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Accelerated CXL

Efstathios Vounotrypidis, Alexis Athanasiou, Karsten Kortüm, Daniel Kook, Mehdi Shajari, Siegfried Priglinger, Wolfgang J Mayer
PURPOSE: To investigate the long-term efficacy of accelerated corneal collagen cross-linking (CXL) in a large mid-European cohort with progressive keratoconus. METHODS: Four hundred thirteen eyes of 316 patients with progressive keratoconus were enrolled and treated with conventional (group A) or accelerated (group B) CXL. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), slit lamp, and Pentacam® examinations were performed before and 12, 24, and 36 months after surgery...
March 10, 2018: Graefe's Archive for Clinical and Experimental Ophthalmology
Mi Tian, Weijun Jian, Ling Sun, Yang Shen, Xiaoyu Zhang, Xingtao Zhou
BACKGROUND: Keratoconus typically presents in the teenage years and is more advanced in younger patients when compared with adults. In the present study, we aimed to assess the safety and efficacy of accelerated transepithelial corneal collagen cross-linking (ATE-CXL) in children with progressive keratoconus. METHODS: In this retrospective consecutive study, 18 eyes were enrolled from 17 pediatric patients (15 boys and 2 girls) with a mean age of 14.44 ± 1...
March 9, 2018: BMC Ophthalmology
Niklas Pircher, Jan Lammer, Stephan Holzer, Andreas Gschließer, Ruth Donner, Stefan Pieh, Gerald Schmidinger
PURPOSE: A stromal demarcation line (DL) after corneal cross-linking (CXL) has lately been suggested as a surrogate parameter for the success of CXL. The aim of this study was to investigate the correlation between depth of the central DL 1 month and the change in K values 12 months after CXL. METHODS: Treatment-naive subjects with keratoconus were treated using an accelerated CXL protocol [A-CXL(9*10)]. Depth of the DL/relative depth of the DL (DL%) was measured using Visante OCT imaging 1 month postoperatively (OP)...
February 23, 2018: Graefe's Archive for Clinical and Experimental Ophthalmology
Alireza Hedayatfar, Hassan Hashemi, Gholamhossein Aghaei, Nahid Ashraf, Soheila Asgari
PURPOSE: To compare the subclinical inflammatory response (as measured by anterior chamber flare) induced after standard (3 mW/cm2, 30 min) and accelerated (18 mW/cm2, 5 min) corneal cross-linking (CXL). METHODS: In this comparative, non-randomized study, patients with progressive keratoconus who underwent standard or accelerated CXL were studied. Laser flare photometery (FM-600; Kowa, Tokyo, Japan) was used to measure anterior chamber flare preoperatively and at 1 week, 1 month, 3 months, and 6 months after the procedure...
January 15, 2018: Ocular Immunology and Inflammation
Louis Lhuillier, Cedric Ghetemme, Mathilde Boiché, Rekia Yahia, Naila Houmad, Mohamed Zaidi, Christophe Goetz, Jean Marc Perone
PURPOSE: To evaluate and compare visibility and depth of the stromal demarcation line (DL) created after corneal collagen cross-linking (CXL) using anterior segment optical coherence tomography (AS-OCT) between 2 groups: CXL with isoosmolar and hypoosmolar riboflavin. METHODS: In this retrospective study performed at Metz-Thionville Regional Hospital, consecutive patients with progressive keratoconus underwent CXL using an accelerated protocol (10 min, 9 mW/cm ultraviolet-A)...
January 3, 2018: Cornea
Boris Knyazer, Yonit Krakauer, Yael Baumfeld, Tova Lifshitz, Sabine Kling, Farhad Hafezi
PURPOSE: To evaluate the effect of accelerated corneal cross-linking with photoactivated chromophore (PACK-CXL) as additional treatment for therapy-resistant infectious keratitis. METHODS: In this interventional cohort study, 20 patients (11 men and 9 women), aged 65.5 (interquartile range = 21.5-78.5) years, who were hospitalized for moderate-sized therapy-resistant bacterial corneal ulcers (11/20 microbiologically confirmed) were treated with hypoosmolar 0.1% riboflavin solution and Ultraviolet A (UVA) irradiation for 3 minutes at 30 mW/cm (5...
January 3, 2018: Cornea
Hun Lee, David Sung Yong Kang, Byoung Jin Ha, Jin Young Choi, Eung Kweon Kim, Kyoung Yul Seo, Tae-Im Kim
BACKGROUND: To investigate the effects of combined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK) and accelerated corneal collagen cross-linking (CXL) after intracorneal ring segment (ICRS) implantation in patients with moderate keratoconus. METHODS: Medical records of 23 eyes of 23 patients undergoing combined tPRK and CXL after ICRS implantation were retrospectively analyzed. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal indices based on Scheimpflug tomography, higher-order aberrations (HOAs), and corneal biomechanical properties were evaluated before and after ICRS implantation, and at 1, 3, and 6 months after combined tPRK and CXL...
December 29, 2017: BMC Ophthalmology
Hassan Hashemi, Mohammad Miraftab, Soheila Asgari
PURPOSE: The purpose of the study was to determine 2-year changes in mesopic higher-order aberrations (HOAs) and contrast sensitivity (CS) after accelerated corneal cross-linking (CXL) in keratoconus patients. MATERIALS AND METHODS: In this before-after interventional case series, patients with progressive keratoconus were subjected to accelerated CXL (18 mW/cm2, 5 min). Patients were examined with the OPD-Scan III and CVS-1000 grating charts under mesopic conditions at baseline and at 12 and 24 months after CXL...
