EVALUATION OF THE CORNEAL STROMAL DEMARCATION LINE AFTER THE ACCELERATED CORNEAL CROSS-LINKING USING ANTERIOR SEGMENT OCT
Authors:
K. Benca Kapitánová 1,2; M. Javorka 3
Authors‘ workplace:
UVEA Klinika s. r. o., Martin
1; Očná klinika, Jesseniova lekárska fakulta a Univerzitná nemocnica Martin
2; Ústav fyziológie, Jesseniova lekárska fakulta, Martin
3
Published in:
Čes. a slov. Oftal., 78, 2022, No. 3, p. 122-127
Category:
Original Article
doi:
https://doi.org/10.31348/2022/14
Overview
Objectives: Evaluation of the visibility and depth of the demarcation line in the corneal stroma in eyes with keratoconus 1 month and 3 months after epi-off accelerated corneal cross-linking (ACXL) using anterior segment optical coherence tomography (AS OCT).
Material and Methods: This study analyses a group of 34 eyes with keratoconus 1 month and 3 months after ACXL (9 mW/cm2 for 10 min). The group was classified based on the ABCD clinical classification of keratoconus according to Belin and Duncan. AS OCT (ZeissCirrus 500, Anterior Segment Premier module) was used to assess the visibility and exact depth of the demarcation line in the corneal stroma.
Results: The demarcation line was visible 1 month after ACXL in 76.5% of eyes with a mean depth of 238.13 ±20.36 μm and 3 months after ACXL in 100% of eyes with a mean depth of 263.43 ±12.59 μm. Statistical analysis of the group did not show a significant relationship between the disease stage and the demarcation line visibility; however, there was a trend towards higher age (>30 years) in the group in those eyes where the demarcation line was visible vs. partially visible 3 months after ACXL. We found no difference in the mean and maximum line depth when comparing 1 month and 3 months after the procedure. There were no cases of disease progression 3 months after ACXL in the group.
Conclusion: Our study suggests that the assessment of the demarcation line in the corneal stroma is more reliable 3 months compared to 1 month after ACXL. We also observed a trend towards higher patient age in eyes where the demarcation line was clearly visible 3 months after ACXL. We did not confirm a relationship between the stage of keratoconus and the depth of the line, nor a difference in its mean and maximum depth 1 month and 3 months after the procedure.
Keywords:
demarcation line – keratoconus – anterior segment optical coherence tomography – accelerated corneal cross-linking
Sources
1. Lhuillier L, Ghetemme C, Boiché M et al. Visibility and depth of the stromal demarcation line after corneal collagen cross-linking using anterior segment optical coherence tomography: comparison between isoosmolar and hypoosmolar riboflavin. Cornea. 2018;0:1-7.
2. Rabinowitz YS. Keratoconus. Surv Ophthalmol. 1998;42:297-319.
3. Hall KGC. A comprehensive study of keratoconus. Br J Physiol Opt.1963;20:215-256.
4. Rabinowitz YS, Rasheed K, Yang H, Elashoff J. Accuracy of ultrasonic pachymetry and videokeratography in detecting keratoconus. J Cataract Refract Surg. 1998;24:196-201.
5. Mannins JM, Holland EJ. Cornea, 5th Edition. Edinburg: Elsevier. 2021. ISBN 978-0323672405.
6. Wollensak G, Spoerl E, Seiler T. Riboflavin/ ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135:620-627.
7. Kanellopoulos AJ. Long term results of a prospective randomized bilateral eye comparison trial of higher fluence, shorter duration ultraviolet A radiation, and riboflavin collagen crosslinking for progressive keratoconus. Clin Ophthalmol. 2012;6:97-101.
8. Jain V, Gazali Z, Biday R. Isotonic riboflavin and HPMC with accelerated cross-linking protocol. Cornea. 2014;33(9):910-913.
9. Hayes S, Sachdev DP, Lamdin LS. An investigation into the importance of complete epithelial debridement prior to Riboflavin/Ultraviolet A (UVA) corneal collagen cross- linkage therapy. J Cataract Ref Surg.2008;34:657-661.
10. Samaras K, Obrart DPS, Doutch J, Hayes S, Marshall J, Meek KM. Effect of epithelialretention and removal on riboflavinabsorption in porcinecorneas. J Refract Surg. 2009;25(9):771-775.
