Epithelial-disruption collagen crosslinking for keratoconus: One-year results

Rechichi, Miguel; Daya, Sheraz M.; Scorcia, Vincenzo; Meduri, Alessando; Scorcia, G

doi:10.1016/j.jcrs.2013.05.022

Cited by 48 publications

(46 citation statements)

References 25 publications

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“…With growing interest in transepithelial CXL, investigators have reported several enhanced techniques such as the use of chemical agents,15 mechanical epithelial disruption16 and iontophoresis17 18 to increase the delivery of riboflavin solution into the corneal stroma through the intact epithelium. However, it is presently unknown whether or not any of these transepithelial techniques are as effective in treating progressive corneal ectasia as the standard epithelium-off technique,19 and there are currently no clinical trials comparing different techniques available.…”

Section: Introductionmentioning

confidence: 99%

Epithelium-off versus transepithelial corneal collagen crosslinking for progressive corneal ectasia: a randomised and controlled trial

Rush

2016

Br J Ophthalmol

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Section: Introductionmentioning

confidence: 99%

Epithelium-off versus transepithelial corneal collagen crosslinking for progressive corneal ectasia: a randomised and controlled trial

Rush

2016

Br J Ophthalmol

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“…The first epithelium-on CXL (epi-on-CXL) protocols included the use of multiple topical applications of tetracaine 1% to disrupt epithelial tight junctions (Boxer Wachler et al., 2010, Chan et al., 2007) and partial epithelial debridement in a grid pattern (Rechichi et al., 2013). More recently, novel formulations of riboflavin have been developed to facilitate epi-on-CXL.…”

Section: Introductionmentioning

confidence: 99%

An investigation into corneal enzymatic resistance following epithelium-off and epithelium-on corneal cross-linking protocols

Aldahlawi

Hayes

O’Brart

et al. 2016

Experimental Eye Research

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The aim of this study was to investigate corneal enzymatic resistance following epithelium off and on riboflavin/UVA cross-linking (CXL). One hundred and fourteen porcine eyes were divided into four non-irradiated control groups and seven CXL groups. The latter comprised; (i) epithelium-off, 0.1% iso-osmolar riboflavin, 9 mW UVA irradiation for 10 min, (ii) disrupted epithelium, 0.1% hypo-osmolar riboflavin, 9 mW UVA for 10 min, (iii) epithelium-on, 0.25% hypo-osmolar riboflavin with 0.01% benzylalkonium chloride (BACS), 9 mW UVA for 10 min, (iv) epithelium-on, 5 min iontophoresis at 0.1 mA for 5 min with 0.1% riboflavin solution, 9 mW UVA for 10 min or (v) 12.5 min, (vi) epithelium-on, prolonged iontophoresis protocol of 25 min with 1.0 mA for 5 min and 0.5 mA for 5 min with 0.25% riboflavin with 0.01% BACS, 9 mW UVA for 10 min or (vii) 12.5 min. Enzymatic resistance was assessed by daily measurement of a corneal button placed in pepsin solution and measurement of corneal button dry weight after 11 days of digestion. This study revealed that the enzymatic resistance was greater in CXL corneas than non-irradiated corneas (p < 0.0001). Epithelium-off CXL showed the greatest enzymatic resistance (p < 0.0001). The prolonged iontophoresis protocol was found to be superior to all other trans-epithelial protocols (p < 0.0001). A 25% increase in UVA radiance significantly increased corneal enzymatic resistance (p < 0.0001). In conclusion, although epithelium-on CXL appears to be inferior to epithelium-off CXL in terms of enzymatic resistance to pepsin digestion, the outcome of epithelium-on CXL may be significantly improved through the use of higher concentrations of riboflavin solution, a longer duration of iontophoresis and an increase in UVA radiance.

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“…The technique involves disruption of the corneal epithelium using a custom-designed surgical instrument, in place of the complete epithelial debridement performed during conventional CXL. 11 The technique of CXL using epithelial disruption was first developed and introduced in our department in 2007 by Dr Sheraz Daya, and we report our results to date.…”

Section: Introductionmentioning

confidence: 83%

“…10 There seems, therefore, a place for a CXL technique that involves minimal disturbance to the corneal epithelium, but where efficacy and safety are maintained for even the most severe cases of keratoconus. 11 In an attempt to address this, a hybrid technique for CXL has been adopted at The Corneoplastic Unit at Queen Victoria Hospital, East Grinstead (UK). The technique involves disruption of the corneal epithelium using a custom-designed surgical instrument, in place of the complete epithelial debridement performed during conventional CXL.…”

Section: Introductionmentioning

confidence: 99%

Corneal collagen crosslinking for keratoconus or corneal ectasia without epithelial debridement

Hirji

Sykakis

Lam

et al. 2015

Eye

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Purpose Corneal collagen crosslinking (CXL) is a relatively new technique to reduce the progression of keratoconus. The technique can be performed with or without complete debridement of the corneal epithelium. We describe a novel intermediate technique involving mechanical disruption of the epithelium, and evaluate its safety and efficacy. Methods The case notes of 128 eyes with progressive keratoconus or iatrogenic corneal ectasia who had undergone CXL using the epithelial disruption technique were retrospectively reviewed. Thin corneas were treated with hypotonic riboflavin. All others were treated with an isotonic solution. Note was made of preoperative and postoperative parameters, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, and corneal tomography. Occurrence of procedure-related complications was recorded. Statistical analyses were performed using the paired sample t-test and Wilcoxon signedrank test, with a level of Po0.05 being accepted as statistically significant. Results At 12 months, 41.8% of patients treated with isotonic riboflavin had improved UCVA and 29.7% had improved BSCVA. Only 13.4% lost lines of UCVA and 14.9% lost BSCVA. Of the patients treated with hypotonic riboflavin, at 12 months, 75% demonstrated stability of BSCVA and 25% had stable Kmax. In addition, 25% showed improved visual acuity at 12 months, and 58.3% showed regression of their Kmax. Our rate of short-term complications was comparable to studies using complete epithelial removal. Conclusions CXL with epithelial disruption is a safe and effective treatment for keratoconus or iatrogenic corneal ectasia, and may be better tolerated by patients than the epithelium-off technique.

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Epithelial-disruption collagen crosslinking for keratoconus: One-year results

Abstract: Corneal epithelial-disruption CXL was safe and effective in medium-term stabilization of keratoconus with an improvement in topographic and refractive parameters and less patient discomfort.

Cited by 48 publications

References 25 publications

Epithelium-off versus transepithelial corneal collagen crosslinking for progressive corneal ectasia: a randomised and controlled trial

Epithelium-off versus transepithelial corneal collagen crosslinking for progressive corneal ectasia: a randomised and controlled trial

An investigation into corneal enzymatic resistance following epithelium-off and epithelium-on corneal cross-linking protocols

Corneal collagen crosslinking for keratoconus or corneal ectasia without epithelial debridement

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