Abstract
Objective:To determine mean change in visual acuity, central corneal thickness and symptoms in patients with pseudophakic bullous keratopathy after treatment with corneal collagen crosslinking.Methods:This quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from April 2015 to Nov 2015. A total of 24 eyes of 24 patients were included in the study. Visual symptoms were graded in five grades (Grade 1-5), Grade-1 being very mild with decreased vision only while patients with all five symptoms (decreased vision, foreign body sensations, pain, watering and photophobia) were graded as Grade-5. Corneal collagen cross linking using topical isotonic riboflavin followed by UVA radiations (3mW/cm2 for 10 minutes) was performed in all the patients. Visual acuity (VA), visual symptoms and central corneal thickness (CCT) were recorded before and 04 weeks after the treatment.Results:A total of 24 eyes of 24 patients (18 male and 6 females) underwent surgery. Age of the patients ranged from 55 to 75 years with mean age 65.83 + 3.89 years. Mean visual acuity was 2.09 + 0.23 before treatment while after treatment it was 2.13 + 0.22. Mean CCT as measured by optical pachymetry (Galilae G6) was 753.96 + 55.16 and 641+ 29.25 before and after surgery respectively. Improvement of clinical symptoms was seen in all the patients.Conclusion:Corneal collagen cross linking is a temporary but effective symptomatic treatment of pseudophakic bullous keratopathy.
Highlights
Pseudophakic bullous keratopathy (PBK) is an important, visually significant, long term complication after cataract surgery that can render the patient legally blind
The role of CXL is well established in the treatment of keratoconus, in recent years this modality has been tried in treatment of PBK
Wollensak and his colleagues observed the possible effectiveness of CXL in PBK and proposed the formation of chemical bonds between collagen fibrils that creates a mechanical barrier and reduce the edema.[14,15]
Summary
Pseudophakic bullous keratopathy (PBK) is an important, visually significant, long term complication after cataract surgery that can render the patient legally blind. It results from dysfunction and loss of corneal endothelial cells leading to corneal edema, corneal opacification and epithelial bullae formation. Symptomatic patients are commonly managed with topical hypertonic saline, mild topical steroids and bandage contact lens. Corneal grafting is a costly procedure, not readily available for all the patient and it is not a good treatment option for those cases where there is guarded visual prognosis.[4,5,6] In such cases various treatment modalities have been tried for symptomatic relief such as PTK (phototherapeutic keratectomy), conjunctival rotation or free flaps, puncturing anterior corneal stroma, and transplantation of amniotic membrane.[7]
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