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      Topographic and Biomechanical Changes after Application of Corneal Cross-Linking in Recurrent Keratoconus


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          Background: Recurrent keratoconus (RKC) develops as a progressive thinning of the peripheral and the inferior cornea after keratoplasty, in both graft and host, causing secondary astigmatism, refractive instability, and reduced visual acuity. We evaluated the effectiveness of corneal cross-linking (CXL) in patients diagnosed with RKC. Methods: Accelerated-CXL via the epi-off technique was performed in15 patients (18 eyes) diagnosed with RKC. Topographic and biomechanical changes were assessed at 12 months. Results: Differences in maximum keratometry, thinnest corneal thickness, and biomechanical parameters (deformation amplituderatio, inverse concave radius, applanation 1 velocity, and applanation 2 velocity, stiffness A1) versus baseline were statistically significant ( p < 0.05).Best corrected visual acuity was improved in 13 eyes and unchanged in 4;manifest refractive spherical equivalent was reduced in 13 eyes, increased in 3,and unchanged in 1 eye; topographic astigmatism was reduced in 9 eyes, remained stable in 1 eye, and increased in 7 eyes. Conclusions: Improved topographic and biomechanic indexes at 1 year after CXL suggest it‘s potential as first-line therapy for RKC, as it is for KC.

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          Influence of Pachymetry and Intraocular Pressure on Dynamic Corneal Response Parameters in Healthy Patients

          To evaluate the influence of pachymetry, age, and intraocular pressure in normal patients and to provide normative values for all dynamic corneal response parameters (DCRs) provided by dynamic Scheimpflug analysis.
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            Current Protocols of Corneal Collagen Cross-Linking: Visual, Refractive, and Tomographic Outcomes.

            To study the effect of different protocols of collagen cross-linking on visual, refractive, and tomographic parameters in patients with progressive keratoconus.
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              Extended long-term outcomes of penetrating keratoplasty for keratoconus.

              To report graft survival results for initial penetrating keratoplasty (PK) performed more than 20 years ago for keratoconus. Secondary outcome measures included recurrent keratoconus, best spectacle-corrected visual acuity (BSCVA), and rates of glaucoma. Retrospective, consecutive, noncomparative case series. All patients with clinical and histopathological keratoconus who underwent initial PK at the University of Iowa Hospitals and Clinics from 1970 to 1983. Patients with pellucid marginal degeneration were excluded. At baseline, age, preoperative BSCVA, keratometric astigmatism, and host/donor graft sizes for each eye were recorded. Visual acuity and intraocular pressure were followed until the eyes reached 1 of 4 end points: graft failure, recurrent keratoconus, loss to follow-up, or death. Kaplan-Meier survival analysis was performed to estimate the long-term probability of graft failure and recurrent keratoconus. Among the 112 eyes of 84 patients who met entry criteria, there was a mean age at transplant of 33.7 years and preoperative BSCVA of 20/193. With a mean follow-up of 13.8 years (range, 0.5-30.4), 7 eyes (6.3%) experienced graft failure. Recurrent keratoconus was confirmed clinically or histologically in 6 eyes (5.4%), with a mean time to recurrence of 17.9 years (range, 11-27). Kaplan-Meier analysis estimated a graft survival rate of 85.4% and a rate of recurrent keratoconus of 11.7% at 25 years after initial transplantation. Six eyes (5.4%) developed open-angle glaucoma, and 2 eyes required trabeculectomy. At the last follow-up visit, 82 eyes (73.2%) had BSCVA of 20/40 or better. Penetrating keratoplasty offers good long-term visual rehabilitation for keratoconus. Relative to other indications for PK, there is a low rate of graft failure. Late recurrence of disease occurs with increasing frequency over time. Given the younger age at which keratoconus patients undergo corneal transplantation, these long-term findings should be incorporated into preoperative counseling.

                Author and article information

                Int J Environ Res Public Health
                Int J Environ Res Public Health
                International Journal of Environmental Research and Public Health
                12 October 2019
                October 2019
                : 16
                : 20
                : 3872
                [1 ]Department of Eye Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; graziacaldarella@ 123456gmail.com (G.C.); adriano.fasolo@ 123456yahoo.it (A.F.); bonaccierika89@ 123456gmail.com (E.B.); giorgio.marchini@ 123456univr.it (G.M.)
                [2 ]Epidemiology Unit, Veneto Region, 35100 Padua, Italy; nicola.gennaro@ 123456azero.veneto.it
                [3 ]Ophthalmic Unit, San Bassiano Hospital, 36061 Bassano del Grappa, Italy; adegre3@ 123456gmail.com
                Author notes
                [* ]Correspondence: emilio.pedrotti@ 123456univr.it ; Tel.: +00390458126115
                Author information
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                : 11 July 2019
                : 08 October 2019

                Public health
                recurrent keratoconus,corneal cross-linking,corneal ectasia,corvis
                Public health
                recurrent keratoconus, corneal cross-linking, corneal ectasia, corvis


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