Intraoperative Pachymetric Measurements during Corneal Collagen Cross-Linking with Riboflavin and Ultraviolet A Irradiation

Kymionis, George D.; Kounis, George A.; Portaliou, Dimitra M.; Grentzelos, Michael A.; Karavitaki, Alexandra E.; Coşkunseven, Efekan; Jankov, Mirko; Pallikaris, Ioannis G.

doi:10.1016/j.ophtha.2009.09.018

Cited by 114 publications

(88 citation statements)

References 14 publications

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“…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%

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%

Intraoperative and Postoperative Corneal Thickness Change after Collagen Crosslinking Therapy

Hassan

Módis

Szalai

et al. 2013

European Journal of Ophthalmology

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“…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: 98%

“…A small decrease of approximately 3% in TCT after iso-osmolar riboflavin solution instillation was noted in our patients. It was probably due to the hyperosmolar effect of the dextran in a de-epithelialized cornea (15) . These results corroborate the statement of other authors (16) who recommend that, during the first part of corneal CXL, the eyelid speculum is removed from the eye and the patient asked to keep the eye closed as much as possible to prevent evaporation of water from the corneal stroma.…”

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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“…Intraoperative ultrasonic pachymetric measurements during CXL with isoosmolar riboflavin showed a mean decrease of 75 µm in central corneal thickness which was statistically significant and had important clinical implications. 4 Another study found a mean corneal thinning of 87 ± 40 µm, most of which occurred during the UV irradiation process, suggesting evaporative losses from a de epithelialized cornea to be a contributing factor. 5 Hence, patients with pachymetry of >400 µm could still cross the borders of safety during the CXL procedure becoming "thin corneas".…”

Section: Introductionmentioning

confidence: 97%

Recent Advances in Corneal Collagen Crosslinking in thin Corneas

Gupta¹,

Sachdev²,

Sachdev³

2016

DJO

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Intraoperative Pachymetric Measurements during Corneal Collagen Cross-Linking with Riboflavin and Ultraviolet A Irradiation

Cited by 114 publications

References 14 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

Recent Advances in Corneal Collagen Crosslinking in thin Corneas

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