Intraoperative Corneal Thickness Measurements During Corneal Collagen Cross-Linking With Hypoosmolar Riboflavin Solution in Thin Corneas

Kaya, Vedat; Utine, Canan Aslı; Ylmaz, Ömer Faruk

doi:10.1097/ico.0b013e31821e4286

Cited by 58 publications

(50 citation statements)

References 26 publications

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“…These data correlate well with our data regarding the decrease in thickness. Kaya et al (38) measured corneal thickness at 5 different times: the thinnest pachymetry data decreased to a mean of 376 µm after the epithelial removal and by a mean of 55 µm after the 30-minute application of the isotonic riboflavin solution. The 10-minute application of hypotonic riboflavin resulted in the cornea thickening by a mean of 59 µm.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, hypoosmolar riboflavin solution is suggested in order to achieve corneal iatrogenic swelling (37), although according to previous research it has only a short-term effect and does not even last until the end of the treatment (38). Publications found in the literature clearly describe the CCT decrease observed after CXL treatment, though only a few and contradicting reports were carried out on the characteristics of CCT decrease in the intraoperative phase (35,38,39). Using isotonic solution, Kymionis et al (35) detected a mean 75 µm CCT decrease between epithelial removal and riboflavin instillation with ultrasound pachymetry measurements; however, they found no further changes in corneal thickness during irradiation.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative and Postoperative Corneal Thickness Change after Collagen Crosslinking Therapy

Hassan

Módis

Szalai

et al. 2013

European Journal of Ophthalmology

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Purpose: To assess intraoperative and postoperative changes in corneal thickness subsequent to riboflavin-UVA (collagen crosslinking [CXL]) treatment. Methods: Forty-one eyes of 41 patients (mean age 27.97 ± 6.97 years) were treated with CXL technique. During treatment, isotonic riboflavin was instilled and corneal thickness measurements were obtained at the cornea apex, the thinnest point, and the pupil center at 15 and 30 minutes, then 3 days, 1 week, and 1, 3, 6, and 12 months after surgery using Pentacam HR and an ultrasound pachymeter. Results: A decrease in corneal thickness was detected 15 minutes intraoperatively with a value of 108.95 ± 48.6 μm, and 112.35 ± 47.3 μm at 30 minutes (p<0.001). Three days after the operation, no deviation was found from the initial values (p = 0.17). No further changes were detected during the follow-up period. Conclusions: Isotonic riboflavin solution used during CXL treatment resulted in a significant decrease in corneal thickness, but its effect had disappeared by postoperative day 3.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative and Postoperative Corneal Thickness Change after Collagen Crosslinking Therapy

Hassan

Módis

Szalai

et al. 2013

European Journal of Ophthalmology

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“…In their studies, a lid speculum was kept in the eye during the whole procedure. Another research (16) showed a twostep TCT decrease of 19% during the 60-minute treatment: a slower thinning during riboflavin instillation (without a lid speculum) and a faster thinning when a lid speculum hold the lids open during UVA exposure. In all these studies, corneal exposure may have contributed to a higher corneal thickness decrease during the procedure and in the early postoperative CXL course.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies (15,16) found significant TCT decrease of about 17 to 20% in central corneal thickness 30 minutes after iso-osmolar riboflavin drops. In their studies, a lid speculum was kept in the eye during the whole procedure.…”

Section: Discussionmentioning

confidence: 99%

Corneal thickness changes during corneal collagen cross-linking with UV-A irradiation and hypo-osmolar riboflavin in thin corneas

Nassaralla¹,

Vieira

Machado

et al. 2013

Arq. Bras. Oftalmol.

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Purpose: To evaluate the thinnest corneal thickness changes during and after corneal collagen cross-linking treatment with ultraviolet-A irradiation, using hypo-osmolar riboflavin solution in thin corneas. Methods: Eighteen eyes of 18 patients were included in this study. After epithelium removal, iso-osmolar 0.1% riboflavin solution was instilled to the cornea every 3 minutes for 30 minutes. Hypo-osmolar 0.1% riboflavin solution was then applied every 20 seconds for 5 minutes or until the thinnest corneal thickness reached 400 µm. Ultraviolet-A irradiation was performed for 30 minutes. During irradiation, iso-osmolar 0.1% riboflavin drops were applied every 5 minutes. Ultrasound pachymetry was performed at approximately the thinnest point of the cornea preoperatively, after epithelial removal, after iso-osmolar riboflavin instillation, after hypo-osmolar riboflavin instillation, after ultraviolet-A irradiation, and at 1, 6 and 12 months after treatment. Results: Mean preoperative thinnest corneal thickness was 380 ± 11 µm. After epithelial removal it decreased to 341 ± 11 µm, and after 30 minutes of iso-osmolar 0.1% riboflavin drops, to 330 ± 7.6 µm. After hypo-osmolar 0.1% riboflavin drops, mean thinnest corneal thickness increased to 418 ± 11 µm. After UVA irradiation, it was 384 ± 10 µm. At 1, 6 and 12 months after treatment, it was 372 ± 10 µm, 381 ± 12.7, and 379 ± 15 µm, respectively. No intraoperative, early postoperative, or late postoperative complications were noted. Conclusions: Hypo-osmolar 0.1% riboflavin solution seems to be effective for swelling thin corneas. The swelling effect is transient and short acting. Corneal thickness should be monitored throughout the procedure. Larger sample sizes and longer follow-up are required in order to make meaningful conclusions regarding safety.

