Transepithelial phototherapeutic keratectomy combined with implantation of a single inferior intrastromal corneal ring segment and collagen crosslinking in keratoconus

Yeung, Sonia N.; Low, Stephanie A.W.; Ku, Judy Y.F.; Lichtinger, Alejandro; Kim, Peter; Teichman, Joshua C.; Iovieno, Alfonso; Rootman, David S.

doi:10.1016/j.jcrs.2013.03.025

Cited by 28 publications

(28 citation statements)

References 33 publications

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“…Promising results have been reported in small case series investigating combinations of ICRS and corneal cross-linking [88–92]. Intact implantation prior to cross-linking results in greater improvement in keratoconus compared to ICRS implant after cross-linking [89].…”

Section: Results With Intacsmentioning

confidence: 99%

Pediatric keratoconus: a review of the literature

2017

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Purpose To describe the epidemiology and prevalence, rates of progression, difference between adult and pediatric populations, and therapeutic approaches to pediatric keratoconus from documented literature. Methods A literature search was done on PubMed using key words including pediatric keratoconus, children with keratoconus, adult keratoconus, penetrating keratoplasty, corneal cross-linking and intra-corneal ring segments. The literature was reviewed and reported to explore the key epidemiological differences between the pediatric and adult population with regards to presentation and treatment options. Results Pediatric keratoconus is more aggressive than adult keratoconus, which has been explained by structural differences in the cornea between both populations. High rates of progression were documented in pediatric populations. While corneal collagen cross-linking, intracorneal ring segments and penetrating keratoplasties have been used as therapies in the pediatric population, the literature overwhelmingly shows higher rates of failure and progression despite these measures as compared to adults. Conclusion Pediatric keratoconus is more aggressive than adult keratoconus, and current therapies used in adults may not be sufficient for the pediatric population.

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Section: Results With Intacsmentioning

confidence: 99%

Pediatric keratoconus: a review of the literature

2017

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“…To achieve such goals, the corneal shape needs to be modified. Combinations of CXL with photorefractive keratectomy and/or intrastromal ring segments have been reported (Kymionis et al 2012;Yeung et al 2013), but the effect of intrastromal ring segments may be insufficient in more pronounced keratoconus (Park & Gritz 2013), and removal of corneal tissue in an already thin and mechanically compromised cornea is still considered controversial (Zhang & Zhang 2013).…”

Section: Introductionmentioning

confidence: 99%

Initial results from mechanical compression of the cornea during crosslinking for keratoconus

Rehnman

Behndig

Hallberg

et al. 2014

Acta Ophthalmologica

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ABSTRACT.Purpose: To compare refractive changes after corneal crosslinking with and without mechanical compression of the cornea. Methods: In a prospective, open, randomized case-control study conducted at the Department of Ophthalmology, Ume a University Hospital, Sweden, sixty eyes of 43 patients with progressive keratoconus aged 18-28 years planned for corneal crosslinking and corresponding age-and sex-matched control subjects were included. The patients were randomized to conventional corneal crosslinking (CXL; n = 30) or corneal crosslinking with mechanical compression using a flat rigid contact lens sutured to the cornea during treatment (CRXL; n = 30). Subjective refraction and ETDRS best spectacle-corrected visual acuity (BSCVA), axial length measurement, keratometry and pachymetry were performed before and 1 and 6 months after treatment. Results: The keratoconus patients had poorer BSCVA, higher refractive astigmatism and higher keratometry readings than the control subjects at baseline (p < 0.01). In the CXL group, BSCVA increased from 0.19 AE 0.26 to 0.14 AE 0.18 logMar (p = 0.03), and the spherical equivalent improved from À1.9 AE 2.8 D to À1.4 AE 2.4 D (p = 0.03). Maximum keratometry readings decreased after CXL from 53.1 AE 4.9 D to 52.6 AE 5.2 D (p = 0.02), and the axial length decreased in the CXL group, likely due to post-treatment corneal thinning (p = 0.03). In the CRXL group, all the above variables were unaltered (p > 0.05). Conclusion: At 6 months, the refractive results from CRXL did not surpass those of conventional CXL treatment. Rather, some variables indicated a slightly inferior effect. Possibly, stronger crosslinking would be necessary to stabilize the cornea in the flattened configuration achieved by the rigid contact lens.

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“…-Intracorneal ring segment implantation with same-day CXL [85][86][87][88] . -Intracorneal ring segment implantation followed by sequential same-day topographyguided PRK and CXL with riboflavin and UVA [85,89,90] .…”

Section: Combined Techniques Of Corneal Collagen Crosslinking and Refmentioning

confidence: 99%

Corneal Collagen Crosslinking Techniques: Updates

Cassagne¹,

Hout²,

Malecaze³

2015

Cornea

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Corneal collagen crosslinking (CXL) is usually practiced on keratoconic corneas to strengthen the corneal biomechanical structure. The conventional CXL procedure, with riboflavin and ultraviolet A (UVA), initially involves corneal de-epithelialization to allow riboflavin penetration into the stroma. Discomfort and complications are related to this corneal debridement. Thus, transepithelial CXL has emerged to substitute for the conventional method. This technique preserves the epithelium and tends to ensure the same efficiency of corneal stiffening. To allow riboflavin penetration through the epithelial barrier, several chemical modifications to riboflavin, such as addition of enhancers (EDTA, benzalkonium chloride or 20% alcohol), and osmolar modifications have been applied. The most studied transepithelial riboflavin is Ricrolin TE ® , which combines two enhancers: amino alcohol and EDTA. The results of clinical studies have not demonstrated effectiveness yet. Moreover, the iontophoresis technique, a noninvasive procedure during which a low-intensity electric current is applied to enhance the penetration of riboflavin into the stroma, stands out as being as efficient as conventional application of riboflavin, based on a pre-clinical study. Another area of improvement of CXL is modification of the UVA irradiation profile or shortening of the UVA irradiation time while increasing the irradiation power. A longer follow-up and more investigations are still necessary to define the future of transepithelial CXL, but it is an exciting and rapidly evolving area.

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Transepithelial phototherapeutic keratectomy combined with implantation of a single inferior intrastromal corneal ring segment and collagen crosslinking in keratoconus

Abstract: Phototherapeutic keratectomy combined with implantation of a single inferior ICRS and CXL on the same day was a safe, effective treatment for improving visual acuity in select patients with progressive keratoconus.

Cited by 28 publications

References 33 publications

Pediatric keratoconus: a review of the literature

Pediatric keratoconus: a review of the literature

Initial results from mechanical compression of the cornea during crosslinking for keratoconus

Corneal Collagen Crosslinking Techniques: Updates

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