Corneal Cross-linking – Modern Method of Keratoconus Treatment
Authors:
E. Strmeňová 1,2; E. Vlková 1; Z. Hlinomazová 1; L. Pirnerová 1; D. Dvořáková 1; M. Goutaib 1; J. Němec 1; V. Loukotová 1; M. Horáčková 1; A. Gerinec 2
Authors‘ workplace:
Oční klinika LFMU a FN, Brno, prednostka prof. Eva Vlková, CSc.
1; Klinika detskej oftalmológie DFNsP, Bratislava, prednosta prof. MUDr. Anton Gerinec, CSc.
2
Published in:
Čes. a slov. Oftal., 66, 2010, No. 6, p. 248-253
Category:
Original Article
Overview
Purpose:
The aim of research study was to evaluate the effect of corneal cross-linking (CXL) in the frame of patients with progressive keratoconus 1 year after treatment.
Methods:
There were 40 eyes of 35 patients with mean age 28, 45 ± 9.3 (SD) (15 to 48 years) included in the study. Patients were treated with standard protocol of CXL with abrasion of corneal epithelium. Complete ophthalmological examination included best corrected spectacles visual acuity (BCSVA), slit-lamp microscopic finding, corneal topography and corneal thickness measured with ultrasound method was performed before, on the 5-th day, 1. 6., 12. month after CXL. We divided patients according to the stage of keratoconus into 2 groups (stage I. and stage II.) and according to the age into 3 groups (until 20, from 21 to 39, over 40 years).
Results:
In all treated eyes, the CXL was without relevant complications. The only complication was stromal haze of cornea.
In the evaluation based on stage of keratoconus, in the first group any patient became a haze of cornea in 1 year after CXL. In the second group 35.7 % of patients had a haze of cornea. The average BCSVA 1 year after treatment was improved in the 1. group about 5.38 letter and in the 2. group about 1.25 letter. Topographic analysis showed decrease of simulated keratometry and refraction (1. group – 0.1 D, 2. group – 0.17 D), maximal keratometry and refraction (1. group – 0.67 D, 2. group – 0.76 D). Minimal keratometry and refraction in the 1. group decreased (1.17 D) and increased in the 2. group (1.09 D).
In the evaluation based on the age was haze monitored in the first group one year after CXL in 12.5% of researched eyes. In the second group was haze of cornea in 20 % of eyes and in the third group consisting of patients over 40 years old, in 50 % of eyes. The average BCSVA was improved in the 1. group (2.85 letter), and in the 2. group (3.68 letter). The average BCSVA was decreased in the oldest patients in about 1.43 letter. In the 1. and 2. group the topographic analysis showed decrease of simulated keratometry and refraction (1. group – 0.12D, 2. group – 0.21D), maximal keratometry and refraction (1. group – 1.13 D, 2. group - 0,68D), minimal keratometry and refraction (1. group – 1.17D, 2. group - 0,69 D). In the 3. group the topography analysis showed increase of simulated keratometry and refraction (0,8D), maximal keratometry and refraction (0,98D), minimal keratometry and refraction (0,28D).
Corneal pachymetry remained stable in all researched groups of patients.
Conclusions:
CXL is considered as safe procedure to stop progression of keratoconus also for patients until 19 years old. The best effect and minimal complications were by patients until 40 years old and by patients with the I. grade.
Key words:
corneal cross-linking, keratoconus, Riboflavin
Sources
1. Krachmer, JH, Feder, RS, Belin MW, et al.: Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol, 1984, 28: 293–322.
2. Rabinowitz, YS.: Keratoconus. Surv Ophthalmol., 1998, 42: 297–319.
3. McMahon, TT, Edrington, TB et al. and the CLEK Study Group, Longitudinal Changes in Corneal Curvature in Keratoconus. Cornea, 2006, 25: 296–305.
4. Zadnik, K, Steger-May, K, Fink, BA et al.: Between-Eye Asymmetry in Keratoconus. Cornea, 2002, 21: 671–679.
5. Kaya, V, Utine, CA, Altunsoy, M et al.: Evaluation of Corneal Topography With Orbscan II in First-degree Relatives of Patients with Keratoconus. Cornea, 2008, 27: 531–534.
6. Steele, TM, Fabinyi, DC, Couper, TA, Loughnan, MS: Prevalence of Orbscan II corneal abnormalities in relatives of patients with keratoconus. Clinical and Experimental Ophthalmology 2008, 36: 824–830.
7. Karimian, F, Aramesh, S, Rabei, HM, Javadi, MA, Rafati, N: Topographic Evaluation of Relatives of Patients with Keratoconus. Cornea, 2008, 27: 874–878.
8. Roe, RH, Lass, JH, Brown, GC et al.: The Value-Based Medicine Comparative Effectiveness and Cost-Effectiveness of Penetrating, Keratoplasty for Keratoconus. Cornea, 2008, 9: 1001–1007.
