Oxygen-supplemented transepithelial-accelerated corneal crosslinking with pulsed irradiation for progressive keratoconus: 1 year outcomes

Cronin, Brendan G.; Ghosh, Atanu; Chang, Clark Y.

doi:10.1097/j.jcrs.0000000000000952

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…This technique was found to stabilize Kmax and improve CDVA by a mean of 0.11 logMAR up to 12 months postoperatively. 8 In this study, we used the same technique (epi-on with supplemental oxygen delivered through customized, singleuse goggles) with the addition of TG pulsating high UV irradiation. We found that, in addition to the visual acuity improvement that was already observed, the TG procedure was associated with a statistically significant mean Kmax flattening of 1.1 D (1.3 D Kmax flattening for the 45 eyes with 12 months or longer follow-up).…”

Section: Discussionmentioning

confidence: 99%

“…This technique was found to stabilize Kmax and improve CDVA by a mean of 0.11 logMAR up to 12 months postoperatively. 8…”

Section: Discussionmentioning

confidence: 99%

“…The treatment protocol followed the steps of our recently published study with the addition of the TG application. 8 The new protocol used in this study consisted of epi-on CXL delivered by the Mosaic system (Glaukos Corp.) with a wearable oxygen delivery device (Boost goggles, Glaukos Corp.); transepithelial riboflavin (ParaCel Part 1 & Part 2, Glaukos Corp.); and pulsed, high UV-A irradiance (1 second on, 1 second off; 30 mW/cm 2 ) being applied to enhance the oxygen kinetics and bioavailability of riboflavin and UV-A.…”

Section: Methodsmentioning

confidence: 99%

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Oxygen-supplemented and topography-guided epithelium-on corneal crosslinking with pulsed irradiation for progressive keratoconus

Cronin,

Gunn,

Chang

2024

J Cataract Refract Surg

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Purpose: To investigate effects of customized topography-guided epithelium-on crosslinking (epi-on CXL) with oxygen supplementation on procedural efficacy and best corrected visual acuity (CDVA) in progressive keratoconus (KCN) patients at 1 year. Setting: Private eye clinic (Brisbane, Australia). Design: Retrospective single-center non-randomized case series Methods: Topography-guided epi-on CXL via the Mosaic system (Glaukos) was performed on progressive KCN patients. Oxygen goggles, transepithelial riboflavin and pulsed, high UVA irradiance (1 sec on, 1 sec off; 30mW/cm2) were applied to enhance oxygen kinetics and bioavailabilities of riboflavin and UVA. Guided by baseline topography, a higher UVA dose (15 J/cm2) was applied to the area of steepest anterior curvature with decreasing fluence (as low as 7.2 J/cm2) towards the outer 9mm. Postoperative CDVA and maximum keratometry (Kmax) were evaluated. Results: 102 eyes (80 patients) were followed for 11.5±4.8 months. At latest follow-up, mean CDVA (logMAR), average K and Kmax (D) improved from 0.18±0.28, 46.2±3.8 and 53.0±5.67 at baseline to 0.07±0.18, 45.8±3.7 and 51.9±5.56 respectively (p<0.001). Three eyes (3%) lost more than one CDVA line and another 3 eyes (3%) had increased Kmax greater than 2D. Forty-three eyes were followed for at least 12 months (n=43): mean CDVA, average K and Kmax improved from 0.19±0.33 logMAR, 46.5±3.5D and 53.6±5.67D to 0.07±0.17 logMAR, 46.0±3.5D, and 52.33±5.49D (p≤0.002). No complications were observed. Conclusion: Tailoring oxygen supplemented epi-on CXL with differential UVA energy distributions, guided by baseline topography, in keratoconus patients appears to be safe and effective. At 1 year, study reports sustained improved CDVA and corneal stabilization.

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Section: Discussionmentioning

confidence: 99%

“…This technique was found to stabilize Kmax and improve CDVA by a mean of 0.11 logMAR up to 12 months postoperatively. 8…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Oxygen-supplemented and topography-guided epithelium-on corneal crosslinking with pulsed irradiation for progressive keratoconus

Cronin,

Gunn,

Chang

2024

J Cataract Refract Surg

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“…Thereafter, part I solution was rinsed with 0.22% riboflavin (Paracel Part II, Avedro), and part II solution was instilled every 90 s over the next 6 min. UV-A was applied using the Avedro KXL System (Avedro Inc., Waltham, USA) with 30 mW/cm 2 UV power for 8 min with a 1 s on/off cycle (7.2 J/cm 2 ) ( 25 ). HF A-CXL : The corneal epithelium was removed with a blunt knife in a 10 mm zone.…”

