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

Rush, Sloan W; Rush, Ryan B

doi:10.1136/bjophthalmol-2016-308914

Cited by 26 publications

(31 citation statements)

References 22 publications

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“…They reported greater improvement in Kmax in epithelium-off group (−1.52 ± 0.66 D) compared with TE (−0.54 ± 0.58 D) with no statistically significant difference in BCVA improvement between two groups (−0.18 ± 0.09 logMAR in the conventional group versus −0.14 ± 0.08 logMAR in TE group). 103 …”

Section: Transepithelial CXL Compared To Conventional Epithelium-off mentioning

confidence: 99%

Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes

Mohammadpour

Masoumi

Mirghorbani

et al. 2017

Journal of Current Ophthalmology

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PurposeTo review the historical background and basic principles of collagen cross-linking, to bring together the data regarding the outcomes and complications of collagen cross-linking and finally to explore the efficacy and safety of new variations of this technique.MethodsA literature review was performed using PubMed and Scopus. The following keywords were used for literature search: cross linking, crosslinking, cross-linking, keratoconus, keratectasia.ResultsIn contrast to traditional treatment modalities for keratoconus (KCN), this new technique addresses the progression of the disease. Several clinical studies have been conducted to assess the efficacy of corneal collagen cross-linking (CXL) in the last decade. The results were promising as collagen cross-linking showed significant improvement in visual acuity and keratometric values. Moreover, initial results show that it is a safe procedure with few reported complications.ConclusionCXL is an emerging treatment method in ophthalmology that offers the possibility to effectively treat progressive KCN.

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Section: Transepithelial CXL Compared To Conventional Epithelium-off mentioning

confidence: 99%

Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes

Mohammadpour

Masoumi

Mirghorbani

et al. 2017

Journal of Current Ophthalmology

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“… 7 And in recent years, several clinical trials have been designed to compare the therapeutic effects between the two methods. 8 , 9 , 10 , 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

“…Both of the surgical techniques resulted in stabilization of the CDVA during the 36-month follow-up, which is similar to the results obtained in a number of other studies, 19 although most of the comparative studies to date have reported improvement with both techniques. 8 , 9 , 10 , 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

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Epithelium-Off vs. transepithelial corneal collagen crosslinking in progressive keratoconus: 3 years of follow-up

Arance-Gil

Villa-Collar

Pérez-Sánchez

et al. 2021

Journal of Optometry

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Purpose To compare the efficacy of epithelium-off corneal collagen crosslinking (CXL) with transepithelial CXL in patients with progressive keratoconus with a follow-up of 3 years, taking into account the patients’ age and the location of the corneal ectasia. Methods In this prospective study participated 64 eyes with progressive keratoconus were included in this long-term study, of which 31 eyes were treated by epithelium-off CXL and 33 by transepithelial CXL. All of the patients with a follow-up of 36 months were evaluated for visual variables (corrected distance visual acuity (CDVA), corneal aberrations, and corneal densitometry), structure variables (astigmatism, keratometry, corneal asphericity, maximum posterior elevation, corneal thickness, and corneal volume), and keratoconus index variables. Results After corneal CXL, CDVA improved significantly in both central and paracentral keratoconus, with greater improvement in the centrals (p = 0.001), asphericity at 6 mm improved in central keratoconus (p = 0.047). In the epi-off group, there was a significant improvement in coma-like (p = 0.038), higher-order aberrations (p = 0.036), asphericity at 8 mm (p = 0.049), asphericity at 10 mm (p = 0.049), and index of surface variance (p = 0.049). Conclusion Although both techniques halted and stabilized the progression of keratoconus, epithelium-off CXL was more effective. In addition, after the corneal CXL, there was a greater degree of regularization of the corneal surface and, therefore, a greater improvement in the CDVA with central keratoconus than with paracentral keratoconus.

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“… 26 – 29 Whatever the method of Rf application, however, transepithelial UVA CXL has yet to reproduce the results of traditional UVA CXL. 14 , 23 , 30 – 32 Specifically, a review of the literature shows that patients with transepithelial crosslinking show improved Best spectacle corrected visual acuity (BSCVA) compared to traditional crosslinking but do not show a halting of the progression of ectasia. 31 This could be due to the reduced concentration of Rf within the corneal stroma when the epithelium is left intact.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Transepithelial Riboflavin Delivery Using Femtosecond Laser-Machined Epithelial Microchannels

Bradford

Mikula

Xie

et al. 2020

Trans. Vis. Sci. Tech.

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This study describes a femtosecond laser (FS) approach to machine corneal epithelial microchannels for enhancing riboflavin (Rf) penetration into the cornea prior to corneal crosslinking (CXL). Methods: Using a 1030-nm FS laser with 5-to 10-μJ pulse energy, the corneal epithelium of slaughterhouse rabbit eyes was machined to create 2-μm-diameter by 25-μmlong microchannels at a density of 100 or 400 channels/mm 2. Rf penetration through the microchannels was then determined by applying 1% Rf in phosphate-buffered saline for 30 minutes followed by removal of the cornea and extraction from the central stromal button. Stromal Rf concentrations were then compared to those obtained using standard epithelial debridement or 0.01% benzalkonium chloride (BAK) to disrupt the epithelial barrier. Results: Microchannels formed using a 5-μJ/pulse at a density of 400 channels/mm 2 achieved a stromal Rf concentration that was 50% of that achieved by removal of the corneal epithelium and imbibing with 1% Rf. Stromal Rf levels were also equal to that of debrided corneas soaked with 0.5% Rf, threefold higher than those soaked with 0.1% Rf, and twofold higher than corneas soaked in BAK without epithelial debridement. Organ culture of treated corneas showed a normal corneal epithelium following FS machining while BAK-treated corneas showed extensive epithelial and stromal damage at 24 hours posttreatment. Conclusions: FS corneal epithelial machining can be used to enhance penetration of Rf into the stroma for corneal CXL. Translational Relevance: The creation of epithelial microchannels allows for stromal Rf concentrations high enough to perform true transepithelial crosslinking.

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

Abstract: NCT01708538; pre-results.

Cited by 26 publications

References 22 publications

Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes

Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes

Epithelium-Off vs. transepithelial corneal collagen crosslinking in progressive keratoconus: 3 years of follow-up

Enhanced Transepithelial Riboflavin Delivery Using Femtosecond Laser-Machined Epithelial Microchannels

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