Effect Of Corneal Collagen Cross-linking Research Articles

Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis.

Corneal ectasia leads to progressive irregular corneal curvature and reduced visual acuity. To assess the safety and effectiveness of corneal collagen cross-linking (CXL) for managing corneal ectasia resulting from refractive laser surgery (RSL). A systematic review and meta-analysis were realized according to PRISMA guidelines. We searched PubMed, EMBASE, Cochrane, and Web of Science databases for studies on CXL in patients with ectasia after RLS. The outcomes of interest included visual acuity, refractive outcomes, topographic parameters (Kmax, index surface variance (ISV), index of Vertical Asymmetry (IVA), keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD) and Rmin (minimum sagittal curvature)), central corneal thickness, endothelial cell count, and possible adverse events. Statistical analysis was performed using the R software (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria). 15 studies encompassing 421 patients (512 eyes) were included. The mean age was 32.03 ± 4.4 years. The pooled results showed a stable uncorrected visual acuity post-CXL, with a significant improvement in corrected distance visual acuity (SMD = 0.09; 95% CI: -0.07 to 0.26). The spherical equivalent decreased significantly (SMD = -0.09; 95% CI: -0.35, -0.02). The topographic parameter Kmax decreased significantly (SMD = 0.15; 95% CI:0.01 to 0.28); however, the other parameters, ISV, IVA, KI, CKI, IHA, IHD, and Rmin, did not change significantly. Central corneal thickness decreased significantly (SMD = 0.24; 95% CI:0.07 to 0.41), and the endothelial cell count remained stable The complications were rare. CXL is a safe and effective technique for managing corneal ectasia after RLS.

Effect of Corneal Collagen Crosslinking with Riboflavin in Patients of Progressive Keratoconus: A Prospective Cohort Study

Introduction: Keratoconus is a non inflammatory disease characterised by progressive corneal thinning that results in a cone-like ectasia, irregular astigmatism, and decreased vision. Advanced disease can result in corneal scarring and blindness, necessitating penetrating keratoplasty. The only treatment believed to have the ability to stop or decrease the progression of keratoconus is Collagen Cross-Linking (CXL). Aim: To evaluate the efficacy of corneal collagen cross-linking with riboflavin (C3R) in patients with keratoconus by studying the outcomes in terms of Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), manifest refraction, and corneal topography. Materials and Methods: A hospital-based prospective cohort study was conducted at the Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala, India from June 2017 to June 2018. Fifteen eyes of 12 patients who underwent corneal collagen cross-linking for progressive keratoconus were included. Routine ophthalmological examinations was done for all patients. Patients under the age of 35 years with progressive keratoconus, an average K value not exceeding 60 D, and who had not undergone any other surgical modalities of treatment were included in the study. Patients with scarred cornea or hydrops, active ocular infection, or pachymetry <400 µm were excluded. Detailed informed consent was obtained from all patients before surgery. Preoperative UCVA, BCVA cylinder, Spherical Equivalent (SE), and topography values were obtained. All patients were followed-up at three and six months postoperative period to look for changes in UCVA, BCVA, manifest refraction, and corneal topography. Data were expressed as the mean±Standard Deviation (SD) pre- and postoperatively and analysed statistically using the paired t-test, with p<0.05 considered statistically significant. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 16.0. Results: On follow-up at six months post-treatment, UCVA (log MAR) improved from 0.87±0.40 to 0.65±0.35 (p-value=0.001), and BCVA (log MAR) changed from 0.37±0.21 to 0.17±0.22 (p-value=0.001). K max decreased from 54.90±6.05 to 52.67±5.02 (p-value=0.001), and K min decreased from 48.14±4.24 to 45.93±4.07 (p-value=0.001). Astigmatism and SE also showed statistically significant improvement post-procedure (p-value 0.001 and 0.002, respectively). Astigmatism reduced from -3.50±1.58 to -2.90±1.37. SE reduced from -4.93±3.92 to -4.28±3.48. No significant complications were noted in any of the patients. Conclusion: The CXL is an effective procedure for stabilising the progression of keratoconus, thus reducing the burden of preventable blindness and the need for keratoplasty.

