Abstract
The aim of the study was to visualize and evaluate the characteristics and depth of the demarcation line with anterior segment optical coherence tomography (AS-OCT) after epithelium-off iontophoresis corneal collagen cross-linking (epi-off I-CXL). In this prospective, consecutive, single center study 18 eyes of 18 patients with keratoconus were involved. One month after epi-off I-CXL, all the patients underwent an AS-OCT scan to search for a demarcation line and its characteristics. The corneal stromal demarcation line was identified in all the eyes. Mean depth of the corneal stromal demarcation line was 261.8 ± 46.7 μm (range: 184 to 362 μm), at 56.7 ± 12% corneal depth. In conclusion, epi-off I-CXL determines a demarcation line that can be visualized with AS-OCT, which seems clearly distinguishable and similar to that created in standard CXL.
Highlights
Keratoconus is a chronic and progressive disease involving the cornea: the biomechanical instability of the stroma causes its thinning and deformation, so the cornea assumes the shape of a cone, losing its characteristic rigidity and resistance
Disease detection is essential for improving the management of keratoconus patients as it can advance from mild changes to a severe loss of visual acuity [2], which might require corneal transplantation because advanced disease with severe thinning and ectasia and eventually corneal scarring would not be further managed by other optical corrections [3]
Med. 2021, 10, 3295 mean central corneal thickness measured with anterior segment optical coherence tomography (AS-OCT) at 1-month post-operative was
Summary
Keratoconus is a chronic and progressive disease involving the cornea: the biomechanical instability of the stroma causes its thinning and deformation, so the cornea assumes the shape of a cone, losing its characteristic rigidity and resistance. The standard method of epithelium off CXL, referred to as “Dresden protocol”, implies the preventive removal of the corneal epithelium to allow the penetration of riboflavin inside the corneal stroma [4]. Iontophoresis allows the penetration of riboflavin into the corneal stroma using electric current [6]. Since 2 weeks after the treatment, it is possible to identify a demarcation line on slit-lamp [9], confocal microscopy [10] and anterior segment optical coherence tomography (AS-OCT). This demarcation line appears on the AS-OCT imaging as a hyper-reflective line in the corneal stroma, at a variable depth [11]. The aim of the study is to visualize and evaluate the characteristics of the demarcation line one month after a novel CXL protocol named epithelium-off iontophoresis CXL (epi-off I-CXL) as assessed by AS-OCT
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