Sequential in Vivo Confocal Microscopy Study of Corneal Wound Healing After Cross-Linking in Patients with Keratoconus

Croxatto, J. Oscar; Tytiun, Adriana; Argento, Carlos

doi:10.3928/1081597x-20091111-01

Cited by 51 publications

(32 citation statements)

References 18 publications

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“…It has been postulated that these structures represent new synthesized collagens possibly the product of activated keratocytes [17,22,24,25]. Gradual posterior to anterior relocation of these structures has been reported by Kymionis et al during sequential examinations [26].…”

Section: Discussionmentioning

confidence: 92%

Comparison of corneal keratocytes before and after corneal collagen cross-linking in keratoconus patients

et al. 2015

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Keratoconus is a bilateral and asymmetric corneal ectasia. Cross-linking uses ultra-violate rays to enhance corneal tissue. The purpose of this study was to use in vivo confocal microscopy to quantitatively analyze microstructural changes over time, after corneal collagen cross-linking (CXL) in keratoconus patients. In this before-and-after study, a total of 45 keratoconic eyes were selected for cross-linking among patients referred to Al-Zahra ophthalmology clinic during 2013-2014. All patients underwent complete ophthalmologic examinations. Keratocytes and the present of activated keratocytes were calculated preoperatively and at 1, 3, 6, and 12 months postoperatively using confocal microscopy. One year after CXL, best corrected and best uncorrected visual acuity was increased significantly (p < 0.001). Spherical equivalent and spherical refractive errors reduced significantly (p < 0.001). The reduction in density of anterior and mid-stromal keratocytes was significant initially (p < 0.001). During follow-up, the density of keratocytes increased significantly in all layers reaching near normal values by 12 months. The percentage of activated keratocytes showed a significant increase 1 month after cross-linking (p < 0.001) albeit this percent reduced as the corneal healing proceeded by month 12. The endothelial cells showed no significant reduction during the follow-up. Collagen cross-linking-induced significant reduction in keratocyte density. The percent of activated keratocytes increased significantly after cross-linking which showed reduction with improvement of corneal healing. After collagen cross-linking, hyper-reflective structures were observed consistent with the stromal collagen structures. Further studies are needed to assess possible changes on corneal biomechanics. The consistency in corneal endothelium numbers proves the safety of this technique.

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Section: Discussionmentioning

confidence: 92%

Comparison of corneal keratocytes before and after corneal collagen cross-linking in keratoconus patients

et al. 2015

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“…In vivo studies using confocal microscopy showed similar findings following CXL, with keratocyte loss and stromal edema. In addition, a superficial nerve layer loss was observed [98]. Stromal edema persists for 4-6 weeks and then gradually resolves, with keratocyte repopulation and stromal collagen compaction.…”

Section: Resultsmentioning

confidence: 99%

“…While central stromal keratocyte loss in the treated area persists at 36 months postoperatively, nerve regeneration starts at 1 month and continues past 36 months. A small percentage of patients demonstrate endothelial damage with gradual healing completed at 1 year postoperatively [98]. Collagen fiber diameter increases following CXL, with a reorganization of collagen fibrils in a parallel, lamellar structure similar to a non-KCN cornea (and opposed to a KCN cornea).…”

Section: Resultsmentioning

confidence: 99%

Corneal Collagen Crosslinking: A Systematic Review

Sorkin

Varssano²

2014

Ophthalmologica

166

122

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Keratoconus (KCN) is an ectatic disorder with progressive corneal thinning and a clinical picture of corneal protrusion, progressive irregular astigmatism, corneal fibrosis and visual deterioration. Other ectatic corneal disorders include: post-LASIK ectasia (PLE) and pellucid marginal degeneration (PMD). Corneal crosslinking (CXL) is a procedure whereby riboflavin sensitization with ultraviolet A radiation induces stromal crosslinks. This alters corneal biomechanics, causing an increase in corneal stiffness. In recent years, CXL has been an established treatment for the arrest of KCN, PLE and PMD progression. CXL has also been shown to be effective in the treatment of corneal infections, chemical burns, bullous keratopathy and other forms of corneal edema. This is a current review of CXL - its biomechanical principles, the evolution of CXL protocols in the past, present and future, indications for treatment, treatment efficacy and safety.

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“…All trials have indicated a time-dependence of the effects of CXL, both in terms of transient haze 54 and edema in the early stages, as well as in refractive outcome, which seems to improve over the first year or more following treatment 26,30,31,[51][52] .…”

Section: Effect Of the Treatment On Cornea Claritymentioning

confidence: 99%

Corneal Collagen Crosslinking with Riboflavin and Ultraviolet - A Irradiation in the Management of Progressive Ectatic Corneal Disorders. Review Article

Eldine

2017

Journal of Ophthalmology and Related Sciences

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Corneal crosslinking (CXL) has been proposed as a new modality to stop progression of keratoconus or secondary corneal ectasia, aiming to prevent progressive visual loss and to delay or avoid corneal transplantation. The possibility of strengthening corneal tissue by means of a photochemical reaction of corneal collagen by the combined action of riboflavin and ultraviolet-A irradiation (UVA), radically modified the conservative management of progressive corneal ectasia. This is a review of the state of the art of CXL. The paper describes basic principles, advantages and limitations of different CXL techniques and possible future evolution of the procedure.

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Sequential in Vivo Confocal Microscopy Study of Corneal Wound Healing After Cross-Linking in Patients with Keratoconus

Abstract: Although the cornea has no significant tissue modifications clinically after CXL, this study has shown that corneal wounding by riboflavin/UVA collagen CXL induces cellular wound-healing mechanisms and alters the normal structure and cellularity of the cornea for up to 36 months.

Cited by 51 publications

References 18 publications

Comparison of corneal keratocytes before and after corneal collagen cross-linking in keratoconus patients

Comparison of corneal keratocytes before and after corneal collagen cross-linking in keratoconus patients

Corneal Collagen Crosslinking: A Systematic Review

Corneal Collagen Crosslinking with Riboflavin and Ultraviolet - A Irradiation in the Management of Progressive Ectatic Corneal Disorders. Review Article

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