Effect of Corneal Collagen Cross-Linking on Subsequent Corneal Fungal Infection in Rats.

The purpose of this study was to determine whether corneal collagen cross-linking (CXL) alters fungal susceptibility and increases the severity of keratitis through macrophage activation in rats. Four weeks following CXL pretreatment, the corneal epithelium of adult rats was removed and inoculated with Candida albicans (C. albicans; CXL+inoculation group). The non-CXL-pretreated corneas were also inoculated with C. albicans (inoculation group). Clinical scoring and histopathological examination were performed to determine the severity of fungal keratitis. Immunofluorescence and confocal microscopy imaging were applied to determine the effects of CXL treatment on corneal local macrophage content. Real-time polymerase chain reaction (RT-PCR) and Western blots were used to evaluate mRNA and protein expression. Flow cytometry assays were performed to detect M1- and M2-type macrophages. CXL pretreatment (CXL+inoculation) resulted in higher infection success rate and more severe fungal keratitis than inoculation alone (inoculation group). On days 1, 3, and 7 following fungal infection, the increase in macrophage infiltration and IL-1β, MMP-9, and VEGFA expression was greater in the CXL+inoculation group than in the inoculation group. Number of M1- and M2-type macrophages, M1 to M2 ratio, M1-type macrophage genes, inducible nitric oxide synthase (iNOS), and tumor necrosis factor (TNFα) expression were higher in the CXL+inoculation group compared with the inoculation group. Our data demonstrate that CXL may increase the colonization of macrophages and activate more M1-type macrophages to increase fungal susceptibility and severity of keratitis. This study may aid long-term risk assessment and treatment of the complications of CXL.

The Keratectasia Volume (KEV) in Corneal Topography to Evaluate the Effect of Corneal Collagen Cross-linking in Pediatric Keratoconus.

The study aimed to evaluate the keratectasia volume (KEV) before and after corneal cross-linking (CXL) in pediatric patients. This study included 40 eyes of 25 pediatric patients (10-19years) undergoing standard CXL. The support vector machine (SVM) algorithm was applied to transform mass pixels in corneal topography into a three-dimensioned model to calculate the KEV. The KEV, Kmax, K1, K2, Kave, keratectasia area (KEA), and thinnest corneal thickness (TCT) were determined before CXL and at 3, 6, and 12months after surgery. The correlation between KEV and other parameters (Kmax, TCT, max decentration, eccentricity, and so on) was calculated. The KEV was 4.75 ± 0.74 preoperatively and 4.43 ± 1.22 postoperatively at last follow-up (p < 0.002). There was strong positive correlation between the KEV and Kmax (r = 0.806, p < 0.0005). The preoperat ive KEV was 4.32 ± 0.69 in mild to moderate keratoconus (Kmax < 58D) and 5.27 ± 0.37 in advanced keratoconus (Kmax > 58D) (p < 0.0005, t-test). Postoperative KEV and K readings remained stable at the early stage, and the KEV showed a more drastic decreasing trend than Kmax at sixth month. Statistical significance was found in the KEV between preoperative and 6months after surgery (p < 0.0005), but not in Kmax and other parameters. In 83.3% (15 eyes out of 18 eyes) of the eyes, the preoperative KEV was greater than 4.6 in patients with significant flattening after CXL. Compared with K readings, the KEV can be regarded as a more sensitive index to evaluate the postoperative morphological changes after CXL in pediatric patients.