11. Salman AG. Transepithelial corneal collagen crosslinking for progressive keratoconus in a pediatric age group. J Cataract Refract Surg. 2013;39(8):1164-1170.
12. Caporossi A, Mazzotta C, Paradiso AL, Baiocchi S, Marigliani D, Caporossi T. Transepithelial corneal crosslinking for progressive keratoconus: 24-month clinical result. J Cataract Refract Surg. 2013;39(8):1157-1163.
13. Seiler T, Hafezi F. Corneal cross-linking-induced stromal demarcation line. Cornea. 2006;25(9):1057-1059.
14. Kymionis GD, Tsoulnaras KI, Liakopoulos DA, Skatharoudi CA, Grentzelos MA. Corneal stromal DL depth following standard and a modified high intensity CXL protocol. J Refract Surg. 2016;32(4):218-222.
15. Gokul A, Vellara HR, Patel DV. Advanced anterior segment imaging in keratoconus: a review: Imaging the keratoconic cornea. Clin Exp Ophthalmol. 2018;46:122-132.
16. Sachdev GS, Sachdev M. Recent advances in corneal collagen cross-linking. Indian J Ophthalmol. 2017;65:787-796.
17. O’Brart DPS. Corneal Collagen Crosslinking for Corneal Ectasias: A Review. Eur J Ophthalmol. 2017;27:253-269.
18. Studeny P. a kol. Keratokonus. Praha: Maxdorf. 2020. ISBN ISBN 978-80-7345-665-8.
19. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-A induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135:620-627.
20. Smoradkova A. Liečba keratokonusu. 26. výročný kongres Slovenskej oftalmologickej spoločnosti. 2021, Bratislava: Slovenská oftalmologická spoločnosť, 76-76. ISBN 978-80-973008-7-6.
21. Studeny P, Krizova D, Stranak Z. Clinical outcomes after complete intracorneal ring implantation and corneal collagen cross-linking in an intrastromal pocket in one session for keratoconus. J Ophthalmol. 2014;2014:568128.
22. Caporossi A, Baiocchi S, Mazzotta C. Parasurgical therapy for keratoconus by riboflavin-ultraviolet type A rays induced cross-linking of corneal collagen: preliminary refractive results in an Italian study. J Cataract Refract Surg. 2006;32(5):837-845.
23. Kymionis GD, Tsoulnaras KI, Grentzelos MA. Corneal stromal demarcation line after standard and high intensity collagen cross linking determined with anterior segment optical coherence tomography. J Cataract Refract Surg. 2014;40(5):736-740.
24. Spadea L, Genova LD, Tonti E.Corneal stromal demarcation line after 4 protocols of corneal crosslinking in keratoconus determined with anterior segment optical coherence tomography. J Cataract Refract Surg. 2018;44(5):596-602.
25. Seiler T, Hafezi F. Corneal cross-linking-induced stromal demarcation line. Cornea. 2006; 25:1057-1059.
26. Mazzotta C, Wollensak G, Raiskup F, Pandolfu AM, Spoerl E. Meaning of the demarcation line after riboflavin-UVA corneal collagen crosslinking, Expert Rev Ophthalmol. 2019;14(2):115-131.
27. Jiang LZ, Jiang W, Qiu SY. Conventional vs. Pulsed light accelerated corneal collagen cross-linking for the treatment of progressive keratoconus: 12-month results from a prospective study. Exp Ther Med. 2017;14(5):4238-4244.
28. Vesely P, Vesely L, Combova V, Zukovic M. Specific corneal parameters and visual acuity changes after corneal crosslinking treatment for progressive keratoconus. Cesk Slov Oftalmol. 2021;77(4):184-189.
Labels
OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2022 Issue 3
Most read in this issue
- INTRAVENOUS THROMBOLYTIC THERAPY FOR ACUTE NONARTERITIC CENTRAL RETINAL ARTERY OCCLUSION. A REVIEW
- EVALUATION OF THE CORNEAL STROMAL DEMARCATION LINE AFTER THE ACCELERATED CORNEAL CROSS-LINKING USING ANTERIOR SEGMENT OCT
- TOPIRAMATE-INDUCED BILATERAL ANGLE-CLOSURE GLAUCOMA. A CASE REPORT
- ACUTE RETINAL NECROSIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT. A CASE REPORT