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“…При этом использование изоосмолярного рибофлавина с декстраном способно привести к снижению толщины человеческой роговицы в среднем на 55 мкм продолжительностью около 30 мин. Однако все-таки возможен кросслинкинг при корне-альной толщине 250−350 мкм за счет искусственного предоперационного отека роговицы, увеличивающего ее толщину до 60 мкм, гипоосмолярным раствором ри-бофлавина [67]. Предложена также оригинальная ме-тодика кросслинкинга тонких роговиц (350−400 мкм) с использованием контактных линз, пропускающих УФ-излучение [68].…”

Section: уф-кросслинкинг тонких роговицunclassified

Ultraviolet Corneal Crosslinking

Бикбов¹,

Khalimov²,

Usubov³

2016

Annals RAMS

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Во всем мире ежегодно отмечается значительный рост заболеваний роговицы, сопровождающихся деструктив-ными изменениями коллагена в ее составе, что связывают с ухудшением экологии, интенсификацией глазной хи-рургии, травмами глаза, а также с увеличившимся числом офтальмоинфекций [1]. В Российской Федерации на больных с заболеваниями роговицы приходится до 18% общего числа слепых и слабовидящих [2].В основе кератоэктазий, в частности кератоконуса, лежит прогрессирующая деградация коллагеновой струк-туры роговицы и, соответственно, снижение ее прочност-но-механических свойств, приводящие к помутнению, нередко рубцеванию и значительному снижению остроты зрения. Как правило, это билатеральный патологический процесс, чаще наблюдаемый у лиц молодого трудоспо-собного возраста. Качественные и количественные из-менения состава коллагена органа зрения, отрицательно сказываясь на его структуре, проявляются в различных сочетаниях симптоматики болезни.Этиология кератоконуса считается многофакторной и наряду с вышеуказанными причинами включает также наследственную, эндокринную, аллергическую, имму-нологическую и другие теории, среди которых наиболее признанной у специалистов считается генетическая ги-потеза [3]. Несомненно, в пользу этого свидетельствуют семейные случаи заболевания, а также их сочетание с некоторыми наследственными синдромами. Так, по дан-ным мультицентрового проспективного исследования CLERK (США), генетические формы кератоконуса были выявлены в 13,5% случаев [4].В последнее десятилетие так называемый инжини-ринг тканей, базирующийся на процессах фотополи-меризации, стали использовать для лечения широкого спектра заболеваний. В частности, с целью укрепления роговой оболочки глаза при хронических дегенеративных процессах успешно применяется ультрафиолетовый (УФ) кросслинкинг роговицы (UV Corneal Crosslinking, CXL), основанный на ее облучении при длине волны 370 нм с использованием светочувствительного рибофлавина [5].Кросслинкинг (перекрестное связывание, или сши-вание) способствует стабилизации биомеханических свойств роговицы за счет увеличения количества свя-зей между фибриллами стромального коллагена, кера-тоцитами и белками межклеточной адгезии посредством рибофлавин-УФ-индуцируемых фотохимических реак-ций [5−8]

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Intraoperative Corneal Thickness Measurements During Corneal Collagen Cross-Linking With Hypoosmolar Riboflavin Solution in Thin Corneas

Abstract: The iatrogenic swelling effect of the hypoosmolar riboflavin solution might be short acting and not durable throughout the UVA application in collagen cross-linking procedure.

Cited by 58 publications

References 26 publications

Intraoperative and Postoperative Corneal Thickness Change after Collagen Crosslinking Therapy

Intraoperative and Postoperative Corneal Thickness Change after Collagen Crosslinking Therapy

Corneal thickness changes during corneal collagen cross-linking with UV-A irradiation and hypo-osmolar riboflavin in thin corneas

Ultraviolet Corneal Crosslinking

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