The outcome of corneal collagen cross-linking in progressive keratoconus: A 24-month follow-up

Purpose: The purpose of this study is to evaluate the effect of corneal collagen cross-linking on visual acuity and corneal parameters like keratometry and pachymetry. Methods: It was a retrospective, noncomparative, open-label study conducted at a tertiary eye care center. The eyes that underwent epithelium-off CXL (corneal collagen cross-linking) for progressive keratoconus between 2018 January and 2019 December, and who completed 24 months' post-CXL follow-up, were included in the study. Data regarding uncorrected and best spectacle-corrected visual acuity (UCVA and BSCVA) and corneal topography parameters, that is, K max, K min, and pachymetry at thinnest point, were collected prior to the procedure and 2 years after the procedure. Results: A total of 92 eyes of 65 patients were included in the study. There was a significant improvement of logMAR BCVA from preoperative 0.40 ± 0.24 to 0.28 ± 0.19 at 24 months after CXL (P &lt; 0.001). UCVA also increased from preoperative value of logMAR 0.70 ± 0.28 to 0.61 ± 0.26 2 years postoperatively (P &lt; 0.001). The number of eyes achieving BCVA of 0.3 logMAR or better significantly increased from 54 (58.7%) preoperatively to 72 (78.26%) at 2 years and it was found to be statistically significant (P &lt; 0.001). There was a significant improvement in K max 49.38 ± 3.70 to 49.07 ± 3.45 (P = 0.0005) and K min 45.65 ± 2.69 to 45.19 ± 2.46 (P &lt; 0.001) following CXL. Conclusion: Corneal collagen cross-linking is a treatment modality to stabilize and even improve UCVA in patients with mild-to-moderate keratoconus.

Visual improvement after corneal collagen cross-linking in keratoconus

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.

Effect of corneal collagen crosslinking on viscoelastic shear properties of the cornea

The cornea is responsible for most of the refractive power in the eye and acts as a protective layer for internal contents of the eye. The cornea requires mechanical strength for maintaining its precise shape and for withstanding external and internal forces. Corneal collagen crosslinking (CXL) is a treatment option to improve corneal mechanical properties. The primary objective of this study was to characterize CXL effects on viscoelastic shear properties of the porcine cornea as a function of compressive strain. For this purpose, corneal buttons were prepared and divided into three groups: control group (n = 5), pseudo-crosslinked group (n = 5), and crosslinked group (n = 5). A rheometer was used to perform dynamics torsional shear experiments on corneal disks at different levels of compressive strain (0%–40%). Specifically, strain sweep experiments and frequency sweep tests were done in order to determine the range of linear viscoelasticity and frequency dependent shear properties, respectively. It was found that the shear properties of all samples were dependent on the shear strain magnitude, loading frequency, and compressive strain. With increasing the applied shear strain, all samples showed a nonlinear viscoelastic response. Furthermore, the shear modulus of samples increased with increasing the frequency of the applied shear strain and/or increasing the compressive strain. Finally, the CXL treatment significantly increased the shear storage and loss moduli when the compressive strain was varied from 0% to 30% (p < 0.05); larger shear moduli were observed at compressive 40% strain but the difference was not significant (P = 0.12).

The mid-term effect of corneal collagen cross-linking for progressive keratoconus and the changes in rigid gas permeable contact lens fitting parameters

