Corneal Epithelial Remodeling After Standard Epithelium-off Corneal Cross-linking in Keratoconic Eyes

Lautert, Jeferson; Doshi, Dharmil; Price, Francis W.; Price, Marianne O.

doi:10.3928/1081597x-20180402-03

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…24 The data presented here show epithelial thickening at month 1 after crosslinking, followed by a subsequent return to baseline values. This is consistent with other previous reports 25 and explains the transient increase in Kmax at month 1.…”

Section: Discussionsupporting

confidence: 94%

Comparison of Corneal Thickness Measurements After Customized Corneal Crosslinking Using High-Resolution Optical Coherence Tomography and Scheimpflug Tomography

Baiao

Wendelstein

Seiler

2023

Cornea

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Purpose:The aim of this study was to compare the evolution of corneal pachymetry after customized corneal crosslinking (CXL) between Scheimpflug-based and optical coherence–based corneal tomography (OCT).Methods:In this retrospective study, central corneal thickness (CCT), thinnest corneal thickness, and epithelial thickness of 33 eyes of 33 patients with keratoconus were measured preoperatively and 1, 3, and 12 months after customized CXL using the Pentacam HR and the MS-39. The mean pachymetry values of measurements were compared with a paired sample t test. Bland–Altman plots and 95% limits of agreement (LoA) were used to assess the agreement between the measurements of the 2 devices.Results:The mean age of the participants was 29.7 ± 11.4 years. At baseline, the mean CCT measurements were equal with Pentacam HR (478.30 ± 36.77 μm) and MS-39 (478.46 ± 38.01 μm). After CXL, CCT obtained by Pentacam HR was 460.65 ± 38.69 μm, 464.65 ± 44.45 μm, and 476.77 ± 39.85 μm, and by MS-39 was 478.18 ± 39.50 μm, 472.89 ± 40.92 μm, and 479.51 ± 39.20 μm at 1, 3, and 12 months, respectively. Pentacam HR measured significantly lower CCT (P < 0.05) at months 1 and 3 after CXL. The agreement was smallest between both devices at month 1 (95% LoA −59 to 24 μm) followed by month 3 (95% LoA: −41 to 23 μm). Epithelial thickness, measured with OCT alone, increased significantly at 1 month and regained preoperative levels at 3 months and thereafter.Conclusions:After CXL, corneal pachymetry significantly differs between OCT-based and Scheimpflug-based corneal tomography. Pentacam HR seems to underestimate pachymetry when haze is present.

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Section: Discussionsupporting

confidence: 94%

Comparison of Corneal Thickness Measurements After Customized Corneal Crosslinking Using High-Resolution Optical Coherence Tomography and Scheimpflug Tomography

Baiao

Wendelstein

Seiler

2023

Cornea

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“…At 6 months after C-CXL, a statistically signi cant improvement in epithelial irregularity indices (SD by -1.31 µm and min-max by 5 µm) together with a thickening at the thinnest point (min:2.75 µm) was evident. Furthermore, Lautert et al [22] showed that the min-max epithelial thickness (from 24 ± 9 to 22 ± 9 µm), which is another index for epithelial uniformity, signi cantly decreased after C-CXL at 6 months in accordance with the results of our study (23 ± 9 to 18 ± 7 µm). In the current study, early after C-CXL (1 month), we observed a decrease (-2.55 to -4.75 µm) in epithelial thickness over the paracentral areas surrounding the cone, the maximum epithelial thickness being reduced by 6.25 µ and a reduction in the epithelial thickness standard deviations by 2.3 µm.…”

Section: Discussionsupporting

confidence: 92%

A comparison of conventional and accelerated corneal crosslinking: corneal epithelial remodeling and in vivo confocal microscopy analysis

