Corneal Collagen Cross-Linking with Hypoosmolar Riboflavin Solution in Keratoconic Corneas

Gu, Shaofeng; Fan, Zhaoshan; Wang, Lihua; Tao, Xiangchen; Zhang, Yong; Mu, Guoying

doi:10.1155/2014/754182

Cited by 12 publications

(16 citation statements)

References 42 publications

(44 reference statements)

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“…16 Such inconsistencies may introduce variability in CXL stiffening and limit its efficacy. 17,26,27 The current study demonstrates this variability with corneal swelling thickness ranging from 401 to 519 μm after swelling. Despite this unpredictability, the current study shows good CXL success.…”

Section: Discussionmentioning

confidence: 54%

Hypo-osmolar accelerated corneal crosslinking on resultant sub-400 μm topography-guided excimer regularized keratoconus corneas

Salimi

Gauvin

Harissi‐Dagher

et al. 2022

J Cataract Refract Surg

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To investigate the efficacy and safety of phototherapeutic keratectomy (PTK) with topography-guided photorefractive keratectomy (T-PRK) corneal regularization followed by sequential hypo-osmolar riboflavin accelerated corneal crosslinking (CXL) in keratoconic (KC) eyes with <400 mm stromal bed thickness after excimer ablation.Setting: Multisurgeon multicenter standardized protocol practice.Design: Retrospective multicenter case series.Methods: This study included progressive KC eyes that underwent PTK and T-PRK combined with accelerated CXL and had a corneal stromal bed thickness of <400 mm after excimer ablation before administration of hypo-osmolar riboflavin. Demographics and clinical measures were reviewed at baseline and every follow-up visit.Results: 61 consecutive eyes had a mean corneal stromal bed thickness of 367 ± 21 mm after excimer laser normalization.Postoperatively, uncorrected distance visual acuity (UDVA) improved by 0.29 logMAR (P < .0001), corrected distance visual acuity (CDVA) improved by 0.07 logMAR (P = .0012), and maximum keratometry (Kmax) decreased by 4.67 diopters (P < .0001). The safety index was favorable (1.29 ± 0.56), with stable manifest astigmatism, Kmax, and pachymetry at 12 months. 2 eyes (3%) showed evidence of keratometric progression on topography. Conclusions:In KC corneas thinner than 400 mm after excimer ablation, PTK epithelial removal followed by T-PRK and hypoosmolar accelerated CXL decreases manifest astigmatism and Kmax, improves UDVA and CDVA, and halted disease progression in 97% of eyes at 12 months. These outcomes are comparable with thicker ablated corneas not requiring hypo-osmolar stromal swelling.

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Section: Discussionmentioning

confidence: 54%

Hypo-osmolar accelerated corneal crosslinking on resultant sub-400 μm topography-guided excimer regularized keratoconus corneas

Salimi

Gauvin

Harissi‐Dagher

et al. 2022

J Cataract Refract Surg

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“…But Hafezi et al study did not include endothelial cell count measurements which could verify the safety of the technique. Gu et al [ 24 ] investigated the safety and efficacy of using hypoosmolar riboflavin solution (0.1%) and UVA cross-linking for the treatment of keratoconus with the thin cornea (mean thinnest CT was 413.9 ± 12.4 μ m and 381.1 ± 7.3 μ m with and without epithelium). During a 12-month follow-up, the mean keratometric ( K ) value improved from 58.7 ± 3.5 diopters (D) to 57.7 ± 4.9 D ( P = 0.611), and the endothelial cell density (ECD) was 2731.4 ± 191.8 cells/mm 2 before treatment and decreased to 2722.5 ± 211.5 cells/mm 2 ( P = 0.208) at 6 months after treatment and returned to 2733.4 ± 222.6 cells/mm 2 ( P = 0.327) at 12 months.…”

Section: Procedures and Modificationmentioning

confidence: 99%

A Review of Collagen Cross-Linking in Cornea and Sclera

Zhang

Tao

Zhang

et al. 2015

Journal of Ophthalmology

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Riboflavin/UVA cross-linking is a technique introduced in the past decades for the treatment of keratoconus, keratectasia, and infectious keratitis. Its efficacy and safety have been investigated with clinical and laboratory studies since its first clinical application by Wollensak for the treatment of keratoconus. Although its complications are encountered during clinical practice, such as infection inducing risk, minimal invasion merits a further investigation on its future application in clinical practice. Recently, collagen cross-linking in sclera shows a promising prospect. In present study, we summarized the representative studies describing the clinical and laboratory application of collagen cross-linking published in past decades and provided our opinion on the positive and negative results of cross-linking in the treatment of ophthalmic disorders.

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“…Hafezi et al, as first in 2009, proposed this technique for corneas thinner than 400 microns, and they observed a stabilization of corneal ectasia in 20 eyes treated with this technique, and similar results were later confirmed by other authors [29][30][31]. However, after this technique was reported permanent corneal scars and permanent stromal scar, and Gu et al showed a decreased endothelial cell density 3 months after the treatment [32,33]. Some authors believe that this technique is not reliable and that is important monitoring the corneal thickness throughout CXL treatment with hypo-osmolar riboflavin because artificial cornea swelling effect is transient.…”

Section: Discussionmentioning

confidence: 78%

Epi-off-lenticule-on corneal collagen cross-linking in thin keratoconic corneas

et al. 2020

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Purpose To evaluate the safety and efficacy of corneal collagen cross-linking (CXL) performed on overlaying a corneal lenticule to thin recipient corneas of progressive keratoconus (KC) patients. Methods In this study were enrolled eyes of patients affected by progressive KC with a minimum corneal thickness less than 400 lm, after overlaying a lenticule of human corneal stroma prepared with the femtosecond laser. The lenticules used were 100 lm thick and of 8.5 mm diameter in all the cases. Both the host cornea and the lenticules were subjected to epithelial debridement. CXL was carried out according to the standard protocol. Visual acuity, refraction, slit-lamp examination, endothelial cell density, pachymetry and keratometry, anterior segment tomography (AS-OCT) and confocal microscopy were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Results CXL was performed in 10 eyes of 8 patients (main age 23), corneal thickness range 379-414 lm, mean 387.6 lm. One patient was lost at follow-up. In all other cases, visual acuity and the endothelial cell density remained stable over a 12-month follow-up. Preoperative mean K1 and mean K2 were 46.91 ± 1.9 and 50.75 ± 2.93, respectively, and at 12 months mean K1 was 47.36 ± 2.66 and mean K2 50.53 ± 3.35. The AS-OCT clearly showed a demarcation line in all patients at 1, 3 (mean depth 283 lm and 267 lm, respectively) and in some cases at 6 months. Reduced keratocyte density and stromal oedema were observed immediately up to 1 month after treatment, while a slight subepithelial haze was present at 1-month and completely disappeared by 6 months. Conclusion This new technique seems to offer a therapeutic opportunity for young patients suffering from progressive KC with very thin corneas, in which the standard treatment is not indicate, and delay or avoid the need for a corneal transplant.

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Corneal Collagen Cross-Linking with Hypoosmolar Riboflavin Solution in Keratoconic Corneas

Cited by 12 publications

References 42 publications

Hypo-osmolar accelerated corneal crosslinking on resultant sub-400 μm topography-guided excimer regularized keratoconus corneas

Hypo-osmolar accelerated corneal crosslinking on resultant sub-400 μm topography-guided excimer regularized keratoconus corneas

A Review of Collagen Cross-Linking in Cornea and Sclera

Epi-off-lenticule-on corneal collagen cross-linking in thin keratoconic corneas

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