Treatment Effect and Corneal Light Scattering With 2 Corneal Cross-linking Protocols

Rehnman, Jeannette Beckman; Lindén, Christina; Hallberg, Per; Behndig, Anders

doi:10.1001/jamaophthalmol.2015.2852

Cited by 13 publications

(9 citation statements)

References 31 publications

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“…On the contrary, a symmetrical treatment pattern (CXL in the present study) also gives a symmetrical treatment effect. In accordance with our previous reports,15 18 this study shows that the increase in corneal densitometry relates to the CXL treatment effect, which is in alignment with recent in vivo confocal microscopy findings, where the phenomenon of light scattering is explained as an ‘indirect sign of CXL-induced stromal collagen compaction and remodeling’ 19. Accordingly, with an asymmetrical treatment pattern as in the present study, an increase in corneal densitometry is seen only where the cornea is crosslinked, but not outside the treatment zone.…”

Section: Discussionsupporting

confidence: 94%

“…Inclusion required a diagnosis of progressive keratoconus with a minimum corneal thickness of 400 µm at the thinnest point after epithelial removal. The keratoconus diagnosis was based on the Amsler-Krumeich grading14 and the ‘Total Deviation’ keratoconus quantification value from the ‘Belin-Ambrosio enhanced ectasia’ measurements of the Pentacam HR, plus an altered red reflex and/or distortion of the keratometric mires 13 15. Disease progression was verified by increasing corneal steepness (increase in K max of ≥1 D in 1 year) and/or thinning of the cornea on repeated Scheimpflug tomography measurements in 41 eyes; in 9 eyes, the progression was verified by increasing keratometric astigmatism and corneal steepness and decreasing best-spectacle-corrected visual acuity.…”

Section: Methodsmentioning

confidence: 99%

“…For comparison, corresponding points were also measured in the CXL-treated corneas. Similarly, the maximum corneal densitometry values (corneal light backscatter), expressed as standardised grey scale units (GSUs))15 were also assessed at P max and P min in all treated corneas using the Pentacam HR. Central corneal endothelial photographs were taken with the Topcon SP-2000P specular microscope (Topcon Europe, Capelle a/d Ijssel, the Netherlands), and the corneal endothelial morphology was calculated from a cluster of 55 cells from each photograph, as previously detailed 17.…”

Section: Methodsmentioning

confidence: 99%

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Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results

et al. 2016

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Section: Discussionsupporting

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results

et al. 2016

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“…The depths were noticeably deep for both protocols, as they probably better correlate with the degree of early postoperative haze, glare and light scattering, which likely goes beyond the area of the morphological changes of the keratocytes. Nevertheless, the light scattering can be used for comparing our two treatment protocols, and one possible explanation to the deeper light scattering for the homogenous protocol might be that the illumination at a given fluence will be higher at the corneal centre because of the corneal curvature (Rehnman et al 2015).…”

Section: Discussionmentioning

confidence: 99%

Treatment effect with 2 photorefractive intrastromal cross‐linking protocols in low‐grade myopia through 24‐month follow‐up

