Effect of Corneal Cross-linking versus Standard Care on Keratoconus Progression in Young Patients

Larkin, Frank; Biswas, Susmito; Bunce, Catey; Burr, Jennifer; Caverly, Emilia; Chowdhury, Kashfia; Doré, Caroline J; Edwards, Matthew; French, L; Kaye, Stephen B.; Klepacz, Anne; Kopsini, Dimitra; Larkin, Frank; Raynor, Mathew K.; Tuft, Stephen; Webber, Sue; Willoughbys, Colin

doi:10.1016/j.ophtha.2021.04.019

Cited by 56 publications

(61 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the decade from 2001 to 2010, 3171 first grafts for keratoconus were performed compared with 2797 in the subsequent decade from 2011 to 2020, a statistically significant decrease (p < 0.001). Whether this decrease of approximately 12% is a reflection of the increasing use of alternative procedures such as corneal collagen crosslinking [35][36][37][38] or insertion of intrastromal corneal ring segments 36,37 remains unclear.…”

Section: Changes In Practice: Deep Anterior Lamellar Keratoplasty For...mentioning

confidence: 99%

Outcomes of corneal transplantation in Australia, in an era of lamellar keratoplasty

Williams

Keane

2022

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

Widespread adoption of modern lamellar procedures has altered the pattern of practice of corneal transplantation. Herein, we describe recent findings from the Australian Corneal Graft Registry and place these data into an international context. The total number of grafts reported to the Registry has doubled over the past decade. Deep anterior lamellar keratoplasty is increasingly used for keratoconus, while endokeratoplasty has displaced penetrating keratoplasty for Fuchs endothelial dystrophy. Graft survival and visual outcomes for modern lamellar procedures have shown improvement over time. First deep anterior lamellar and penetrating grafts for keratoconus show comparable survival and long-term best-corrected visual acuity is equivalent. Penetrating grafts for Fuchs endothelial dystrophy exhibit significantly better survival than do endokeratoplasties, largely because the latter undergo more early graft failures.However, visual rehabilitation is swifter in surviving endokeratoplasties. Significantly fewer recipients of a deep anterior lamellar graft or endokeratoplasty require spectacle or contact lens correction, compared with penetrating keratoplasty.

show abstract

Section: Changes In Practice: Deep Anterior Lamellar Keratoplasty For...mentioning

confidence: 99%

Outcomes of corneal transplantation in Australia, in an era of lamellar keratoplasty

Williams

Keane

2022

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

show abstract

“…Although using the cutoff of 0.4 D does not constitute a conservative approach, it may be useful in a subset of patients in an attempt to treat the disease as early as possible prior to the development of additional visual dysfunction, especially when tomographical worsening is seen in numerous parameters. Due to the higher risk of rapid progression in younger individuals [ 6 , 14 – 16 ], subjects under 25 years of age were offered crosslinking immediately if best spectacle-corrected visual acuity (BSCVA) was <20/25 with tomographical evidence of keratoconus and there was a history of progressive decrease in visual acuity.…”

Section: Methodsmentioning

confidence: 99%

Crosslinking vs. Observation in Fellow Eyes of Keratoconus Patients

Meglio

Wang

et al. 2022

Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose. To evaluate whether unilateral crosslinking (CXL) and conservative follow-up of the fellow eye is an acceptable management strategy in patients with keratoconus (KC). Methods. Seventy-nine fellow eyes of KC subjects that initially underwent unilateral CXL were included. Thirty fellow eyes ultimately received CXL (group 1) whereas 49 fellow eyes were followed (group 2). Best spectacle corrected visual acuity (BSCVA) and corneal tomographic parameters were collected in all eyes preoperatively and at the last follow-up. Results. Subjects who received CXL in the fellow eye (group 1) were younger than subjects who did not (group 2, p = 0.026 ). Group 1 eyes had higher baseline K1 ( p = 0.026 ), K2 ( p = 0.006 ), Km ( p = 0.01 ), and Kmax ( p = 0.002 ) compared to group 2 eyes. Amongst the 49 naïve fellow eyes (group 2), 19 eyes showed evidence of progression. Progressing naïve eyes had higher baseline K1, K2, Km, and Kmax ( p < 0.01 ); progressors also had thinner pachymetry at the pupil, apex, and thinnest point ( p < 0.01 ). Baseline values of K1 ≥ 43.5 Diopter (D), K2 > 45.1D, Km > 44.3D, Kmax > 47.9D, astigmatism > 1.4D, pachymetry at the pupil <475 μm, and thinnest pachymetry <478 μm were tentative predictors of progression in the naïve fellow eye. Conclusions. Unilateral CXL with vigilant follow up of the fellow eye may be an acceptable management strategy in a subset of KC eyes.

show abstract

“…Léoni-Mesplié et al 47 found that of 216 subjects diagnosed with keratoconus, 22.7% of subjects were 15 years or under, and 27.8% had advanced disease compared with only 7.8% of adults. Larkin et al 48 found that, on average, subjects undergoing CXL had a 90% reduced risk of progression compared with conservative management. However, a systematic review of 1508 pediatric subjects by Achiron et al 49 reported that on average, 19.9% of subjects progressed despite undergoing epithelium-off CXL.…”

Section: Pediatric Crosslinkingmentioning

confidence: 99%

Corneal Crosslinking: Present and Future

Angelo¹,

Boptom²,

McGhee³

et al. 2022

Asia-Pacific Journal of Ophthalmology

View full text Add to dashboard Cite

Keratoconus is a progressive corneal thinning disorder that can lead to vision loss. In the last 2 decades, corneal crosslinking (CXL) has emerged as an effective method to halt the progression of keratoconus and reduce the number of patients requiring keratoplasty. The procedure has been adopted globally and has evolved to become a part of combination treatments to regularize the cornea and improve visual outcomes. CXL has even been extrapolated in managing other ocular pathologies such as progressive myopia, infectious keratitis, and bullous keratopathy. This review aims to summarize the current role of CXL in keratoconus and its alternative uses, and provide insights into future developments in this fast-developing field.

show abstract

Effect of Corneal Cross-linking versus Standard Care on Keratoconus Progression in Young Patients

Cited by 56 publications

References 33 publications

Outcomes of corneal transplantation in Australia, in an era of lamellar keratoplasty

Outcomes of corneal transplantation in Australia, in an era of lamellar keratoplasty

Crosslinking vs. Observation in Fellow Eyes of Keratoconus Patients

Corneal Crosslinking: Present and Future

Contact Info

Product

Resources

About