Topographic Outcomes in Keratoconus Surgery: Epi-on versus Epi-off Iontophoresis Corneal Collagen Cross-Linking

Napolitano, Pasquale; Tranfa, Fausto; D’Andrea, Luca; Caruso, Ciro; Rinaldi, Michele; Mazzucco, Alberto; Ciampa, Nicola; Melenzane, Antonietta; Costagliola, Ciro

doi:10.3390/jcm11071785

Cited by 8 publications

(7 citation statements)

References 45 publications

(50 reference statements)

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“…Corneal collagen cross-linking forms new covalent bonds between collagen fibers, which increase the strengthens and the rigidity of the cornea by more than 300%. 24 Excellent outcomes are possible if early diagnosis and rapid interventions were performed. 25…”

Section: Discussionmentioning

confidence: 99%

Visual improvement after corneal collagen cross-linking in keratoconus

Sultana¹,

Kadir²,

Hassan³

et al. 2022

IJCEO

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This study was carried out to evaluate the effect of corneal collagen cross-linking on visual acuity, astigmatism and topographic readings (K1, K2, Kapex). : A nonrandomized noncontrolled clinical study was conducted in two tertiary eye centres in Bangladesh from July 2017 to June 2019. All attending patients diagnosed with Keratoconus were included in this study according to selection criteria. Patients with a corneal thickness of fewer than 400 microns, previous viral infection, cornea scarring, corneal opacification, severe ocular surface disease, history of immune disorders, pregnancy, and breastfeeding were excluded from the study. All selected patients underwent collagen cross-linking with Riboflavin and Ultraviolet A, followed up five days, one and six months following the procedure. Visual acuity, topographic readings (K1, K2, Kapex) and cylindrical values were assessed on every visit. The mean value of visual acuity was compared statistically with the baseline value.: A total of 30 eyes of 30 patients were studied in this study. The male-to-female ratio was 2:1. The Mean age (± SD) of the study subjects was 22.7±7.10. Before CXL, the Mean uncorrected visual acuity (UCVA) ±SD was 0.86±.35. In post-CXL follow-up time, the mean UCVA±SD was 0.46±.23 after six months of CXL. Before CXL, the Mean BCVA±SD was 0.35±.22. In post CXL era, the Mean ± SD BCVA was 0.14±.13 after six months of CXL. The Mean K1±SD was 45.66±3.43 before CXL, and the result changed after CXL. The Mean K1±SD was 43.29±3.29 after six months of CXL. The Mean K2±SD was 50.22±5.93 before CXL, and the result differed after six months of CXL. The Mean Kapex ±SD was 54.50±7.38 before CXL, and that was 51.32±6.93 after six months of CXL. Keratoconus is a bilateral non-inflammatory disorder progressively leading to vision-threatening ocular morbidity. Collagen cross-linking improves visual and topographic findings– K1, K2, and Kapex and reduces astigmatism. Early diagnosis of Keratoconus and prompt treatment will help achieve better vision.

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Section: Discussionmentioning

confidence: 99%

Visual improvement after corneal collagen cross-linking in keratoconus

Sultana¹,

Kadir²,

Hassan³

et al. 2022

IJCEO

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Section: Preventing Progression Of Diseasementioning

confidence: 99%

“…In a study comparing iontophoresis-assisted epi-on versus iontophoresis-assisted epi-off CXL, there were no significant differences in maximum keratometry, mean keratometry, flat keratometry, or steep keratometry values. 41 Furthermore, iontophoresis-assisted epi-off techniques were associated with reduced surgical times and fewer complications. 41 In a systematic review of 15 randomized controlled trials comparing epi-on to epi-off CXL, the authors concluded that there were no significant differences in uncorrected distance visual acuity, maximum keratometry, central corneal thickness, or endothelial cell density between the two procedures.…”

mentioning

confidence: 99%

“…41 Furthermore, iontophoresis-assisted epi-off techniques were associated with reduced surgical times and fewer complications. 41 In a systematic review of 15 randomized controlled trials comparing epi-on to epi-off CXL, the authors concluded that there were no significant differences in uncorrected distance visual acuity, maximum keratometry, central corneal thickness, or endothelial cell density between the two procedures. 32 They did find, however, improved postoperative corrected distance visual acuity, increased patient comfort, faster epithelial healing, and a decreased risk of persistent stromal haze in those who underwent epi-on protocols.…”

mentioning

confidence: 99%

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Keratoconus Diagnosis and Treatment: Recent Advances and Future Directions

Bui,

Truong,

Pasricha

et al. 2023

OPTH

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Keratoconus is a disorder characterized by progressive corneal thinning and steepening that may result in significant visual impairment secondary to high astigmatism, corneal scarring, or even corneal perforation. Early detection and screening of keratoconus are essential for effective management and treatment. Several screening methods, such as corneal topography and tomography, corneal biomechanics, and genetic testing, are being developed to detect keratoconus at an early stage. Once detected, prevention of progression is the mainstay of keratoconus management. Corneal collagen cross-linking is a minimally invasive treatment option that can slow or halt the progression of keratoconus. Additionally, recent studies have investigated the potential use of copper sulfate eye drops (IVMED-80) and extracellular vesicles to prevent the progression of keratoconus as non-invasive treatment options. For visual rehabilitation, currently available treatments include scleral lenses, intracorneal ring segments, corneal allogenic intrastromal ring segments, and deep anterior lamellar keratoplasty. The safety and efficacy of these emerging treatment options for keratoconus are currently being investigated.

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“…With regard to the anterior segment, corneal topography and tomography have an established role in the accurate evaluation of the corneal shape as well as in the preoperative assessment for refractive and cataract surgery [24]. They are also relevant in the diagnosis, surgical planning, and long-term monitoring of various corneal pathologies, including keratoconus [25][26][27], ectatic corneal diseases, and pterygium or corneal scars [28,29]. It worth noting that keratometry measurements may significantly differ on the basis of the methodology used (e.g., anterior segment-OCT vs. Pentacam) [30].…”

mentioning

confidence: 99%