Objective: To investigate the effect of corneal collagen cross-linking (CXL) for progressive keratoconus and to evaluate changes in the parameters of rigid gas permeable contact lens (RGPCL) fitting after surgery. Methods: It was a prospective cohort study. Fifty-three eyes of 41 keratoconus patients received accelerated CXL in Qingdao Eye Hospital of Shandong First Medical University from May to December 2018. There were 31 males and 10 females, aged (20.46±4.15) years. According to the corneal thickness, de-epithelial CXL (33 eyes) or trans-epithelial CXL (20 eyes) was performed. The best spectacle-corrected visual acuity, refractive power and the thinnest corneal thickness at baseline and at 6 weeks were compared. Corneal topography was performed at baseline and at 6 weeks, 3, 6 and 12 months postoperatively. Rose K RGPCLs were used before and 6 weeks after surgery, and the fitting status was monitored until 12 months after surgery. The t test was performed to analyze the difference before and after the operation. Results: The best spectacle-corrected visual acuity, refractive power, and the thinnest corneal thickness were not significantly changed over 6 weeks of follow-up, but the Kf, Ks and Kmax values were significantly increased in all patients (all P<0.05). In the de-epithelial group, the Kmax values before the operation, at 3, 6 and 12 months after the operation were (55.00±5.51) diopters (D), (54.73±5.34) D, (54.58±6.15) D and (54.20±5.49) D, respectively, and the decrease at 12 months was significant [(0.80±2.05) D; t=2.25, P=0.001]. In the trans-epithelial group, the Kmax values were (59.43±8.98) D, (57.97±8.79) D, (58.19±8.37) D and (56.94±7.19) D at the four time points, respectively, and the decreases at 3, 6 and 12 months were all significant [(1.46±2.09) D, (1.25±1.82) D, (2.49±3.64) D; t=3.12, 3.06, 3.50; P=0.006, 0.006, 0.007]. The best RGPCL-corrected visual acuity, the diameter and the average diopters of RGPCLs showed no significant change in both groups. The RGPCL base curve decreased by 0.07 mm in the de-epithelial group and by 0.13 mm in the trans-epithelial group (both P<0.05). The design of edge lifting was used in 10 eyes postoperatively in the de-epithelial group compared with 8 eyes preoperatively, and in 4 eyes postopratively in the trans-epithelial group compared with 7 eyes preoperatively. The number of eyes using the toric peripheral design of the lens was increased to 3 compared with 2 preoperatively in the de-epithelial group and from 1 to 4 in the trans-epithelial group. The acceptance rate of RGPCL fitting in both groups increased at 6 and 12 months after surgery compared to 6 weeks after surgery. Conclusions: The corneal curvature became steep slightly at 6 weeks after CXL and gradually recovered and flattened. The Kmax in the trans-epithelial group decreased earlier and more than that in the de-epithelial group. The base curve of the RGPCLs was slightly reduced after 6 weeks, and the toric peripheral design was increasingly needed, but the requirement for the design of the lifted edge was different between the two groups. A good RGPCL fitting can be achieved within 1 year after CXL.

Effect of corneal collagen cross-linking on higher-order aberrations in patients with early keratoconus

Effect of corneal collagen cross-linking on higher-order aberrations in patients with early keratoconus

Mueller Matrix-Based Approach for the Ex Vivo Detection of Riboflavin-Treated Transparent Biotissue

Corneal collagen cross-linking is an established procedure for the treatment of certain eye diseases which is applied to enhance the mechanical stability of such biotissue without deteriorating its functionality. However, being transparent, the optical analysis of the outcome of such treatments is cumbersome and relies on relatively expensive experimental equipment. We aim to apply the Mueller matrix polarimetry for the detection of photo-induced collagen cross-linking in transparent biotissue after treatment with riboflavin and UV irradiation. A simple Mueller matrix polarimetry setup could provide a fast and non-invasive analysis of transparent media to sensitively detect small photo-induced cross-linking effects in biotissue. We demonstrated the current capabilities of the approach on non-planar porcine cornea samples ex vivo. We reported the distinction between untreated and riboflavin-treated samples. The differences observed were correlated with the variation of certain Mueller matrix elements and parameters derived from the decomposition. The measurement data show variation in the cross-linked and non-cross-linked samples, although the effect of the UV treatment on the riboflavin-treated samples was not at the same level of significance yet and needs further investigation. The Mueller matrix measurement represents a promising approach for the detection of the effects of corneal collagen cross-linking. Further studies with a larger sample number are required to validate this approach. In the future, this could enable the reliable and non-invasive detection of photo-induced effects in biotissue and open the possibility for in vivo application, e.g., in eye disease treatment or the detection of scar collagen development.

