Eine neue Behandlung der Keratektasie nach LASIK durch Kollagenvernetzung mit Riboflavin/UVA-Licht

Kohlhaas, M.; Spoerl, Eberhard; Speck, A; Schilde, T; Sandner, Dirk; Pillunat, Lutz E

doi:10.1055/s-2005-857950

Cited by 87 publications

(32 citation statements)

References 5 publications

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“…Recently, several groups have reported that CCL with riboflavin and ultraviolet-A can stop and even partially reverse progressive LASIK-induced keratectasia. 8,9 In our case, CCL stabilized the ectasia and led to a partial regression of maximum K-readings over a period of 2 years. However, during the patient's second pregnancy, the keratectasia exacerbated.…”

Section: Discussionmentioning

confidence: 86%

Pregnancy-related exacerbation of iatrogenic keratectasia despite corneal collagen crosslinking

Hafezi¹,

Iseli²

2008

Journal of Cataract and Refractive Surgery

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Iatrogenic keratectasia after laser in situ keratomileusis (LASIK) represents a serious complication of refractive laser surgery. We describe a woman who developed bilateral iatrogenic keratectasia during her first pregnancy 26 months after LASIK. Corneal collagen crosslinking (CCL) with riboflavin and ultraviolet-A was performed in March 2005 (right eye) and April 2005 (left eye). This treatment stopped the progression and even caused the keratometric steepness to regress over a postoperative follow-up of 22 months, as demonstrated by preoperative and postoperative corneal topographies and maximum K-readings. During the patient's second pregnancy, the keratectasia exacerbated. To our knowledge, this is the first case showing exacerbation of keratectasia despite CCL and, as the exacerbation occurred only during pregnancy, suggesting that hormonal changes might affect corneal biomechanical stability.

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Section: Discussionmentioning

confidence: 86%

Pregnancy-related exacerbation of iatrogenic keratectasia despite corneal collagen crosslinking

Hafezi¹,

Iseli²

2008

Journal of Cataract and Refractive Surgery

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“…CXL has been used for the treatment of progressive keratoconus since 2003 and received US Food and Drug Administration approval in 2016 19. In addition, this CXL method is also used in corneal ulcers, pellucid marginal degeneration, corneal melting, and iatrogenic keratectasia after laser eye surgery 20. Riboflavin is a photosensitizer and can be photoactivated by UV light to produce reactive oxygen radicals 21.…”

Section: Introductionmentioning

confidence: 99%

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Hou

Tóth

et al. 2018

American Journal of Transplantation

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Immunologic graft rejection is the main complication after corneal transplant into pathologically prevascularized so‐called high‐risk eyes. The aim of this study was to evaluate whether ultraviolet (UV) light crosslinking can regress pathologic corneal blood and lymphatic vessels and thereby improve subsequent graft survival. Using the murine model of suture‐induced corneal neovascularization, we found that corneal crosslinking with UVA light and riboflavin regressed both preexisting blood and lymphatic vessels significantly via induction of apoptosis in vascular endothelial cells. In addition, macrophages and CD45+ cell counts were significantly reduced. Consistently, corneal crosslinking reduced keratocyte density and corneal thickness without affecting corneal nonvascular endothelial cells, iris, and lens depending on the crosslinking duration. Furthermore, using the murine model of corneal transplant, long‐term graft survival was significantly promoted (P < .05) and CD4+ CD25+FoxP3+ T regulatory cells were upregulated (P < .01) in high‐risk eyes preoperatively treated with crosslinking. Our results suggest UV light crosslinking as a novel method to regress both pathologic corneal blood and lymphatic vessels and to reduce CD45+ inflammatory cells. Furthermore, this study demonstrates for the first time that preoperative corneal crosslinking in prevascularized high‐risk eyes can significantly improve subsequent graft survival and may become a promising novel therapy in the clinic.

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“…The therapeutic potential of CXL to treat progressive keratoconus was demonstrated in a clinical pilot study, 3 as well as in controlled prospective studies and in case reports and case series of patients with iatrogenic keratectasia after refractive laser surgery. [7][8][9][10] Before the first application in humans in 1999, 3 the parameters of the method (riboflavin concentration, intensity and wavelength of UVA light, and duration of treatment) were established in a series of time-and dose-response assays in animal models over several years. [2][3][4][11][12][13][14] To protect the corneal endothelium and deeper ocular structures, the currently used treatment parameters are set so the anterior 250 to 350 mm of corneal stroma are treated.…”

mentioning

confidence: 99%

Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas

Hafezi¹,

Mrochen²,

Iseli³

et al. 2009

Journal of Cataract and Refractive Surgery

314

230

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Corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light is a method for treating progressive keratectasia. The currently accepted treatment parameters induce collagen crosslinking in the anterior 250 to 350 mm of corneal stroma. To protect the endothelium, CXL inclusion criteria require a minimum corneal thickness of 400 mm after removal of the epithelium. In advanced keratoconus, however, progressive corneal thinning often leads to a remaining stromal thickness of less than 400 mm. We have therefore modified the current treatment protocol by preoperatively swelling thin corneas to a stromal thickness of at least 400 mm using hypoosmolar riboflavin solution. This treatment protocol was performed in a case series of 20 patients, and no complications were observed. Preoperative swelling of the cornea safely broadens the spectrum of CXL indications to thin corneas that would otherwise not be eligible for treatment.

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Eine neue Behandlung der Keratektasie nach LASIK durch Kollagenvernetzung mit Riboflavin/UVA-Licht

Abstract: Collagen cross-linking leads to a stiffening of the anterior parts of the corneal stroma. The increase of biomechanical stability can stop the progression of a keratectasia after LASIK by means of a simple procedure.

Cited by 87 publications

References 5 publications

Pregnancy-related exacerbation of iatrogenic keratectasia despite corneal collagen crosslinking

Pregnancy-related exacerbation of iatrogenic keratectasia despite corneal collagen crosslinking

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas

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