Outcomes of iontophoretic corneal collagen crosslinking in keratoconic eyes with very thin corneas

Cantemir, Alina; Alexa, Anisia-Iuliana; Galan, Bogdan Gabriel; Anton, Nicoleta; Ciuntu, Roxana Elena; Danielescu, Ciprian; Chiseliţă, D; Costin, D

doi:10.1097/md.0000000000008758

Cited by 12 publications

(3 citation statements)

References 31 publications

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“…The assessment of endothelial cell density (ECD) loss in standard and accelerated and transepithelial CXL protocols in the pediatric group has not produced a statistically significant decrease in ECD after the procedure [ 21 , 23 , 56 , 58 , 61 , 69 , 70 , 76 , 80 , 82 , 96 , 97 ]; however, other studies reported that, depending on the protocol and carrier used, there is damage to endothelial cell density [ 68 , 98 – 100 ]. In a retrospective SCXL study developed by Barbisan et al in 2020, involving 105 eyes, a statistically significant reduction in ECD was observed, as well as corneal thinning after 1 year of follow-up, evidencing the potential impact of CXL on anatomy and corneal physiology [ 68 ].…”

Section: Resultsmentioning

confidence: 99%

Pediatric Crosslinking: Current Protocols and Approach

et al. 2022

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Keratoconus (KC) is likely to be more aggressive in the pediatric population, with a higher risk of progression and visual loss. Several techniques have been proposed for corneal crosslinking (CXL) so far. The standard CXL (SCXL) technique, or the Dresden Protocol, originally developed by Wollensak et al., has been shown to be safe and effective in the pediatric KC group. With similar efficacy to the conventional method, the accelerated CXL (ACXL) protocols proposed a reduced UVA exposure time by increasing the intensity of UVA irradiation. Transepithelial CXL (TCXL), considered an “epithelium-on” method, emerged as a strategy to improve safety and reduce postoperative complications and discomfort. For thinner corneas, we can highlight the use of hypoosmolar riboflavin and new studies, such as contact lens-assisted CXL (CACXL), the epithelial-island CXL (EI-CXL), and the Sub400 protocol. In addition to the different protocols used, another factor that changes CXL results is the type of carrier used: dextran-based or hydroxypropyl methylcellulose-based (HPMC) riboflavin solutions. There are several ways to perform a CXL surgery, and it is still unclear which method is the safest and most effective in the pediatric group. This review of the literature in English, available in PubMed, provides an update on corneal CXL in the pediatric KC group, exploring the data on the techniques currently used and under investigation, including their advantages, efficacy, safety profiles, risks, and cost analyses.

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Section: Resultsmentioning

confidence: 99%

Pediatric Crosslinking: Current Protocols and Approach

et al. 2022

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“…I-CXL represents an attractive solution for patients with thinner corneas. Cantemir et al [51] treated 15 keratoconus patients, each with thinnest pachymetry values of \ 400 lm (with epithelium) and not treatable using S-CXL technique. The mean UDVA and CDVA significantly increased 12 months after I-CXL and K max readings significantly decreased until the last follow-up (12 months).…”

Section: I-cxl On Special Groups Of Patientsmentioning

confidence: 99%

New perspectives in keratoconus treatment: an update on iontophoresis-assisted corneal collagen crosslinking

et al. 2021

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Keratoconus is a bilateral, asymmetric and progressive corneal disease. It usually results in apical thinning and steepening with corneal deformation and impaired vision. Since the early 1990 s, corneal collagen crosslinking (CXL) has remained the primary treatment to stabilize the progression of the disease. Iontophoresis-assisted CXL (I-CXL) has been proposed as a non-invasive alternative to standard epithelium-off technique, showing promising results. In this article, we review up to date literature to provide state of art knowledge and future perspectives of I-CXL.

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“…4,5 Therefore, several modifications of the standard protocol have been proposed to achieve safe and effective stabilization in progressive keratoconus patients with thin corneas (<400 μm). These modifications include stromal swelling using hypo-osmolar riboflavin, 6 transepithelial and iontophoretic CXL, 7,8 contact lens-assisted CXL, 9 pachymetric-guided epithelial debridement, 10 lenticule-assisted CXL, 11 and the recently introduced individualized CXL (sub400 protocol). 12 Jacob et al 9 introduced a simple technique called contact lens-assisted CXL (CL-CXL), which provides safe and effective CXL in even ultra-thin corneas without the need for stromal swelling.…”

Section: Introductionmentioning

confidence: 99%

Comparison of safety and efficacy of silicone hydrogel contact Lens-assisted CXL and accelerated CXL in keratoconus patients with thin corneas

Uysal

Özmen

Yuksel

et al. 2022

European Journal of Ophthalmology

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Purpose To evaluate the efficacy and safety of silicone hydrogel contact lens-assisted corneal cross-linking (CL-CXL) and compare 12-month visual and topographic outcomes with accelerated CXL using hypo-osmolar riboflavin (A-CXL) in keratoconus patients with thin corneas (below 400 μm with epithelium). Methods This retrospective study included 27 eyes of 27 keratoconus patients who underwent CL-CXL (n = 14) or A-CXL (n = 13). Uncorrected and corrected distance visual acuity (UDVA and CDVA) and data obtained from corneal topography were analyzed at baseline and again at 6- and 12-month follow-ups. Corneal demarcation line depth (DLD) was measured at one month, and changes in the corneal endothelial cell density (ECD) at 12 months were also assessed. Results Mean UDVA improved significantly in both groups at 12 months (all p < 0.05). Maximum keratometry (K-max) decreased by 1.04 ± 1.90 D in the CL-CXL group and by 0.87 ± 1.89 D in the A-CXL group at 12 months, which was not statistically significant (all p>0.05). Total corneal higher-order aberrations (HOAs) analysis showed a significant improvement in only the CL-CXL group at 12 months (p = 0.041). Average DLD was 227.18 ± 65.60 μm in the CL-CXL group and 245.30 ± 66.84 μm in the A-CXL group (p = 0.275). No significant change in ECD was found in either group (all p>0.05). Mean changes in UDVA, CDVA, K-max, K-mean, HOAs, and ECD were not statistically significant between the groups (all p>0.05). Conclusions Silicone hydrogel CL-assisted CXL seems as effective as A-CXL in halting keratoconus progression in thin corneas with no side effects during the one-year follow-up period.

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Outcomes of iontophoretic corneal collagen crosslinking in keratoconic eyes with very thin corneas

Cited by 12 publications

References 31 publications

Pediatric Crosslinking: Current Protocols and Approach

Pediatric Crosslinking: Current Protocols and Approach

New perspectives in keratoconus treatment: an update on iontophoresis-assisted corneal collagen crosslinking

Comparison of safety and efficacy of silicone hydrogel contact Lens-assisted CXL and accelerated CXL in keratoconus patients with thin corneas

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