The Effect of Corneal Collagen Cross-Linking on Higher Order Aberrations in Keratoconus

Purpose: To assess the changes in ocular high order aberrations after collagen cross linking for keratoconus.&#x0D; Patients and Methods: This study included 30 eyes with confirmed KCN. Baseline evaluation focused on: UDVA and BSCVA using logMAR notation, MRSE, corneal topography using Orbscan IIZ and wave-front aberrometry using Zywave II. CXL was performed per ‘Dresden protocol’ through a 30-minutes exposure to 370 nm UVA with an irradiance of 3 mW/cm 2. Patients had comprehensive ophthalmic evaluation after 6 months with special attention to: UDVA, BSCVA, MRSE, corneal topography and wave-front aberrometry changes. &#x0D; Results: The mean age was 25.5±5.84 (20:31) years. After 6 months, there was a significant decrease in corneal thickness from 493.2± 24.17µ to 486.7±24.26µ (P&lt;0.05) and a significant decrease in K max from 47.4±1.17D to 46.1±1.17D (P&lt;0.05). BSCVA improved from preoperative value (0.00:0.5 logMAR (median 0.3)) to 6 months’ value (0.1:1.00 logMAR (median 0.2) (P &lt;0.05). Preoperative MRSE was -7.25: -0.5D (median -2.85D) and at 6 months was -6.25: -0.5D (median - 2.125D) (P&lt;0.05). A significant correlation was found at 6 months between changes in both BSCVA and: K max (P&lt;0.001), corneal thickness (P&lt;0.05), vertical coma (P&lt;0.001) and trefoil (P&lt;0.001). &#x0D; Conclusions: Improvement in HOA was detected after CXL for KCN. The changes in total, vertical coma and vertical trefoil aberrations were significantly correlated with postoperative improvement in BSCVA. Thus, improvement in HOA profile after CXL is one of the explanations of improvement in visual function after CXL in KCN.

The Effect of Cone Localization on Higher Order Aberrations After Corneal Crosslinking for Keratoconus.

Objectives:This study was designed to evaluate the effects of corneal collagen cross-linking (CXL) on topographic parameters, visual acuity, and corneal high-order aberrations according to the preoperative cone location in keratoconus.Methods:This retrospective study assessed patients with keratoconus who underwent CXL between March 2016 and February 2019. Patients with a history of corneal surgery, corneal hydrops, corneal scar tissue, delayed epithelial healing, and a corneal thickness of <400 μm were excluded. The included eyes were divided into 2 groups according to the preoperative cone location: maximum K in the central 3-mm optical zone (group 1) or the central 3-mm to 5-mm optical zone (group 2). The preoperative and postoperative 24-month, best-corrected visual acuity (BCVA), intraocular pressure, K max, symmetry index front, corneal thickness, and high order aberration findings were recorded.Results:The study included 67 eyes of 67 patients with keratoconus: 39 in group 1, and 28 in group 2. There were statistically significant differences between the groups in the preoperative BCVA values (p=0.04). There was no significant difference between the preoperative and postoperative mean K max between the 2 groups (p=0.08). The mean difference in corneal thickness between preoperative and postoperative measurements was significantly lower in group 2 than in group 1 (p=0.03). The preoperative and postoperative mean spherical aberration was significantly higher in group 1 than in group 2 (p=0.001 and p=0.005, respectively).Conclusion:The preoperative cone location in keratoconus may affect CXL outcomes. At the end of the second year, CXL was found to have a similar efficacy on visual acuity and keratometry parameters in the central and paracentral cone groups, and the recovery in terms of a spherical aberration among high-order aberrations after CXL in the central cone group was better than that of the paracentral cone group.

Ten years experience of corneal collagen cross-linking : An observational study of 6120 cases.

