Corneal Crosslinking: Present and Future

Angelo, Lize; Boptom, Akilesh Gokul; McGhee, Charles N.H.; Ziaei, Mohammed

doi:10.1097/apo.0000000000000557

Cited by 18 publications

(14 citation statements)

References 93 publications

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“…Since 2007, collagen crosslinking (CXL) has been used internationally to halt KC progression in mild–moderate cases [ 7 ]. In the United States, the epithelium-off technique (Dresden protocol) has been utilized by clinicians since FDA approval in 2016 [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Collagen Crosslinking for Keratoconus: Cellular Signaling Mechanisms

et al. 2023

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Collagen crosslinking (CXL) is a widely used treatment to halt the progression of keratoconus (KC). Unfortunately, a significant number of patients with progressive KC will not qualify for CXL, including those with corneas thinner than 400 µm. The present study aimed to investigate the molecular effects of CXL using in vitro models, mirroring the normal, as well as thinner corneal stroma seen in KCs. Primary human corneal stromal cells were isolated from healthy (HCFs) and keratoconus (HKCs) donors. Cells were cultured and stimulated with stable Vitamin C resulting in 3D self-assembled extracellular matrix (ECM), cell-embedded, constructs. CXL was performed on (a) thin ECM with CXL performed at week 2 and (b) normal ECM with CXL performed at week 4. Constructs without CXL served as controls. All constructs were processed for protein analysis. The results showed modulation of Wnt signaling, following CXL treatment, as measured by the protein levels of Wnt7b and Wnt10a, correlated to the expression of α-smooth muscle actin (SMA). Further, the expression of a recently identified KC biomarker candidate, prolactin-induced protein (PIP), was positively impacted by CXL in HKCs. CXL-driven upregulation of PGC-1 and the downregulation of SRC and Cyclin D1 in HKCs were also noted. Although the cellular/molecular impacts of CXL are largely understudied, our studies provide an approximation to the complex mechanisms of KC and CXL. Further studies are warranted to determine factors influencing CXL outcomes.

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Section: Introductionmentioning

confidence: 99%

Collagen Crosslinking for Keratoconus: Cellular Signaling Mechanisms

et al. 2023

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“…However, novel modified techniques such as transepithelial corneal crosslinking and accelerated corneal crosslinking can avoid the removal of the corneal epithelium. 3 The procedure results in the strengthening of corneal collagen and its biomechanical property. 4 The ocular surface is naturally inhabited by a microbiota system in healthy people.…”

Section: Introductionmentioning

confidence: 99%

Herpetic Keratitis Following Corneal Crosslinking for Keratoconus: A Case Series

Wang¹,

Deng²,

Ma³

et al. 2022

IDR

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Background: Corneal crosslinking is widely applied to enhance corneal biomechanical properties and delay the progression of keratoconus. The surgical procedure and application of ultraviolet A irradiation (UVA) during corneal crosslinking have been recognized to induce the reactivation of simplex herpes virus (HSV) but are rarely reported and poorly analyzed. Case Presentation: We report the first case series of herpetic keratitis in 4 keratoconus patients undertaking corneal crosslinking, who were all clinically diagnosed at routine follow-up visits 3 days to 1 month after the surgery. Different from the typical new onset of secondary herpetic keratitis that mainly presents with epithelial lesions and severe eye pain, these patients all presented with stromal infiltrates and were generally asymptomatic except for vision blurring in 2 patients. All patients responded well to antiviral therapy, topical steroids, and epithelial nourishment medication, leaving corneal macula or nebula at the last follow-up visit. Conclusion:Close follow-up is essential and the most effective way to diagnose herpetic keratitis after corneal crosslinking due to the lack of subjective symptoms. The prophylactic use of antiviral therapy on asymptomatic patients is controversial and should be evaluated based on long-term prognosis.

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“…1,3 Over the past two decades, corneal crosslinking (CXL) has revolutionized the management of keratoconus by effectively stabilizing the underlying ectatic process, with a reported success rate of 73% to 100%. 4 Keratoconus is diagnosed by slitlamp evaluation and indicative signs on corneal topography and tomography such as corneal asymmetry, steepening of the anterior corneal surface, posterior elevation, and corneal thinning. [4][5][6] These imaging devices are not always accessible in primary care because of the purchase expense.…”

mentioning

confidence: 99%

“…4 Keratoconus is diagnosed by slitlamp evaluation and indicative signs on corneal topography and tomography such as corneal asymmetry, steepening of the anterior corneal surface, posterior elevation, and corneal thinning. [4][5][6] These imaging devices are not always accessible in primary care because of the purchase expense. 7 Moreover, keratoconus progression can be indicated by worsening visual acuity, change in refraction, and the development of clinical signs, such as acute corneal hydrops or apical scarring.…”

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confidence: 99%

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Keratoconus Management in the Community: A Survey of Optometrists

Angelo,

Gokul,

McGhee

et al. 2023

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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Objectives: Defining the patterns of practice and referral criteria of optometrists within New Zealand to investigate the diagnosis and management of keratoconus. Methods: Optometrists recruited through the New Zealand Association of Optometrists, Cornea and Contact Lens Society of New Zealand, and private practices were invited to complete an anonymous survey. Results: Responses were received from 168 optometrists (representing 20.0% of the optometrist population). Half (48%) of optometrists had ≥15 years of experience, and 22% prescribed soft contact lenses daily, whereas only 6.4% prescribed rigid gas-permeable (RGP) lenses daily. The main barriers to prescribing RGPs were experience with fitting, low market demand, and patient discomfort. When referring to an ophthalmologist, 41% reported referring on progression of corneal parameters, 27% on initial diagnosis, 21% at no set time, and 10% with a reduction in visual acuity. Most optometrists (64%) would refer for possible surgery when visual acuity dropped between 6/9 and 6/12. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal imaging unit suggested an increased likelihood of prescribing RGP lenses but did not alter referral patterns. Conclusion: This survey provides an overview of current practice and highlights the importance of optometrists in the diagnosis and management of keratoconus. There was a significant discrepancy in keratoconus management, regarding optical correction modality and referral criteria for ophthalmology review. Further interdisciplinary work is required between optometry and ophthalmology to standardize referral guidelines and enhance visual outcomes.

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Corneal Crosslinking: Present and Future

Cited by 18 publications

References 93 publications

Collagen Crosslinking for Keratoconus: Cellular Signaling Mechanisms

Collagen Crosslinking for Keratoconus: Cellular Signaling Mechanisms

Herpetic Keratitis Following Corneal Crosslinking for Keratoconus: A Case Series

Keratoconus Management in the Community: A Survey of Optometrists

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