Mechanical versus transepithelial phototherapeutic keratectomy epithelial removal followed by accelerated corneal crosslinking for pediatric keratoconus: Long-term results

Saraç, Özge; Kösekahya, Pınar; Çağlayan, Mehtap; Tanriverdi, Burak; Uzel, Ayşe Güzin Taşlıpınar; Çağıl, Nurullah

doi:10.1016/j.jcrs.2018.04.039

Cited by 15 publications

(5 citation statements)

References 19 publications

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“…Excimer laser ablation combined with CXL treatment has been proposed as an ideal technique due to its optimal refractive outcome that can provide both stability and functional vision, by both stabilizing and reshaping the cornea [ 25 ]. Previous studies also suggested that the CXL-plus-PTK procedure is more effective than the S-CXL procedure [ 26 , 27 ]. Further, the improved efficacy could last up to 2 years after surgery [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Independent-effect comparison of five crosslinking procedures for Progressive Keratoconus based on Keratometry and the ABCD Grading System using Generalized Estimating Equations (GEE)

et al. 2023

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Purpose Corneal collagen crosslinking (CXL) is an effective treatment for progressive keratoconus. Multiple CXL modalities are clinically available. The present study compared the 1 year outcomes of five types of CXL procedures for progressive keratoconus in a Chinese population using generalized estimating equations (GEE). Methods This retrospective study included 239 eyes in 171 patients with keratoconus who underwent CXL and were followed up for 1 year. Five CXL procedures were assessed, including Accelerated Transepithelial CXL, Iontophoresis CXL for 10 min, CXL plus phototherapeutic keratectomy (CXL-plus-PTK), High-Fluence Accelerated CXL, and Accelerated CXL. Patients treated with the Accelerated CXL procedure represented the reference group. Primary outcomes were visual acuity change, spherical equivalence, endothelial cell density, mean keratometry (Kmean), maximum keratometry (Kmax), minimum corneal thickness (MCT), and the ABCD Grading System, consisting of A (staging index for ARC; ARC = anterior radius of curvature), B (staging index for PRC, PRC = posterior radius of curvature), and C (staging index for MCT) values 1 year postoperatively compared to baseline. Secondary outcomes were corrected GEE comparisons from each procedure versus the Accelerated CXL group. Results The Accelerated Transepithelial CXL group had lower performance than the Accelerated CXL group according to Kmean and Kmax. The CXL-plus-PTK group performed significantly better than the reference group as reflected by Kmax (β = -0.935, P = 0.03). However, the CXL-plus-PTK group did not perform as well for B and C, and the Iontophoresis CXL group performed better for C. Conclusions The CXL-plus-PTK procedure was more effective than the Accelerated CXL procedure based on Kmax, and the Iontophoresis CXL procedure performed better on the C value based on the ABCD Grading System.

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Section: Discussionmentioning

confidence: 99%

Independent-effect comparison of five crosslinking procedures for Progressive Keratoconus based on Keratometry and the ABCD Grading System using Generalized Estimating Equations (GEE)

et al. 2023

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“…While excimer lasers have been used to perform full epithelial debridement, to our knowledge, this is the first study to apply an excimer laser in order to create small epithelium penetrating channels (Kanellopoulos & Asimellis 2014 ; Sarac et al. 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…They show stromal RF concentrations of approximately 50% the concentration after regular epi-off protocols, but biomechanical effects are not reported on. While excimer lasers have been used to perform full epithelial debridement, to our knowledge, this is the first study to apply an excimer laser in order to create small epithelium penetrating channels (Kanellopoulos & Asimellis 2014;Sarac et al 2018).…”

Section: Strip Extensiometrymentioning

confidence: 99%

Excimer laser‐assisted corneal epithelial pattern ablation for corneal cross‐linking

