New treatments for keratoconus

Pedrotti, Emilio; Chierego, Chiara; Bonacci, Erika; Gregorio, Alessandra De; Rossi, Arianna De; Zuliani, Andrea; Fasolo, Adriano; Marchini, Giorgio

doi:10.1007/s10792-020-01455-9

Cited by 7 publications

(3 citation statements)

References 39 publications

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“…[ 1 2 ] Intrastromal corneal rings enhance visual acuity, and corneal collagen cross-linking (CXL) may slow disease development, and it may be modified to keep the cornea under the damage threshold[ 3 ] in relation to ultraviolet (UV) power and duration. [ 4 5 ]…”

Section: Introductionmentioning

confidence: 99%

Biomechanical changes in keratoconus after customized stromal augmentation

Niazi,

del Barrio,

Doroodgar

et al. 2024

Taiwan Journal of Ophthalmology

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PURPOSE: To verify corneal biomechanical changes, poststromal augmentation using myopic small-incision lenticule extraction’s (SMILEs) lenticules in advanced keratoconus (KCN) through Corvis ST (Oculus, Wetzlar, Germany). MATERIALS AND METHODS: A clinical trial enrolled 22 advanced KCN patients. We implanted lenticules exceeding 100 μ according to a nomogram and evaluated biomechanical factors through Corvis ST at 3-, 6-, and 24-month postimplantation. We examined parameters during the first applanation (A1), second applanation (A2), highest concavity (HC)/max concavity events, and Vinciguerra screening parameters, as recently established criteria derived from the ideal blend of diverse biomechanical and ocular factors and formulated through the application of logistic regression. Regression analyses explored relationships with age, mean keratometry value, thickness, sphere, cylinder, and best-corrected visual acuity. RESULTS: Patients were well matched for age, intraocular pressure, and central corneal thickness (CCT). The mean spherical equivalent decreased from −13.48 ± 2.86 Diopters (D) to −8.59 ± 2.17 D (P < 0.007), and mean keratometry decreased from 54.68 ± 2.77 D to 51.95 ± 2.21 D (P < 0.006). Significant increases were observed in HC time (HCT), Radius–central curvature radius at the HC state–, peak distance (PD) during HC state, CCT, first applanation time, and stiffness parameter (A1T and SP-A1), whereas HC deformation amplitude, maximum deformation amplitude ratio at 2 mm, Corvis Biomechanical Index (CBI), integrated radius (IR), second applanation deformation amplitude (A2DA), first applanation velocity and deflection amplitude (A1V and A1DeflA) significantly decreased postlenticule implantation. Multivariable regression revealed age positively correlated with SP-A1 (P = 0.003) and negatively with HC delta Arc length (P = 0.007). Mean K positively correlated with CCT (P = 0.05) and negatively with CBI (P = 0.032). Best-corrected visual acuity positively correlated with HCT (P = 0.044), and the cylinder positively correlated with PD (P = 0.05) and CCT (P = 0.05) whereas negatively with IR (P = 0.025). CONCLUSIONS: Stromal augmentation using myopic SMILE lenticules induces significant corneal biomechanical changes in KCN.

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Section: Introductionmentioning

confidence: 99%

Biomechanical changes in keratoconus after customized stromal augmentation

Niazi,

del Barrio,

Doroodgar

et al. 2024

Taiwan Journal of Ophthalmology

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“…A wide range of contact lenses on the market allows us to offer alternative types, from hybrid lens and piggy-back to corneoscleral and scleral lens [2]. Nonetheless, in patients with a documented clinical progression we should perform corneal cross-linking (CXL), the aim of which is to stiffen the cornea by means of a photochemical reaction that occurs after removal of the central 6-7 mm of corneal epithelium and applying riboflavin (B2 vitamin isomer) followed by irradiation with UVA light at 370 nm [3]. The severe cases may require corneal surgery (intrastromal corneal ring implantation, refractive surgery, keratoplasty).…”

Section: Introductionmentioning

confidence: 99%

Analysis of Cytokine and Chemokine Level in Tear Film in Keratoconus Patients before and after Corneal Cross-Linking (CXL) Treatment