9. Sutton, G, Hodge, C, McGhee, CNJ: Rapid visual recovery after penetrating keratoplasty for keratoconus. Clin Exper Ophthalmol, 2008; 36: 725–730.
10. Bawazeer, AM, Hodge, GH, Lorimer, B: Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol, 2000, 84: 834–836.
11. Boxer Wachler BS, Christie JP, Chandra NS, et al.: Intacs for keratoconus. Ophthalmology, 2003, 110: 1031–1040.
12. Wollensak, G: Crosslinking treatment of progressive keratoconus: new hope, Curr Opin Ophthalmol, 2006, 17: 356–60.
13. Spoerl, E, Huhle, M, Seiler, T: Induction of cross-linking in corneal tissue, Exp Eye Res, 1998), 66: 97–103.
14. Kuchyňka, P et al.: Oční lékařství. 1. vyd., Grada, Praha 2007, 768, 224–226.
15. Vlková, E, Hlinomazová, Z: Riziková keratoplastika. Acta facultatis medicinae Universitatis Brunenis Masarykianae 118. 1. vyd., MU Brno 1999, Brno, 76.
16. Abad, JC, Panesso, JL: Cornel collagen cross-linking induced by UVA and riboflavin (CXL), Techniques in Ophthalmol, 2008, 6: 8–12.
17. Wollensak, G, Redl, B: Gel Electrophoretic Analysis of Corneal Collagen After Photodynamic Cross-linking Treatment. Cornea, 2008, 27: 353–356.
18. Wollensak, G, Spoerl, E, Seiler, T: Stress–strain measurements of human and porcine corneas after riboflavin @ ultraviolet- A-induced cross-linking. J Cataract Refract Surg, 29: 1780–1785.
19. Caporossi, A, Baiocchi, S, Mazzotta, C, Caporossi, T: Mid term results in keratoconus treatment by Riboflavin – UVA corneal collagen Cross-Linking. ActaOphtalmol Scand, 2007, 85, (DOI: 10.1111/j.1600-0420.2007.01063_3074.x).
20. Raiskup-Wolf, F, Hoyer, A, Spoerl, E et al.: Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: Long-term results, J CATARACT REFRACT SURG, 2008, 34: 796–801.
21. Spoerl, E, Mrochen, M, Sliney, D et al.: Safety of UVA-Riboflavin Cross-Linking of the Cornea. Cornea, 2007, 26: 385–389.
22. El-Raggal, TM: Riboflavin-Ultraviolet A Corneal Cross-linking for Keratoconus. Middle East Afr J Ophthalmol, 2009, 16: 256–259.
23. George, D. , GD, Portaliou, DM, Bouzoukis, DI et al.: Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus. J Cataract Refract Surg, 2007, 33, 11: 1982–1984.
24. Sharma, N, Maharana P, Singh G, et al.: Pseudomonas keratitis after collagen crosslinking for keratoconus: Case report and review of literature. J Cataract Refract Surg, 36, 3: 517–520.
25. Zamora, KV, Males, JJ: Polymicrobial Keratitis After a Collagen Cross-Linking Procedure With Postoperative Use of a Contact Lens: A Case Report. Cornea 2009, 28: 474–476.
26. Koppen, C, Vryghem, JC, Gobin, L, Tassignon, MJ: Keratitis and corneal scarring after UVA/riboflavin cross-linking for keratoconus. J Refract Surg, 2009, 25: 819–23
27. Raiskup, F, Hoyer, A, Spoerl, E: Permanent Corneal Haze after Ribofl avin- UVA-induced Cross-linking in Keratoconus. J Refract Surg, 2009, 25: 824–828.
28. Koller, T, Mrochen, M, Seiler, T: Complication and failure rates after corneal crosslinking. J Cataract Refractive Surg, 35, 8: 1358–1362.
29. Erlich, CM, Rootman, DS, Morin, JD: Corneal transplantation in infants, children and young adults: experience of the Toronto Hospital for Sick Children 1979–88. Can J Ophthalmol, 1991, 26: 206–10.
30. Rosetta, P, Vinciguerra, P, Albe, E: Riboflavin/Ultraviolet a corneal collagen Cross-Linking: one-year results. Acta Ophthalmol Scand, 2007, 85: 240.
31. Elsheikh, A, Wang, D, Brown, M et al.: Assessement of corneal biomechanical properties and their variation with age. Curr Eye Res, 2007, 32, 1: 11–19.
32. Malik, NS, Moss, SJ, Ahmed, N et al.: Ageining of the human cornea: structural and biochemical changes. Biochemica et biophysica Acta (BBA) – Molecular basis of disease, 1992, 1138, 3: 222–228.
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OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2010 Issue 6
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