Section: Methodsmentioning

confidence: 99%

Development and validation to predict visual acuity and keratometry two years after corneal crosslinking with progressive keratoconus by machine learning

et al. 2023

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PurposeTo explore and validate the utility of machine learning (ML) methods using a limited sample size to predict changes in visual acuity and keratometry 2 years following corneal crosslinking (CXL) for progressive keratoconus.MethodsThe study included all consecutive patients with progressive keratoconus who underwent CXL from July 2014 to December 2020, with a 2 year follow-up period before July 2022 to develop the model. Variables collected included patient demographics, visual acuity, spherical equivalence, and Pentacam parameters. Available case data were divided into training and testing data sets. Three ML models were evaluated based on their performance in predicting case corrected distance visual acuity (CDVA) and maximum keratometry (Kmax) changes compared to actual values, as indicated by average root mean squared error (RMSE) and R-squared (R2) values. Patients followed from July 2022 to December 2022 were included in the validation set.ResultsA total of 277 eyes from 195 patients were included in training and testing sets and 43 eyes from 35 patients were included in the validation set. The baseline CDVA (26.7%) and the ratio of steep keratometry to flat keratometry (K2/K1; 13.8%) were closely associated with case CDVA changes. The baseline ratio of Kmax to mean keratometry (Kmax/Kmean; 20.9%) was closely associated with case Kmax changes. Using these metrics, the best-performing ML model was XGBoost, which produced predicted values closest to the actual values for both CDVA and Kmax changes in testing set (R2 = 0.9993 and 0.9888) and validation set (R2 = 0.8956 and 0.8382).ConclusionApplication of a ML approach using XGBoost, and incorporation of identifiable parameters, considerably improved variation prediction accuracy of both CDVA and Kmax 2 years after CXL for treatment of progressive keratoconus.

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“…In addition to the UV-barrier effect, the epithelium may diminish oxygen diffusion into the corneal stroma, further attenuating the crosslinking effect by limiting the crosslinking reactions that occur through oxygen-dependent pathways. Investigators are studying the effects of pulsed-light protocols to allow greater oxygen diffusion as well as oxygen supplementation as modalities to enhance crosslinking in transepithelial procedure [17]. Most recently, a phase 2 FDA study is underway investigating the efficacy of transepithelial crosslinking using a scanning laser diode as the source of UV light to induce the crosslinking effect (NCT05314738).…”

Section: Transepithelial Crosslinkingmentioning

confidence: 99%

Update on corneal crosslinking for keratoconus and corneal ectasia

Greenstein,

Hersh

2024

Current Opinion in Ophthalmology

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Purpose of review To review corneal crosslinking for keratoconus and corneal ectasia, and recent developments in the field. This study will review the mechanism of crosslinking, clinical approaches, current results, and potential future innovations. Recent findings Corneal crosslinking for keratoconus was first approved by U.S. FDA in 2016. Recent studies have confirmed the general long-term efficacy of the procedure in decreasing progression of keratoconus and corneal ectasia. New types of crosslinking protocols, such as transepithelial treatments, are under investigation. In addition, adjunctive procedures have been developed to improve corneal contour and visual function in these patients. Summary Crosslinking has been found to be well tolerated and effective with the goal of decreasing progression of ectatic corneal diseases, keratoconus and corneal ectasia after refractive surgery. Studies have shown its long-term efficacy. New techniques of crosslinking and adjunctive procedures may further improve treatments and results.

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Oxygen-supplemented transepithelial-accelerated corneal crosslinking with pulsed irradiation for progressive keratoconus: 1 year outcomes

Abstract: Performing supplemental oxygen epithelium-on crosslinking with accelerated, pulsed UV-A light irradiation in conjunction with riboflavin permeability enhancers resulted in improved keratometry and corrected distance visual acuity with a good safety profile.

Cited by 5 publications

References 33 publications

Oxygen-supplemented and topography-guided epithelium-on corneal crosslinking with pulsed irradiation for progressive keratoconus

Oxygen-supplemented and topography-guided epithelium-on corneal crosslinking with pulsed irradiation for progressive keratoconus

Development and validation to predict visual acuity and keratometry two years after corneal crosslinking with progressive keratoconus by machine learning

Update on corneal crosslinking for keratoconus and corneal ectasia

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