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      Clinical Outcomes after Complete Intracorneal Ring Implantation and Corneal Collagen Cross-Linking in an Intrastromal Pocket in One Session for Keratoconus

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      Journal of Ophthalmology

      Hindawi Publishing Corporation

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          Abstract

          Purpose. The aim of this work was to evaluate the results after combined surgery implantation of full rings and CXL in one session in a group of patients with keratoconus during a 12-month follow-up. Material and Methods. The study included 22 eyes of 20 keratoconic patients, mean age of 28.41 (from 18 to 50) years. A full ring was inserted and afterwards 0.1% riboflavin solution was injected into the corneal pocket through the incision tunnel. The cornea was irradiated with UV-A light for 30 minutes. Postoperative visits were scheduled for the first week and months 1, 3, 6, 12, and 24 after surgery. Minimal follow-up time was 12 months. Results. The mean UDVA improved by 6 lines from before the operation to 1 year after the operation, the mean CDVA improved by approximately 2.5 lines, and the mean K improved by 3.94 D. Statistically significant reductions of sphere ( P < 0.001), cylinder ( P = 0.004), and spherical ( P < 0.001) equivalents were found 1 month after surgery. Conclusion. The combined surgery MyoRing implantation and CXL seems to be a safe method in the treatment of keratoconus. We noticed an improvement of the refractive error in all of our patients.

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          Most cited references 24

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          Riboflavin/ultraviolet-a–induced collagen crosslinking for the treatment of keratoconus

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            Stress-strain measurements of human and porcine corneas after riboflavin-ultraviolet-A-induced cross-linking.

            To evaluate the biomechanical effect of combined riboflavin-ultraviolet A (UVA) treatment on porcine and human corneas. Department of Ophthalmology, Technical University of Dresden, Dresden, Germany. Corneal strips from 5 human enucleated eyes and 20 porcine cadaver corneas were treated with the photosensitizer riboflavin and irradiated with 2 double UVA diodes (370 nm, irradiance = 3 mW/cm2) for 30 minutes. After cross-linking, static stress-strain measurements of the treated and untreated corneas were performed using a microcomputer-controlled biomaterial tester with a prestress of 5 x 10(3) Pa. There was a significant increase in corneal rigidity after cross-linking, indicated by a rise in stress in treated porcine corneas (by 71.9%) and human corneas (by 328.9%) and in Young's modulus by the factor 1.8 in porcine corneas and 4.5 in human corneas. The mean central corneal thickness was 850 microm +/- 70 (SD) in porcine corneas and 550 +/- 40 microm in human corneas. Riboflavin-UVA-induced collagen cross-linking led to an increase in mechanical rigidity in porcine corneas and an even greater increase in human corneas. As collagen cross-linking is maximal in the anterior 300 microm of the cornea, the greater stiffening effect in human corneas can be explained by the relatively larger portion of the cornea being cross-linked in the overall thinner human cornea.
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              Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena eye cross study.

              To report the long-term results of 44 keratoconic eyes treated by combined riboflavin ultraviolet A collagen cross-linking in the first Italian open, nonrandomized phase II clinical trial, the Siena Eye Cross Study. Perspective, nonrandomized, open trial. After Siena University Institutional Review Board approval, from September 2004 through September 2008, 363 eyes with progressive keratoconus were treated with riboflavin ultraviolet A collagen cross-linking. Forty-four eyes with a minimum follow-up of 48 months (mean, 52.4 months; range, 48 to 60 months) were evaluated before and after surgery. Examinations comprised uncorrected visual acuity, best spectacle-corrected visual acuity, spherical spectacle-corrected visual acuity, endothelial cells count (I Konan, Non Con Robo; Konan Medical, Inc., Hyogo, Japan), optical (Visante OCT; Zeiss, Jena, Germany) and ultrasound (DGH; Pachette, Exton, Pennsylvania, USA) pachymetry, corneal topography and surface aberrometry (CSO EyeTop, Florence, Italy), tomography (Orbscan IIz; Bausch & Lomb Inc., Rochester, New York, USA), posterior segment optical coherence tomography (Stratus OCT; Zeiss, Jena, Germany), and in vivo confocal microscopy (HRT II; Heidelberg Engineering, Rostock, Germany). Keratoconus stability was detected in 44 eyes after 48 months of minimum follow-up; fellow eyes showed a mean progression of 1.5 diopters in more than 65% after 24 months, then were treated. The mean K value was reduced by a mean of 2 diopters, and coma aberration reduction with corneal symmetry improvement was observed in more than 85%. The mean best spectacle-corrected visual acuity improved by 1.9 Snellen lines, and the uncorrected visual acuity improved by 2.7 Snellen lines. The results of the Siena Eye Cross Study showed a long-term stability of keratoconus after cross-linking without relevant side effects. The uncorrected visual acuity and best spectacle-corrected visual acuity improvements were supported by clinical, topographic, and wavefront modifications induced by the treatment. Copyright 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi Publishing Corporation
                2090-004X
                2090-0058
                2014
                8 September 2014
                : 2014
                Affiliations
                Ophthalmology Department, 3rd Medical Faculty, Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034 Prague, Czech Republic
                Author notes

                Academic Editor: Suphi Taneri

                Article
                10.1155/2014/568128
                4172981
                Copyright © 2014 Pavel Studeny et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Clinical Study

                Ophthalmology & Optometry

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