To study the effect of corneal collagen cross-linking (CXL) using riboflavin and ultraviolet rays on cases of corneal ectasia in keratoconus cases, post-laser-assisted in situ keratomileusis ectasia, and pellucid marginal degeneration and to present its long-term results over many years. This study was conducted throughout 10 "years" experience in corneal collagen CXL, including 6120 cases. The study consists of two parts: a retrospective and a prospective part. All patients in the retrospective part were operated by epi-off, while in the prospective part, the epi-on procedure was used. Also, other machines were used as Peschke Vario, Peschke Phoenix, and different types of riboflavin. The results were analyzed using SPSS. The study showed stabilization ectasia in 95% of cases using our standard protocol, and this was proved by topography, pachymetry, refraction, and visual acuity. The effect of CXL was continued in 20% of cases, over a period of 3-5years, some cases needed to repeat CXL due to the progression of corneal ectasia after cross-linking, in six eyes, that were rubbing their eyes and/or hormonal disturbance. Corneal collagen cross-linking CXL is an effective method to prevent the progression of corneal ectasia, whether primary or post-laser-assisted in situ keratomileusis, and the effect was stable over the years of study.

What are the effects of corneal collagen cross-linking for people with keratoconus?

What are the effects of corneal collagen cross-linking for people with keratoconus?

The effects of corneal collagen cross-linking on the corneal structure in keratoconus

The article reviews the key information regarding morphological changes in keratoconic corneas and dramatic alterations of the corneal tissue induced by corneal cross-linking according to data obtained with in vivo corneal confocal microscopy, presents basic information on keratoconus visualization techniques widely used for diagnosis, monitoring of ectasia, as well as efficacy assessment of its treatment, and lists basic principles of corneal cross-linking procedure and confocal microscopy with consideration of morphology specifics of keratoconic corneas. The article also discusses prospective benefits of further research and longitudinal studies aimed to define the origin of keratoconus and to develop advanced corneal cross-linking protocols.

Optimization of Oxygen Dynamics, UV-A Delivery, and Drug Formulation for Accelerated Epi-On Corneal Crosslinking

ABSTRACTPurpose: Corneal collagen crosslinking (CXL) through an intact epithelium (epi-on) at high irradiance could potentially improve patient comfort, visual recovery, and clinical workflow compared to conventional epi-off CXL. However, intact epithelium limits stromal delivery of the oxygen, photosensitizer, and ultraviolet-A (UV-A) radiation needed to drive CXL. This ex vivo study evaluated three different epi-on CXL protocols compared to positive and negative controls, specifically focusing on the impact of supplemental oxygen. Endpoints included stromal oxygen levels, stiffness of crosslinked tissue, and acute flattening of whole eyes.Materials & Methods: Ex vivo porcine eyes were held in a custom environmental chamber. Intrastromal oxygen levels were continuously measured before, during, and after UV illumination by a fiberoptic probe inserted into a laser-cut flap. Accelerated, high irradiance, epi-on CXL protocols using riboflavin formulated with benzalkonium chloride (BAC) were studied, with and without supplemental oxygen. These were compared to an alternate, low irradiance, epi-on protocol using riboflavin formulated with sodium iodide. Both negative (no CXL) and positive (epi-off modified Dresden protocol) controls were performed. Post-CXL elastic modulus was measured using extensiometry and anterior tangential curvature was measured using a Scheimpflug tomographer.Results: Protocols including supplemental oxygen resulted in an approximately 5-fold increase in stromal oxygen levels prior to CXL. During epi-on, high-irradiance UV-A delivery under hyperoxic conditions, an aerobic state was maintained. Conversely, under normoxic conditions, stromal oxygen rapidly depleted to 0-5% for all other protocols. The combination of supplemental oxygen, BAC formulation, and high-irradiance UV-A resulted in the largest biomechanical changes and most pronounced flattening effects of the three epi-on protocols.Conclusions: Ex vivo analysis of stromal oxygen levels, corneal stiffness, and acute anterior curvature change indicates that simultaneous optimization of the oxygen environment, riboflavin formulation, and UV-A protocol can significantly increase the effects of corneal collagen crosslinking.

