Effect of corneal cross-linking on endothelial cell density and morphology in the peripheral cornea

Goukon, Hiroyasu; Kamiya, Kazutaka; Takahashi, Masahide; Shoji, Nobuyuki

doi:10.1186/s12886-020-01415-y

Cited by 5 publications

(1 citation statement)

References 23 publications

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“…The assessment of endothelial cell density (ECD) loss in standard and accelerated and transepithelial CXL protocols in the pediatric group has not produced a statistically significant decrease in ECD after the procedure [ 21 , 23 , 56 , 58 , 61 , 69 , 70 , 76 , 80 , 82 , 96 , 97 ]; however, other studies reported that, depending on the protocol and carrier used, there is damage to endothelial cell density [ 68 , 98 – 100 ]. In a retrospective SCXL study developed by Barbisan et al in 2020, involving 105 eyes, a statistically significant reduction in ECD was observed, as well as corneal thinning after 1 year of follow-up, evidencing the potential impact of CXL on anatomy and corneal physiology [ 68 ].…”

Section: Resultsmentioning

confidence: 99%

Pediatric Crosslinking: Current Protocols and Approach

et al. 2022

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Keratoconus (KC) is likely to be more aggressive in the pediatric population, with a higher risk of progression and visual loss. Several techniques have been proposed for corneal crosslinking (CXL) so far. The standard CXL (SCXL) technique, or the Dresden Protocol, originally developed by Wollensak et al., has been shown to be safe and effective in the pediatric KC group. With similar efficacy to the conventional method, the accelerated CXL (ACXL) protocols proposed a reduced UVA exposure time by increasing the intensity of UVA irradiation. Transepithelial CXL (TCXL), considered an “epithelium-on” method, emerged as a strategy to improve safety and reduce postoperative complications and discomfort. For thinner corneas, we can highlight the use of hypoosmolar riboflavin and new studies, such as contact lens-assisted CXL (CACXL), the epithelial-island CXL (EI-CXL), and the Sub400 protocol. In addition to the different protocols used, another factor that changes CXL results is the type of carrier used: dextran-based or hydroxypropyl methylcellulose-based (HPMC) riboflavin solutions. There are several ways to perform a CXL surgery, and it is still unclear which method is the safest and most effective in the pediatric group. This review of the literature in English, available in PubMed, provides an update on corneal CXL in the pediatric KC group, exploring the data on the techniques currently used and under investigation, including their advantages, efficacy, safety profiles, risks, and cost analyses.

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Section: Resultsmentioning

confidence: 99%

Pediatric Crosslinking: Current Protocols and Approach

et al. 2022

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Donor Endothelial Cell Density Not Changed Immediately After Ex Vivo Corneal Cross-Linking

Arrigunaga

Benetz

Farazdaghi

et al. 2023

Eye Banking and Corneal Transplantation

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Purpose: The aim of this study was to evaluate the effect of corneal cross-linking on central endothelial cell density (ECD) by comparing masked measurements before and immediately after preparation of cross-linked (CXL) and non–cross-linked (non-CXL) donor corneas. Methods: Thirty donor corneas were randomized 1:1 to either CXL or non-CXL using a modified Dresden protocol. Specular microscopic images of the central corneal endothelium were obtained within 36 hours of recovery and within 3 hours of preparation completion. Images were sent to a central cornea image analysis reading center for ECD determination in a masked, dual-graded manner. Results: Before and after preparation, the mean ECD was 2567 ± 305 cells/mm2 and 2525± 339 cells/mm2 for the CXL group (n =15) and 2652 ± 365 cells/mm2 and 2572 ± 513 cells/mm2 for the non-CXL group (n =15), respectively. The mean difference in ECD before and after preparation was not statistically significant for the CXL and non-CXL groups (P = 0.36; P = 0.31, respectively). In addition, an independent sample t test showed no statistically significant difference in the ECD change between the CXL and non-CXL groups (P = 0.67). Conclusions: Our specular microscopic findings show that ex vivo cross-linking of donor corneas does not seem to produce acute decrease of central endothelial cell density. These findings are encouraging and assist in warranting a clinical trial examining its value in reducing refractive errors and improving postoperative visual outcomes in eyes with keratoconus that undergo keratoplasty.

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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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Effect of corneal cross-linking on endothelial cell density and morphology in the peripheral cornea

Cited by 5 publications

References 23 publications

Pediatric Crosslinking: Current Protocols and Approach

Pediatric Crosslinking: Current Protocols and Approach

Donor Endothelial Cell Density Not Changed Immediately After Ex Vivo Corneal Cross-Linking

Definition of Progressive Keratoconus: A Systematic Review

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