Corneal endothelial changes after accelerated corneal collagen cross-linking in keratoconus and postLASIK ectasia

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Abstract

Purpose

The purpose of this study was to evaluate the effects of accelerated cross-linking (CXL) on corneal endothelium in keratoconus and postlaser-assisted in situ keratomileusis (LASIK) ectasia.

Design

This study is a prospective nonrandomized controlled study.

Setting

This study was conducted in Mansoura Ophthalmic Center (Mansoura University) and Al-Mostakbal Ophthalmic Center, Mansoura, Egypt.

Methods

In total, 40 eyes with progressive keratoconus and 10 eyes with postLASIK ectasia were subjected to an accelerated CXL (10 mW/cm ² for 9 minutes). Qualitative and quantitative analyses of the corneal endothelial cells were conducted before CXL and 3, 6, and 12 months after CXL by using a specular microscope (Tomy EM-3000).

Results

There was a significant reduction in endothelial cell count particularly at 3 and 6 months postCXL. In addition, the coefficient of variance was also statistically significantly higher at 3 and 6 months postoperatively than the preCXL value. There was a slight change in the percentage of hexagonal cells.

Conclusion

The use of accelerated CXL (10 mW/cm ² for 9 minutes) has a transient negative impact on endothelial cell density and/or endothelial morphology.

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Most cited references 27

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Risk factors and prognosis for corneal ectasia after LASIK.

J Bradley Randleman, R Doyle Stulting, Stephen A. Ward … (2003)

To review cases of corneal ectasia after laser in situ keratomileusis (LASIK), identify preoperative risk factors, and evaluate methods and success rates of visual rehabilitation for these cases. Retrospective nonrandomized comparative trial. Ten eyes from seven patients identified as developing corneal ectasia after LASIK, 33 previously reported ectasia cases, and two control groups with uneventful LASIK and normal postoperative courses: 100 consecutive cases (first control group), and 100 consecutive cases with high myopia (> 8 diopters [D]) preoperatively (second control group). Retrospective review of preoperative and postoperative data for each case compared with that of previously reported cases and cases with uneventful postoperative courses. Preoperative refraction, topographic features, residual stromal bed thickness (RSB), time to the development of ectasia, number of enhancements, final best-corrected visual acuity (BCVA), and method of final correction. Length of follow-up averaged 23.4 months (range, 6-48 months) after LASIK. Mean time to the development of ectasia averaged 16.3 months (range, 1-45 months). Preoperative refraction averaged -8.69 D compared with -5.37 D for the first control group (P = 0.005). Preoperatively, 88% of ectasia cases met criteria for forme fruste keratoconus, compared with 2% of the first control group (P < 0.0000001) and 4% of the second control group (P = 0.0000001). Seven eyes (70%) had RSB <250 microm, as did 16% of eyes in the first control group and 46% of the second control group. The mean RSB for ectasia cases (222.8 microm) was significantly less than that for the first control group (293.6 micro m, P = 0.0004) and the second control group (256.5 microm; P = 0.04). Seven eyes (70%) had enhancements. Only 10% of eyes lost more than one line of BCVA, and all patients eventually achieved corrected vision of 20/30 or better. One case required penetrating keratoplasty (10%), while all others required rigid gas-permeable contact lenses for correction. Significant risk factors for the development of ectasia after LASIK include high myopia, forme fruste keratoconus, and low RSB. All patients had at least one risk factor other than high myopia, and significant differences remained even when controlling for myopia. Multiple enhancements were common among affected cases, but their causative role remains unknown. We did not identify any patients who developed ectasia without recognizable preoperative risk factors.

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Review of corneal endothelial specular microscopy for FDA clinical trials of refractive procedures, surgical devices, and new intraocular drugs and solutions.

Bernard McCarey, Henry F. Edelhauser, Michael Lynn (2008)

Specular microscopy can provide a noninvasive morphologic analysis of the corneal endothelial cell layer from subjects enrolled in clinical trials. The analysis provides a measure of the endothelial cell physiologic reserve from aging, ocular surgical procedures, pharmaceutical exposure, and general health of the corneal endothelium. The purpose of this review is to discuss normal and stressed endothelial cell morphology, the techniques for determining the morphology parameters, and clinical trial applications.

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Corneal thickness changes after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results.

S Hersh, Norman Fry, Sohrab Shah … (2011)

To determine the changes in corneal thickness over time after corneal collagen crosslinking (CXL) for keratoconus and corneal ectasia. Cornea and refractive surgery subspecialty practice. Prospective randomized controlled clinical trial. Corneal thickness at the apex, thinnest point, and pupil center were measured using Scheimpflug imaging (Pentacam) at baseline and 1, 3, 6, and 12 months after CXL. The treatment group was compared with both a sham-procedure control group and a fellow-eye control group. Associations with clinical outcomes (uncorrected and corrected distance visual acuities and maximum keratometry) were analyzed. The study comprised 82 eyes, 54 with keratoconus and 28 with ectasia after laser in situ keratomileusis. The mean preoperative thinnest pachymetry was 440.7 μm ± 52.9 (SD). After CXL, the cornea thinned at 1 month (mean change -23.8 ± 28.7 μm; P<.001) and from 1 to 3 months (mean change -7.2 ± 20.1 μm, P=.002), followed by a recovery of the corneal thickness between 3 months and 6 months (mean +20.5 ± 20.4 μm; P<.001). At 1 year, apex and pupil-center thicknesses returned to baseline (P=.11 and P=.06, respectively); however, the thinnest pachymetry remained slightly decreased from baseline to 12 months (mean change -6.6 ± 22.4 μm; P=.01). The recovery of corneal thickness was more rapid in ectasia than in keratoconus. There was no association between the degree of corneal thinning at 3 months and clinical outcomes after CXL. After CXL, the cornea thins and then recovers toward baseline thickness. The cause and implications of corneal thickness changes after CXL remain to be elucidated. No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Ophthalmol

Journal ID (iso-abbrev): Clin Ophthalmol

Journal ID (publisher-id): Clinical Ophthalmology

Title: Clinical Ophthalmology (Auckland, N.Z.)

Publisher: Dove Medical Press

ISSN (Print): 1177-5467

ISSN (Electronic): 1177-5483

Publication date Collection: 2016

Publication date (Electronic): 30 September 2016

Volume: 10

Pages: 1891-1898

Affiliations

Department of Ophthalmology, Mansoura University, Mansoura, Egypt

Author notes

Correspondence: Amani E Badawi, Department of Ophthalmology, Mansoura Ophthalmic Center, Mansoura University, 60 El Gomhoureya St., El mansoura, El dakahleya, Mansoura, Egypt, Tel +20 100 381 8271, Email amanibadawi37@ 123456yahoo.com

Article

Publisher ID: opth-10-1891

DOI: 10.2147/OPTH.S113412

PMC ID: 5053387

PubMed ID: 27757009

SO-VID: eeaeaf74-cbfe-442b-a76e-e901bfe45bbd

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Corneal endothelial changes after accelerated corneal collagen cross-linking in keratoconus and postLASIK ectasia

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Abstract

Purpose

Design

Setting

Methods

Results

Conclusion

Related collections

Karger: Ophthalmology

Most cited references 27

Risk factors and prognosis for corneal ectasia after LASIK.

Review of corneal endothelial specular microscopy for FDA clinical trials of refractive procedures, surgical devices, and new intraocular drugs and solutions.

Corneal thickness changes after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results.

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