Toric Topographically Customized Transepithelial, Pulsed, Very High-Fluence, Higher Energy and Higher Riboflavin Concentration Collagen Cross-Linking in Keratoconus

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Abstract

Purpose

To report a novel application of toric topographically customized transepithelial collagen cross-linking (CXL) aiming to achieve refractive astigmatic changes in a keratoconic cornea.

Methods

Specially formulated riboflavin transepithelial administration and delivery of high-fluence UVA in a topographically customized pattern was applied in an eye with progressive keratoconus. Visual acuity, cornea clarity, keratometry, topography, and pachymetry with a multitude of modalities, as well as endothelial cell counts were evaluated for >6 months.

Results

Uncorrected distance visual acuity changed from preoperative 20/40 to 20/25 at 6 months. A mean astigmatic reduction of 0.8 D, and significant cornea surface normalization was achieved 6 months postoperatively. There was some mild change in the epithelial distribution, with the treated area having a slight normalization in the average epithelial thickness.

Conclusions

We introduce herein the novel application of a topographically customizable transepithelial CXL in progressive keratoconus in order to achieve an astigmatic refractive effect and ectasia stabilization. This novel technique offers a nonablative and nonincisional approach to treat irregular astigmatism in ectatic cornea with rapid visual rehabilitation.

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Most cited references 20

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Corneal collagen crosslinking with riboflavin and ultraviolet A to treat induced keratectasia after laser in situ keratomileusis.

Rainer Wiltfang, Farhad Hafezi, Theo Seiler … (2007)

To determine whether riboflavin and ultraviolet-A (UVA) corneal crosslinking can be used as an alternative therapy to prevent the progression of keratectasia. Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland, and a private clinic, Athens, Greece. Corneal crosslinking was performed in 10 patients with formerly undiagnosed forme fruste keratoconus or pellucid marginal corneal degeneration who had laser in situ keratomileusis (LASIK) for myopic astigmatism and subsequently developed iatrogenic keratectasia. Surgery was performed in 1 eye per patient. Crosslinking induced by riboflavin and UVA arrested and/or partially reversed keratectasia over a postoperative follow-up of up to 25 months as demonstrated by preoperative and postoperative corneal topography and a reduction in maximum keratometric readings. Riboflavin-UVA corneal crosslinking increased the biomechanical stability of the cornea and may thus be a therapeutic means to arrest and partially reverse the progression of LASIK-induced iatrogenic keratectasia.

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Corneal topography indices after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results.

Steven Greenstein, Kristen L Fry, Peter S Hersh (2011)

To evaluate changes in corneal topography indices after corneal collagen crosslinking (CXL) in patients with keratoconus and corneal ectasia and analyze associations of these changes with visual acuity. Cornea and refractive surgery subspecialty practice. Prospective randomized controlled clinical trial. Corneal collagen crosslinking was performed in eyes with keratoconus or ectasia. Quantitative descriptors of corneal topography were measured with the Pentacam topographer and included 7 indices: index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, minimum radius of curvature, index of height asymmetry, and index of height decentration. Follow-up was 1 year. The study comprised 71 eyes, 49 with keratoconus and 22 with post-LASIK ectasia. In the entire patient cohort, there were significant improvements in the index of surface variance, index of vertical asymmetry, keratoconus index, and minimum radius of curvature at 1 year compared with baseline (all P < .001). There were no significant differences between the keratoconus and ectasia subgroups. Improvements in postoperative indices were not correlated with changes in corrected or uncorrected distance visual acuity. There were improvements in 4 of 7 topography indices 1 year after CXL, suggesting an overall improvement in corneal shape. However, no significant correlation was found between the changes in individual topography indices and changes in visual acuity after CXL. Copyright © 2011. Published by Elsevier Inc.

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In vivo three-dimensional corneal epithelium imaging in normal eyes by anterior-segment optical coherence tomography: a clinical reference study.

Anastasios Kanellopoulos, George Asimellis (2013)

To evaluate the safety and efficacy of real-time measurement of corneal epithelial thickness and investigate the distribution characteristics in a large normal-eye population using a clinically available spectral-domain anterior-segment optical coherence tomography (AS OCT) system.

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Author and article information

Journal

Journal ID (nlm-ta): Case Rep Ophthalmol

Journal ID (iso-abbrev): Case Rep Ophthalmol

Journal ID (publisher-id): COP

Title: Case Reports in Ophthalmology

Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )

ISSN (Electronic): 1663-2699

Publication date Collection: May-Aug 2014

Publication date (Electronic): 18 June 2014

Publication date PMC-release: 18 June 2014

Volume: 5

Issue: 2

Pages: 172-180

Affiliations

[1] ^aLaservision.gr Eye Institute, Athens, Greece

[2] ^bDepartment of Ophthalmology, NYU Medical School, New York, N.Y., USA

[3] ^cDepartment of Ophthalmology, Cleveland State University, Cleveland, Ohio, USA

[4] ^dDepartment of Biomedical Engineering, Cleveland Clinic, Cleveland State University, Cleveland, Ohio, USA

[5] ^eDepartment of Cole Eye Institute, Cleveland Clinic, Cleveland State University, Cleveland, Ohio, USA

[6] ^fDepartment of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, Ohio, USA

Author notes

*A. John Kanellopoulos, MD, Laservision.gr Eye Institute, 17 Tsocha Street, GR-115 21 Athens (Greece), E-Mail ajk@ 123456brilliantvision.com

Article

Publisher ID: cop-0005-0172

DOI: 10.1159/000363371

PMC ID: 4105951

SO-VID: 8225a14e-05c4-40ba-a850-8626eb9f376a

License:

This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

History

Page count

Figures: 4, Tables: 1, References: 26, Pages: 9

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