A Study of the Effect of Corneal Collagen Crosslinking in Pediatric Patients with Keratoconus

A Study of the Effect of Corneal Collagen Crosslinking in Pediatric Patients with Keratoconus

Using ultraviolet corneal crosslinking for the treatment of corneal ulcers and other corneal pathologies in animals

Purpose. To study the effects of corneal collagen cross-linking (CCL) using ultraviolet-A (UVA) irradiation with riboflavin on the eye’s anterior segment structures in corneal ulcers and other keratopathies in animals.Material and methods. The study involved 26 animals (39 eyes) — 10 cats, 10 dogs, and 6 horses with ulcers, corneal staphyloma, dry and autoimmune keratoconjunctivitis. Examination included slit-lamp biomicroscopy, ophthalmoscopy (in cases of transparent cornea), tear production test, and staining the eye surface with vital dyes. CCL was performed using UVA radiation of LEDs with a fiber optic output (wavelength 370 nm, radiation power 3 mW/cm2) combined with 0.1 % riboflavin instillation according to the protocol we developed, which specifies various numbers and durations depending on the diagnosis and therapeutic effect desired.Results. Restoration of the shape and transparency of the cornea, relief of anterior eye inflammation, and normalization of tear production occurred much sooner than using traditional treatment. The restoration of vision occurred 2 to 3 months earlier in eyes with corneal staphyloma; more than 4 to 5 months earlier in eyes with keratoconjunctivitis; no relapses were noted in eyes with ulcerative processes, and the restoration of the function of stratified squamous epithelium was achieved within 2 or 3 weeks.Conclusions. The inclusion of modified UFA-based CCL in the treatment scheme of corneal ulcers and staphylomas as well as dry and autoimmune keratoconjunctivitis enables a high therapeutic effect of anterior eye structure restoration. In future, the results obtained could serve as basis for using the developed technology in the treatment of similar eye pathologies in humans.

This issue of ACTA

This issue of ACTA

Clinical evaluation of different types of contact lenses in keratoconus management

PurposeTo compare the clinical and topographical findings of the keratoconus patients according to the prescribed contact lens type and to investigate the effects of corneal collagen cross-linking (CXL) and cone location on lens selection. MethodsThe records of 301 eyes of 195 keratoconus patients who were prescribed contact lenses were analyzed retrospectively. The eyes were grouped according to the lens type: Soft toric contact lens (STCL), rigid gas-permeable contact lens (RGPCL), hybrid contact lens (HCL) and mini-scleral contact lens (MSCL). The history of having CXL, ophthalmological examination findings, and the topographical findings were compared between the groups. Brown-Forsythe, Chi-square, and post-hoc tests were used to compare the groups. Mann-Whitney U test was used for subgroup analysis. Comparison of the lens-corrected visual acuity (LCVA) and spectacle-corrected visual acuity (SCVA) levels was made with Wilcoxon signed-ranks test. ResultsThere was no significant difference between the groups regarding topographical cone location, CXL history, spherical refraction, and LCVA. The difference between spectacle-corrected visual acuity and LCVA was higher in RGPCL and MSCL groups than STCL group (p=0.01). Keratometry of RGPCL and MSCL groups were higher than STCL and HCL groups (p=0.01, p<0.001). In RGPCL group, eyes with central cones had a higher increase in visual acuity with contact lenses compared to eyes with paracentral cones (p=0.043). STCL and MSCL were mostly prescribed in mild and severe keratoconic eyes, respectively. In RGPCL group, the increase in visual acuity with contact lens was higher in eyes treated with CXL (p= <0.01). ConclusionsWhile STCL and HCL were mostly prescribed in mild keratoconus, RGPCL and MSCL were selected for moderate or advanced disease. If appropriately chosen, all types of contact lenses could result in a good visual acuity level. CXL history did not affect the prescribed lens type. Having central cone location and CXL history in RGPCL group improved visual acuity more efficiently.