelial corneal cross-linking (ATE-CXL) in children with progressive keratoconus.MethodsFifty-three eyes of 41 paediatric patients (34 boys, 7 girls; mean age 14.81±1.96 years) undergoing ATE-CXL were enrolled in the study. Corrected distance visual acuity (CDVA) and manifest refraction were assessed preoperatively and 36 months postoperatively. Corneal keratometry, corneal thickness and posterior elevation were measured using Pentacam preoperatively and 1, 6, 12 and 36 months postoperatively. Pachymetry and epithelial thicknesses were measured using optical coherence tomography preoperatively and 6, 12, and 36 months postoperatively.ResultsThirty-six months postoperatively, CDVA improved from 0.32±0.28 to 0.26±0.25 in logarithm of the minimum angle resolution (p=0.025). Maximum keratometry was 58.73±9.70 D preoperatively and 59.20±10.24, 58.28±9.33, 57.88±9.99 and 58.98±10.79 D at 1, 6, 12 and 36 months postoperatively throughout the 36-month follow-up period (p>0.05). Similarly, corneal central thickness, which was 492.42±33.83 µm postoperatively, also remained stable during the 36-month follow-up (p>0.05). Both posterior central elevation and posterior highest elevation were stable at 12 months after ATE-CXL (p>0.05), but increased at 36 months postprocedure (p<0.05). Corneal pachymetry and epithelial thicknesses remained stable throughout the follow-up period (p>0.05).ConclusionsATE-CXL is a safe and effective treatment in paediatric progressive keratoconus patients, leading to stable keratometry and corneal thickness throughout the 36-month follow-up.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Three-year follow-up of accelerated transepithelial corneal cross-linking for progressive paediatric keratoconus

et al. 2020

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“…Corneal CXL is a relatively new and promising treatment that halts the progression of the disease at the corneal ectasia stage. Several studies [ 7 – 10 ] have provided evidence that CXL is safe and effective in slowing or halting the progression of keratoconus,but most of these studies examined conventional CXL (C-CXL). To our knowledge, this study is the first to report the safety and efficacy of ATE-CXL in pediatric keratoconus patients.…”

Section: Discussionmentioning

confidence: 99%

“…Corneal collagen cross-linking (CXL) can halt the progression of keratoconus by increasing the biomechanical rigidity of the corneal stroma via an interaction of riboflavin and ultraviolet radiation (UV) [ 5 , 6 ]. Many publications have reported on the safety and efficacy of CXL in the treatment of pediatric keratoconus patients [ 7 – 10 ], but treatment by accelerated transepithelial corneal collagen cross-linking (ATE-CXL) [ 11 , 12 ], which maintains the integrity of the corneal epithelium layer in pediatric keratoconus patients with a higher irradiation intensity of UV light and a reduced duration of irradiation, has not reported. The present study aimed to assess the safety and efficacy of ATE-CXL in children with progressive keratoconus.…”

Section: Introductionmentioning

confidence: 99%

One-year follow-up of accelerated transepithelial corneal collagen cross-linking for progressive pediatric keratoconus

et al. 2018

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BackgroundKeratoconus typically presents in the teenage years and is more advanced in younger patients when compared with adults. In the present study, we aimed to assess the safety and efficacy of accelerated transepithelial corneal collagen cross-linking (ATE-CXL) in children with progressive keratoconus.MethodsIn this retrospective consecutive study, 18 eyes were enrolled from 17 pediatric patients (15 boys and 2 girls) with a mean age of 14.44 ± 1.98 years. Manifest refraction, best-corrected visual acuity (BCVA), steepest meridian keratometry (K1), flattest meridian keratometry (K2), maximum keratometry (Kmax), thinnest corneal thickness (TCT), posterior central elevation (PCE), and posterior mean elevation (PME) were measured before and after ATE-CXL. The patients were followed-up at 1, 6, and 12 months. Repeated measures analysis of variance was used for statistical analysis. P < 0.05 was considered statistically significant.ResultsThere were no complications in any case during or after ATE-CXL. BCVA improved from 0.64 ± 0.32 preoperatively to 0.69 ± 0.32 at 1-year postoperatively. The Kmax value was 56.67 ± 9.60 D before the treatment and 56.19 ± 8.55 D, 56.08 ± 8.85 D, and 55.94 ± 8.46 D at 1, 6, and 12 months postoperatively, respectively. No statistically significant differences were present in K1, K2, Kmax, PCE, and TCT before and after ATE-CXL during the 12-month follow-up (P > 0.05).ConclusionsATE-CXL is a safe and effective treatment in pediatric progressive keratoconus patients. The long-term effects need further observation.Trial registrationRetrospectively registered. Registration number: ChiCTR-OIC-16008181. Registered 29 March 2016.

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“…Another CXL drawback is the prolonged treatment time that is required based on the Dresden protocol. Studies on CXL effectiveness have illustrated variable and sometimes adverse outcomes, such as worsening of topographic and pachymetric values [ 11 , 12 ]. Perhaps the most important drawback related to CXL is the fact that it is not suitable for every single patient with KC.…”

Section: Introductionmentioning

confidence: 99%

Collagen cross-linking impact on keratoconus extracellular matrix

2018

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BackgroundKeratoconus (KC) is a common multifactorial ectatic corneal disease with unknown onset. KC most commonly appears in adolescence and affects approximately 1:400 people worldwide. Treatment options, for advanced KC cases, are collagen cross-linking (CXL) and corneal transplants. CXL is a new KC treatment that helps arrest the disease. Unfortunately, only a fraction of KC patients will qualify for CXL treatment. Our goal, in this study, was to begin to understand how CXL affects the corneal microenvironment and pave the way towards a more patient-driven CXL treatment.MethodsPrimary human corneal fibroblasts from healthy and KC donors were plated on transwell polycarbonate membranes and stimulated by a stable vitamin C. At 4 weeks, riboflavin was added followed by UVA irradiation. Transmission Electron Microscopy (TEM) and western blots were used to assess the effect of CXL on the extracellular matrix (ECM) and the resident cells, pre- and post CXL.ResultsData shows CXL improved lamellar organization showing more organized collagen fibrils decorated with proteoglycans (PGs). The distribution of the collagen fibrils and interfibrillar spacing was also visibly improved, post-CXL. Lumican, mimecan, and decorin were the dominant PGs and were significantly upregulated in post-CXL cultures. ECM degradation proteins, matrix metalloproteinases (MMPs), MMP-1, -3, and -9, but not MMP-2, were significantly downregulated post-CXL. TIMP-1 and -2 were not modulated by CXL.ConclusionThe unknown effects of CXL on the human corneal microenvironment have hampered our ability to make CXL available to all KC patients. Our current study provides a deeper understanding on CXL activity, using our unique 3D in vitro model.

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Analysis of pseudoprogression after corneal cross‐linking in children with progressive keratoconus

Cited by 14 publications

References 30 publications

Three-year follow-up of accelerated transepithelial corneal cross-linking for progressive paediatric keratoconus

Three-year follow-up of accelerated transepithelial corneal cross-linking for progressive paediatric keratoconus

One-year follow-up of accelerated transepithelial corneal collagen cross-linking for progressive pediatric keratoconus

Collagen cross-linking impact on keratoconus extracellular matrix

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