Hacıağaoğlu,

Akkaya Turhan,

Toker

2024

Int Ophthalmol

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To evaluate the effect of conventional and accelerated corneal crosslinking (CXL) on visual acuity, corneal topography, corneal epithelial thickness, and subbasal nerve morphology in progressive keratoconus patients. MethodsIn this prospective and randomized study, twenty eyes of 20 patients were treated with conventional CXL (3mW/cm2, 30 minutes, C-CXL) and 19 eyes of 19 patients were treated with accelerated CXL (9 mW/cm2, 10 minutes, A-CXL). The spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), keratometric measurements, demarcation line measurement and epithelial thickness mapping analyses, and subbasal nerve morphology with in vivo confocal microscopy (IVCCM) were evaluated at baseline and at postoperative months 1, 3 and 6. ResultsAt postoperative 6 months, a signi cant improvement was observed in all keratometric values in both treatment groups (p < 0.05). All epithelial thickness indices, except central, temporal, and inferotemporal thickness, were reduced at 1 month postoperatively in both treatment groups. The epithelial map uniformity indices (standard deviation and difference between min-max thickness) were signi cantly lower than the baseline values at all time points after CXL in both treatment groups (p < 0.001). Compared with the preoperative values, there was a signi cant decrease in all IVCCM parameters at 1 month postoperatively (p < 0.05). At 6 months postoperatively, corneal nerve ber density and corneal nerve branch density recovered to preoperative values in the A-CXL group, whereas corneal nerve regeneration was not complete in the C-CXL group. ConclusionBoth conventional and accelerated CXL treatments appear to be effective in halting the progression of KC. Corneal epithelial irregularity slightly improves after CXL. The regeneration of subbasal nerves is faster after A-CXL treatment.

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“…Lautert et al described a significantly decreased min-max value in ETM measured by SD-OCT at 6-month follow-up of their 93 KCN patients. The min-max parameter decrease strongly correlated with maximum keratometry readings on Scheimpflug imaging [ 126 ]. While a study using accelerated CXL by epithelium-off method (30 mW/cm2 for 4 minutes) found thinner CET in multiple nasal and inferior sectors and lower ETM SD in 12-month follow-up [ 127 ], others using transepithelial accelerated ETM could not find such changes in the same [ 128 ] or longer [ 129 ] follow-up periods.…”

Section: Etm In Corneal Diseasesmentioning

confidence: 99%

Corneal Epithelial Thickness Mapping: A Major Review

Abtahi,

Beheshtnejad,

Latifi

et al. 2024

Journal of Ophthalmology

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The corneal epithelium (CE) is the outermost layer of the cornea with constant turnover, relative stability, remarkable plasticity, and compensatory properties to mask alterations in the underlying stroma. The advent of quantitative imaging modalities capable of producing epithelial thickness mapping (ETM) has made it possible to characterize better the different patterns of epithelial remodeling. In this comprehensive synthesis, we reviewed all available data on ETM with different methods, including very high-frequency ultrasound (VHF-US) and spectral-domain optical coherence tomography (SD-OCT) in normal individuals, corneal or systemic diseases, and corneal surgical scenarios. We excluded OCT studies that manually measured the corneal epithelial thickness (CET) (e.g., by digital calipers) or the CE (e.g., by confocal scanning or handheld pachymeters). A comparison of different CET measuring technologies and devices capable of producing thickness maps is provided. Normative data on CET and the possible effects of gender, aging, diurnal changes, refraction, and intraocular pressure are discussed. We also reviewed ETM data in several corneal disorders, including keratoconus, corneal dystrophies, recurrent epithelial erosion, herpes keratitis, keratoplasty, bullous keratopathy, carcinoma in situ, pterygium, and limbal stem cell deficiency. The available data on the potential role of ETM in indicating refractive surgeries, planning the procedure, and assessing postoperative changes are reviewed. Alterations in ETM in systemic and ocular conditions such as eyelid abnormalities and dry eye disease and the effects of contact lenses, topical medications, and cataract surgery on the ETM profile are discussed.

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Corneal Epithelial Remodeling After Standard Epithelium-off Corneal Cross-linking in Keratoconic Eyes

Abstract: Epithelium-off CXL resulted in modest regularization of the epithelial thickness profile across the central 5 mm of the cornea at 6 months. This could slightly mask flattening of the underlying stroma. [J Refract Surg. 2018;34(6):408-412.].

Cited by 9 publications

References 29 publications

Comparison of Corneal Thickness Measurements After Customized Corneal Crosslinking Using High-Resolution Optical Coherence Tomography and Scheimpflug Tomography

Comparison of Corneal Thickness Measurements After Customized Corneal Crosslinking Using High-Resolution Optical Coherence Tomography and Scheimpflug Tomography

A comparison of conventional and accelerated corneal crosslinking: corneal epithelial remodeling and in vivo confocal microscopy analysis

Corneal Epithelial Thickness Mapping: A Major Review

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