Customised Peripheral Corneal Cross-linking (P-CXL) for Ultra-thin Corneas with Stage III and IV Keratoconus

Abbondanza, Marco; Wong, Zoie Shui-Yee; Felice, Valentina De; Abbondanza, Gabriele

doi:10.1080/08820538.2023.2179407

Seminars in Ophthalmology

2023

DOI: 10.1080/08820538.2023.2179407

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Customised Peripheral Corneal Cross-linking (P-CXL) for Ultra-thin Corneas with Stage III and IV Keratoconus

Marco Abbondanza¹,

Zoie Shui-Yee Wong

Valentina De Felice³

et al.

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Cited by 4 publications

References 27 publications

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Effect of corneal cross-linking on biomechanical properties of swollen rabbit corneas

Li,

Bao,

Zhang

et al. 2025

Experimental Eye Research

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Effect of corneal cross-linking on biomechanical properties of swollen rabbit corneas

Li,

Bao,

Zhang

et al. 2025

Experimental Eye Research

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Definition of Progressive Keratoconus: A Systematic Review

Henriquez,

Larco,

Izquierdo

2024

Cornea

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Purpose: To identify the definitions used for progressive keratoconus in the literature. Methods: A systematic literature review aimed to identify the definitions used for “progressive keratoconus” in the published articles. A comprehensive search from January 2018 to May 2023 was conducted across Cochrane Library, PubMed, Taylor & Francis, Web of Science, and other bibliographic databases at Oftalmosalud, Lima, Peru. The inclusion criteria were articles including patients with keratoconus without any previous surgical procedure and containing the definition of “progressive keratoconus” or “keratoconus progression” and a sample size greater than 10 eyes. Results: A total of 221 articles were included for analysis. The 3 most frequent parameters to define progression included data from anterior curvature, pachymetry, and refraction used in 97.8% (216/221), 37.6% (83/221), and 32.1% (71/221) of the articles, respectively. Specifically, the most frequent criterion used was maximum keratometry (Kmax), used in 85.5% (189/221) of the articles. Progression was assessed between 6- and 12-month follow-up in 64.7% (143/221) of the articles. Data from posterior cornea were used in only 8.1% (18/221) of the studies. None of the studies included data from the corneal epithelium. Conclusions: The present study demonstrates the lack of unified criteria to define progression of keratoconus and an underutilization of the technology described. It also shows that the single point Kmax measurement is the most commonly used criterion, followed by a change in refractive astigmatism and thinning at the thinnest pachymetric point.

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Combining Riboflavin/UV-A Light and Rose Bengal/Green Light Corneal Cross-Linking Increases the Resistance of Corneal Enzymatic Digestion

Aydemir,

Hafezi,

et al. 2024

Trans. Vis. Sci. Tech.

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Purpose The purpose of this study was to determine if concurrent riboflavin/UV-A light (RF/UV-A) and rose Bengal/green light (RB/green) epi-off PACK-CXL enhances corneal resistance to enzymatic digestion compared to separate chromophore/light treatments. Methods Ex vivo porcine corneas were allocated as follows. Group A corneas were soaked with riboflavin (RF) and were either not irradiated (A1, controls) or were irradiated with 10 (A2) or 15 J/cm² (A3) UV-A light at 365 nm, respectively. Group B corneas were soaked with RB and either not irradiated (B1, controls) or were illuminated with 10 (B2) or 15 J/cm² (B3) green light at 525 nm, respectively. Corneas in group C were soaked with both RF and RB and were either not irradiated (C1, controls) or were subjected to the same session consecutive 10 J/cm 2 (C2) or 15 J/cm 2 (C3) UV-A and green light exposure. Following treatment, all corneas were exposed to 0.3% collagenase A to assess digestion time until corneal button dissolution. Results A1 to A3 digestion times were 21.38, 30.5, and 32.25 hours, respectively, with A2 and A3 showing increased resistance to A1. B1-3 had digestion times of 31.2, 33.81, and 34.38 hours, with B3 resisting more than B1. C1 to C3 times were 33.47, 39.81, and 51.94 hours; C3 exhibited superior resistance to C1 and C2 (both P < 0.05). Conclusions Same-session combined RF/UV-A and RB/green PACK-cross-linking significantly increases corneal enzymatic digestion resistance over standalone treatments. Translational Relevance Combining RF-based and RB-based PACK-CXL considerably increases corneal collagenase digestion resistance, potentially minimizing ulcer size in clinical contexts.

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Customised Peripheral Corneal Cross-linking (P-CXL) for Ultra-thin Corneas with Stage III and IV Keratoconus

Cited by 4 publications

References 27 publications

Effect of corneal cross-linking on biomechanical properties of swollen rabbit corneas

Effect of corneal cross-linking on biomechanical properties of swollen rabbit corneas

Definition of Progressive Keratoconus: A Systematic Review

Combining Riboflavin/UV-A Light and Rose Bengal/Green Light Corneal Cross-Linking Increases the Resistance of Corneal Enzymatic Digestion

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