Krok,

Wróblewska-Czajka,

Łach-Wojnarowicz

et al. 2024

IJMS

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Keratoconus (KC) is a degenerative corneal disorder whose aetiology remains unknown. The aim of our study was to analyse the expressions of cytokines and chemokines in KC patients before and after specified time intervals after corneal cross-linking (CXL) treatment to better understand the molecular mechanisms occurring before and after CXL in KC patients process of corneal regeneration.; Tear samples were gathered from 52 participants immediately after the CXL procedure and during the 12-month follow-up period. All patients underwent a detailed ophthalmological examination and tear samples were collected before and after CXL at regular intervals: 1 day before and after the surgery, at the day 7 visit, and at 1, 3, 6, 9, and 12 months after CXL. The control group consisted of 20 healthy people. 10 patients were women (50%) and 10 were men (50%). The mean age was 30 ± 3 years of age. Tear analysis was performed using the Bio-Plex 3D Suspension Array System. Corneal topography parameters measured by Scheimpflug Camera included: keratometry values (Ks, Kf), PI-Apex, PI-Thinnest, Cylinder.; All the 12 months post-op values of the KC patients’ topographic measurements were significantly lower than the pre-op. As for the tear cytokine levels comparison between the patient and control groups, cytokine levels of TNF-α, IL-6, and CXCL-10, among others, were detected in lower amounts in the KC group. The pre-op level of IL-6 exhibited a significant increase the day after CXL, whereas comparing the day after the procedure to 12 months after CXL, this showed a significant decrease. Both TNF-α and IL-1 showed a significant decrease compared to the day before and after CXL. We observed significantly higher levels of IL-1β, IL-10, IFN-γ and TNF-α in moderate and severe keratoconus than in mild keratoconus (p < 0.05). We also demonstrated a statistically significant positive correlation between both pre-op and 12 months after CXL TNF-α, IFN-γ, IL-6 and Ks and Kf values (p < 0.05, r > 0); Alterations of inflammatory mediators in tear fluid after CXL link with topographic changes and may contribute to the development and progression of KC.

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“…[ 2 ] Keratoconus usually occurs in adolescence and progresses until the third or fourth decade of life. [ 3 4 ] The economic costs of keratoconus for patients have caused considerable concerns. [ 5 ]…”

Section: Introductionmentioning

confidence: 99%

Evaluation of changes in corneal volume, volume and angle of anterior chamber in keratoconus patients using Pentacam after CXL

Farrahi

Ostadian²,

Nickkhah³

et al. 2021

Journal of Family Medicine and Primary Care

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Introduction and Objective: Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) is a new technique of mechanical stability of the cornea and prevention of keratoconus progression. The present study aimed at the evaluation of the changes in the corneal volume (CV), volume, and the angle of anterior chamber in keratoconus patients using the Pentacam after CXL. Methods: This prospective study was performed on 48 eyes of 24 patients (including 12 men, 17–33 years old) with progressive keratoconus undergoing CXL treatment at collagen cross-linking Imam Khomeini Hospital in Ahvaz in 2019. The CV (CV) and anterior chamber parameters such as anterior chamber volume (ACV) and anterior chamber angle (ACA) were measured using the Pentacam before CXL and at 6 and 12 months after CXL. Also, all of the patients were evaluated in terms of best-corrected visual acuity (BCVA), during the follow-up. Results: The pre-CXL values of BCVA was significantly lower than the post-CXL values in 6 and 12 months (0.18 ± 0.11, 0.15 ± 0.10, and 0.11 ± 0.10, respectively, P < 0.0001). In general, there was a significant improvement in the BCVA ( P < 0.0001), a significant decrease in the CV ( P = 0.001), and a significant increase in the ACV ( P < 0.0001), and angle ( P < 0.0001) 6 and 12 months after CXL. Conclusion: It seems that CXL has a positive effect on the anterior chamber parameters (ACV and ACA) and CV after 6 months and 1 year in the treatment of keratoconus patients. In addition, the visual acuity improves after CXL. Finally, further studies with a higher sample size and longer follow-up periods are recommended.

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New treatments for keratoconus

Cited by 7 publications

References 39 publications

Biomechanical changes in keratoconus after customized stromal augmentation

Biomechanical changes in keratoconus after customized stromal augmentation

Analysis of Cytokine and Chemokine Level in Tear Film in Keratoconus Patients before and after Corneal Cross-Linking (CXL) Treatment

Evaluation of changes in corneal volume, volume and angle of anterior chamber in keratoconus patients using Pentacam after CXL

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