Näslund

Fredriksson

Alm

et al. 2020

Acta Ophthalmologica

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Purpose To assess the effect of two high‐oxygen epi‐on PiXL treatments for low‐grade myopia. Methods This prospective, randomized, intra‐individually comparing, single‐masked study included 23 healthy volunteers (46 eyes) aged 18–35 years with mild myopia, −0.75 to −2.50 D manifest refractive spherical equivalent (MRSE). One eye was randomized to a 4.0‐mm homogenous treatment zone and the fellow eye to a 4.0‐mm annular zone (16:40 min at 30 mW/cm2, fluence 15 J/cm2). Uncorrected distance visual acuity (UDVA), MRSE, best spectacle‐corrected visual acuity (BSCVA), Scheimpflug light scattering depths, mean keratometry (Kmean) and endothelial cell count (ECC) were assessed through 24 months. Results Similar improvements in UDVA were seen for the homogeneous and annular protocols at 1 month: −0.52 (−0.59, −0.39) and −0.49 (−0.59, −0.39) logMAR, respectively (medians and interquartile ranges, IQR), p = 0.91, and MRSE: +1.0 D (0.94, 1.31) and +1.0 D (0.69, 1.25), p = 0.17. Light scattering depths were 496 (465, 527) and 349 (247, 378) µm, respectively, and the reduction in mean keratometry was −0.8 D (−1.1, −0.7) and 0 D (−0.1, 0.1), p < 0.001. The treatment effect remained stable throughout 24 months. At 1 week, the participants reported less ocular discomfort with the annular protocol. No reductions were seen in BSCVA or ECC. No adverse events were reported. Conclusion PiXL can reduce low‐grade myopia and improve uncorrected vision in healthy eyes. The initial ocular discomfort may be reduced with an annular treatment zone. Further studies are needed to optimize PiXL treatment parameters.

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“…e conservative treatment modalities, such as spectacles and gas permeable rigid contact lenses, become insufficient for visual rehabilitation in the advanced stages of KC, and 10-20% of patients need corneal transplantation [3]. Wollensak et al [5] introduced the CXL treatment in 2003, which is being considered a standard, minimally invasive, and safe therapeutic option for progressive KC [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. e principle goal of CXL is to stabilize the progression of KC by increasing the mechanical stability of the cornea [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Preliminary Characterization of Predictive Factors of the Visual Change after Epi-On and Epi-Off Corneal Collagen Crosslinking Techniques

Abdelkader

Fernández²,

Sebastián³

et al. 2021

Journal of Ophthalmology

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Purpose. To investigate the potential predictive factors of the visual change achieved with accelerated epi-on and epi-off corneal collagen crosslinking (CXL) in keratoconus. Methods. This retrospective comparative study analyzed 67 eyes treated with an accelerated epithelium-on (epi-on group) and epithelium-off (epi-off group) CXL. The clinical outcomes were evaluated and compared during a 1-year follow-up. Likewise, the relationship of the change achieved with both CXL techniques in the corrected distance visual acuity (CDVA) with different preoperative data was investigated. Results. The mean CDVA change at 3 months postoperatively was −0.04 ± 0.19 and −0.07 ± 0.25 in the epi-on and epi-off groups, respectively ( p = 0.809). In the epi-on group, this change was significantly correlated with the preoperative apical (r = −0.375, p = 0.045) and central corneal thickness (r = −0.402, p = 0.031). In the epi-off group, the CDVA change was significantly correlated with not only the preoperative apical (r = 0.402, p = 0.028) and central corneal thickness (r = 0.367, p = 0.046) but also with some topometric and aberrometric indices (r ≤ −0.374, p ≤ 0.042). Furthermore, the change in CDVA in the epi-on group could be predicted from age, preoperative refractive astigmatism J45 component, anterior corneal asphericity, and posterior corneal high order aberration root mean square ( p = 0.002, R2 = 0.503). In the epi-off group, the CDVA change could be predicted from the preoperative minimum corneal thickness and magnitude of the vertical anterior corneal primary coma component ( p = 0.001, R2 = 0.446). Conclusions. Clearly, different predictive factors of the visual change induced with the accelerated epi-on and epi-off CXL techniques are present, suggesting a different mechanism of action for stiffening the cornea and inducing changes in this structure.

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Treatment Effect and Corneal Light Scattering With 2 Corneal Cross-linking Protocols

Cited by 13 publications

References 31 publications

Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results

Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results

Treatment effect with 2 photorefractive intrastromal cross‐linking protocols in low‐grade myopia through 24‐month follow‐up

Preliminary Characterization of Predictive Factors of the Visual Change after Epi-On and Epi-Off Corneal Collagen Crosslinking Techniques

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