Corneal collagen crosslinking for keratoconus and corneal ectasia: One-year results

Hersh, Peter S.; Greenstein, Steven A.; Fry, K. L.

doi:10.1016/j.jcrs.2010.07.030

Cited by 405 publications

(362 citation statements)

References 26 publications

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“…The effect of CXL found in our patients with regard to improved visual acuity and reduced keratometry is very similar to all other studies investigating the effect of CXL with epithelial removal in KC patients. [2][3][4]11,12 An important objective of this study was to assess the risk of adverse events after CXL. Despite the overall enthusiasm for offering CXL to KC patients, adverse events have been incompletely assessed in the literature.…”

Section: Resultsmentioning

confidence: 99%

“…1 Corneal cross-linking (CXL) using riboflavin and ultraviolet-A light has been shown to effectively increase corneal stiffness and even to reduce ectasia. [2][3][4] These findings originate from studies done mainly in young adults and led to the widespread use of CXL to stabilize KC in this group of patients, who have a 20% risk of progressing to a stage that requires therapeutic keratoplasty.…”

Section: Introductionmentioning

confidence: 99%

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Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

Baenninger

Bachmann

Wienecke

et al. 2014

Eye

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Purpose To compare the effect, failure rate and the risks of corneal cross-linking (CXL) in keratoconus patients aged Z35 years to patients o35 years. Methods In 141 eyes of 116 keratoconus patients we compared the changes in best phoropter-corrected visual acuity (BCVA) and maximum keratometry values (K max ) before and 12 months after CLX in patients aged Z35 years (n ¼ 34, 38 eyes) to the cohort of patients below 35 years of age. Results Overall, CXL significantly improved BCVA from 0.487 logMAR (95% confidence interval (CI) 0.426-0.548) by À 0.197 logMAR (95% CI À 0.243 to À 0.150; Po0.001) and reduced K max from 48.96 diopter (Dpt) by À 1.33 Dpt (95% CI À 1.85 to À 0.81: Po0.001). Age Z35 years had no effect on the changes of BCVA ( À 0.02 (95% CI À 0.13 to 0.09); P ¼ 0.757) or K max (0.58 (95%CI À 0.51 to 1.68); P ¼ 0.294) as compared with younger patients. In 54 patients (55 eyes, 38.5%) aged o35 years and in 18 patients (18 eyes, 47.4%) aged Z35 years, BCVA increased by Z2 Snellen lines. Failure (increase in K max Z1 Dpt) was observed in 17 eyes (16.5%) of patients aged o35 years and in 3 eyes (7.9%) of patients aged Z35 years during the 12-month follow-up period. Adverse outcomes (loss of Z2 Snellen lines) occurred in 4 (3.9%) eyes of patients aged o35 years and 1 (2.6%) eye of a patient aged Z35 years. Conclusion Effects and adverse events of CXL treatment do not seem to differ between subjects younger or older than 35 years.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

Baenninger

Bachmann

Wienecke

et al. 2014

Eye

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“…After diagnosis, we are currently monitoring six monthly for 2 years with annual review subsequently. More frequent initial monitoring 14,18,21 Excluding one study 18 in which control eyes were crossed over to treatment after just 3 months, we combined 1-year post-CXL keratometric and acuity outcome data for patients (n ¼ 31) in the remaining two trials. Clinically significant ectatic progression (increase in Kmax Z1D at 12 months) was observed in 32% untreated control eyes and 3% eyes treated with CXL (P ¼ 0.01, z-test); whereas significant regression (decrease in KmaxZ1D at 12 months) was seen in 45% of CXL treated eyes and 10% untreated control eyes (P ¼ 0.005, z-test) (Figures 1a and b).…”

Section: Defining Disease Progression-monitoring Keratoconusmentioning

confidence: 99%

“…Spontaneous disease regression does not normally occur in keratoconus, and apparent disease regression (decrease in KmaxZ1D) in 10% of control eyes in RCTs may simply reflect limitations in measurement accuracy for contemporary topographers 16 -a problem compounded by corneal warpage in rigid contact lens Table 2 Criteria for keratoconus progression vs baseline measurement used in contemporary clinical trials of corneal collagen crosslinking 14,18,21 Kmax Z1D increase Kmax À Kmin Z1D increase Kmean Z0.75D increase Pachymetry Z2% decrease in CCT Corneal apex power 41D increase MRSE 40.5D wearers. These limitations and varying inclusion criteria (Table 2) in contemporary studies underline the problem of defining disease progression in keratoconus and defining thresholds for intervention.…”

Section: Defining Disease Progression-monitoring Keratoconusmentioning

confidence: 99%

New clinical pathways for keratoconus

Gore

Shortt

Allan

2012

Eye

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Pre-2000, the clinical management of keratoconus centred on rigid contact lens fitting when spectacle corrected acuity was no longer adequate, and transplantation where contact lens wear failed. Over the last decade, outcome data have accumulated for new interventions including corneal collagen crosslinking, intracorneal ring implantation, topographic phototherapeutic keratectomy, and phakic intraocular lens implantation. We review the current evidence base for these interventions and their place in new management pathways for keratoconus under two key headings: corneal shape stabilisation and visual rehabilitation.

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“…Problems may range from relatively mild irregular astigmatism that may be corrected by rigid contact lenses to severe visual disability requiring keratoplasty. 1,2 Corneal ectasia may be caused by keratoconus or may be iatrogenic after laser vision correction among other causes, but the common final pathway is a loss of integrity of the corneal structure.…”

Section: Introductionmentioning

confidence: 99%

Corneal collagen crosslinking for keratoconus or corneal ectasia without epithelial debridement

Hirji

Sykakis

Lam

et al. 2015

Eye

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Purpose Corneal collagen crosslinking (CXL) is a relatively new technique to reduce the progression of keratoconus. The technique can be performed with or without complete debridement of the corneal epithelium. We describe a novel intermediate technique involving mechanical disruption of the epithelium, and evaluate its safety and efficacy. Methods The case notes of 128 eyes with progressive keratoconus or iatrogenic corneal ectasia who had undergone CXL using the epithelial disruption technique were retrospectively reviewed. Thin corneas were treated with hypotonic riboflavin. All others were treated with an isotonic solution. Note was made of preoperative and postoperative parameters, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, and corneal tomography. Occurrence of procedure-related complications was recorded. Statistical analyses were performed using the paired sample t-test and Wilcoxon signedrank test, with a level of Po0.05 being accepted as statistically significant. Results At 12 months, 41.8% of patients treated with isotonic riboflavin had improved UCVA and 29.7% had improved BSCVA. Only 13.4% lost lines of UCVA and 14.9% lost BSCVA. Of the patients treated with hypotonic riboflavin, at 12 months, 75% demonstrated stability of BSCVA and 25% had stable Kmax. In addition, 25% showed improved visual acuity at 12 months, and 58.3% showed regression of their Kmax. Our rate of short-term complications was comparable to studies using complete epithelial removal. Conclusions CXL with epithelial disruption is a safe and effective treatment for keratoconus or iatrogenic corneal ectasia, and may be better tolerated by patients than the epithelium-off technique.

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Corneal collagen crosslinking for keratoconus and corneal ectasia: One-year results

Abstract: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Cited by 405 publications

References 26 publications

Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

New clinical pathways for keratoconus

Corneal collagen crosslinking for keratoconus or corneal ectasia without epithelial debridement

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