Brekelmans

Dickman

Verma

et al. 2021

Acta Ophthalmologica

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Purpose To determine corneal cross‐linking (CXL) efficacy and chromophore penetration after excimer laser‐assisted patterned de‐epithelialization. Methods Two‐hundred‐twenty porcine eyes were de‐epithelialized ex vivo, either fully (mechanical; n = 88) or patterned (excimer laser; n = 132). Consecutively, corneas were impregnated with hypo‐ or hyperosmolar riboflavin (RF; n = 20, RF‐D; n = 40, respectively) or water‐soluble taurine (WST11; n = 40, and WST‐D; n = 40, respectively), or kept unimpregnated (n = 80). Sixty corneas were subsequently irradiated, inducing CXL, with paired contralateral eyes serving as controls. Outcome measurements included strip extensiometry to assess CXL efficacy, and spectrophotometry and fluorescence microscopy to determine stromal chromophore penetration. Results All tested chromophores induced significant CXL (p < 0.001), ranging from 7.6% to 14.6%, with similar stiffening for all formulations (p = 0.60) and both de‐epithelialization methods (p = 0.56). Light transmittance was significantly lower (p < 0.001) after full compared with patterned de‐epithelialization. Stromal chromophore penetration was comparable between fully and patterned de‐epithelialized samples, with full penetration in RD and RF‐D samples and penetration depths measuring 591.7 ± 42.8 µm and 592.9 ± 63.5 µm for WST11 (p = 0.963) and 504.2 ± 43.2 µm and 488.8 ± 93.1 µm for WST‐D (p = 0.669), respectively. Conclusions Excimer laser‐assisted patterned de‐epithelialization allows for effective CXL. Stromal chromophore concentration is, however, reduced, which may have safety implications given the need for sufficient UVA attenuation in RF/UVA CXL. The different safety profile of near‐infrared (NIR) may allow safe WST11/NIR CXL even with reduced stromal chromophore concentration values. In vivo studies are needed to evaluate the benefits and further assess safety of excimer laser‐assisted patterned de‐epithelialization for corneal CXL.

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“…TCT only returned to preoperative values after 5 years. Sarac et al 31 performed CCL using mechanic or phototherapeutic keratectomy and observed significant decreases in TCT at postoperative 3 years in both groups. Wittig-Silva et al 32 performed CCL using a modified Dresden Protocol and reported that at 3-year follow-up, TCT measured by ultrasonic pachymetry was significant reduced in the control group and unchanged in the CCL group, whereas TCT measured using Orbscan computerized videokeratography showed significant decreases, consistent with our study.…”

Section: Discussionmentioning

confidence: 99%

Five-Year Long-Term Results of Standard Collagen Cross-Linking Therapy in Patients with Keratoconus

Tasci¹,

Taşlıpınar²,

Eyidoğan³

et al. 2020

tjo

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Objectives: We aimed to demonstrate the 5-year visual, topographic, and aberrometry long-term results of standard collagen cross-linking (CCL) treatment in keratoconus patients. Materials and Methods: The files and topographic measurements of patients who underwent standard CCL treatment for progressive keratoconus were retrospectively reviewed. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction values, and topographic values were evaluated. Results: Thirty-seven eyes of 27 patients were included in the study. The female to male ratio was 15 (56%)/12 (44%) and the mean age was 22.16±6.4 (12-39) years. The increase in UCVA and BCVA was statistically significant at postoperative 1-5 years (all p values <0.05). The changes in the spherical equivalent after CCL were not statistically significant (p>0.05), but the decrease in the manifest astigmatism values were significant after CCL at 3-5 years (p<0.05). Decrease in K2 (steep keratometry) and K apex values were statistically significant at 1-5 years (p<0.05). There was a significant decrease in the thinnest corneal thickness compared to the preoperative values up to 6 months and 1-4 years (p<0.05), but the change at 5 years was not significant (p=0.08). Post-CCL reductions in high-order aberrations and spherical aberrations were significant at postoperative 5 years and 3-5 years (p<0.05). Conclusion: In long-term follow-up, CCL treatment is seen to arrest keratoconus progression, increase vision, and improve visual quality by reducing higher-order aberrations and spherical aberrations. For these reasons, CCL treatment continues to be the first treatment modality in patients with progressive keratoconus.

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Mechanical versus transepithelial phototherapeutic keratectomy epithelial removal followed by accelerated corneal crosslinking for pediatric keratoconus: Long-term results

Abstract: The initial visual and topographic outcomes of transepithelial PTK ablation were better than those of mechanical epithelium removal before accelerated CXL in pediatric patients with keratoconus. Over the long-term, the results were similar between the 2 groups.

Cited by 15 publications

References 19 publications

Independent-effect comparison of five crosslinking procedures for Progressive Keratoconus based on Keratometry and the ABCD Grading System using Generalized Estimating Equations (GEE)

Independent-effect comparison of five crosslinking procedures for Progressive Keratoconus based on Keratometry and the ABCD Grading System using Generalized Estimating Equations (GEE)

Excimer laser‐assisted corneal epithelial pattern ablation for corneal cross‐linking

Five-Year Long-Term Results of Standard Collagen Cross-Linking Therapy in Patients with Keratoconus

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