July 2017: Middle East African Journal of Ophthalmology
Sabine Kling, Arthur Hammer, Emilio A Torres Netto, Farhad Hafezi
Purpose: We studied changes in gene transcription after corneal crosslinking (CXL) in the rabbit cornea in vivo and identified potential molecular signaling pathways. Methods: A total of 15 corneas of eight male New-Zealand-White rabbits were de-epithelialized and equally divided into five groups. Group 1 served as an untreated control. Groups 2 to 5 were soaked with 0.1% riboflavin for 20 minutes, which in Groups 3 to 5 was followed by UV-A irradiation at a fluence of 5...
December 2017: Translational Vision Science & Technology
Joshua N Webb, Johnny P Su, Giuliano Scarcelli
PURPOSE: To quantify corneal mechanical changes induced by corneal crosslinking (CXL) procedures of different ultraviolet-A (UVA) intensity and exposure time using Brillouin microscopy. SETTINGS: University of Maryland, College Park, Maryland, USA. DESIGN: Experimental study. METHODS: Porcine cornea samples were debrided of epithelia and soaked with riboflavin 0.1% solution. Samples were exposed to a standard 5.4 J/cm2 of UVA radiation with varying intensity and exposure time as follows: 3 mW/cm2 for 30...
November 2017: Journal of Cataract and Refractive Surgery
J J Males, D Viswanathan
PurposeTo compare the long-term outcomes of accelerated corneal collagen crosslinking (CXL) to conventional CXL for progressive keratoconus.Patients and methodsComparative clinical study of consecutive progressive keratoconic eyes that underwent either accelerated CXL (9 mW/cm2 ultraviolet A (UVA) light irradiance for 10 min) or conventional CXL (3 mW/cm2 UVA light irradiance for 30 min). Eyes with minimum 12 months' follow-up were included. Post-procedure changes in keratometry readings (Flat meridian: K1; steep meridian: K2), central corneal thickness (CCT), best spectacle-corrected visual acuity (BSCVA), and manifest refraction spherical equivalent (MRSE) were analysed...
January 2018: Eye
Rohit Shetty, Nimisha Rajiv Kumar, Natasha Pahuja, Rashmi Deshmukh, KrishnaPoojita Vunnava, Valsala Gopalakrishnan Abilash, Abhijit Sinha Roy, Arkasubhra Ghosh
PURPOSE: To evaluate the correlation of visual and keratometry outcomes after corneal cross-linking (CXL) in patients with keratoconus with cone epithelium-specific gene expression levels. METHODS: Corneal epithelium was obtained from 35 eyes that underwent accelerated CXL (KXLII, 9 mW/cm for 10 min). Using corneal topography, epithelium over the cone and periphery was obtained separately from each subject. The ratio of gene expression for lysyl oxidase (LOX), matrix metalloproteinase 9 (MMP9), bone morphogenic protein 7, tissue inhibitor of metalloproteinase 1, collagen, type I, alpha 1, and collagen, type IV, alpha 1 (COL IVA1) from the cone and peripheral cornea was correlated with the outcome of cross-linking surgery...
March 2018: Cornea
Steve R Roof, Yukie Ueyama, Reza Mazhari, Robert L Hamlin, J Craig Hartman, Mark T Ziolo, John E Reardon, Carlos L Del Rio
The nitroxyl (HNO) prodrug, CXL-1020, induces vasorelaxation and improves cardiac function in canine models and patients with systolic heart failure (HF). HNO's unique mechanism of action may be applicable to a broader subset of cardiac patients. This study investigated the load-independent safety and efficacy of CXL-1020 in two rodent (rat) models of diastolic heart failure and explored potential drug interactions with common HF background therapies. In vivo left-ventricular hemodynamics/pressure-volume relationships assessed before/during a 30 min IV infusion of CXL-1020 demonstrated acute load-independent positive inotropic, lusitropic, and vasodilatory effects in normal rats...
2017: Frontiers in Physiology
David P Piñero, Vicente J Camps, Esteban Caravaca-Arens, Dolores de Fez, Francisco J Blanes-Mompó
Purpose: To analyze the errors associated to corneal power calculation using the keratometric approach in keratoconus eyes after accelerated corneal collagen crosslinking (CXL) surgery and to obtain a model for the estimation of an adjusted corneal refractive index ( n k adj ) minimizing such errors. Methods: Potential differences (Δ P c ) among keratometric ( P k ) and Gaussian corneal power ( P c Gauss ) were simulated. Three algorithms based on the use of n k adj for the estimation of an adjusted keratometric corneal power ( P k adj ) were developed...
2017: Journal of Ophthalmology
Karsten U Kortuem, Efstathios Vounotrypidis, Alexandros Athanasiou, Michael Müller, Alexander Babenko, Christoph Kern, Siegfried Priglinger, Wolfgang J Mayer
BACKGROUND: The purpose of this study was to identify differences in clinical corneal findings after standard and accelerated epithelial off cross-linking (CXL) during a long-term follow-up. METHODS: Two hundred forty-one patients (184 male) were included in this monocentric, retrospective, non-randomized and unmasked study. One hundred forty-eight eyes were treated with the accelerated protocol and 138 with the standard protocol with epithelial off CXL, if diagnosed with keratoconus and a progression in Kmax of more than one dioptre during the preceding 6 months, plus a minimal pachymetry measurement of 400 μm in keratometry (Pentacam, Oculus GmbH, Wetzlar, Germany)...
November 28, 2017: BMC Ophthalmology
R Ghaffari, M Mortazavi, P Anvari, A Salamat Rad, F Alipour, F Hafezi, S Asgari, H Hashemi
PurposeTo investigate intraoperative anterior segment optical coherence tomography (AS-OCT) to compare pachymetry changes between two methods (group 1: speculum-on, group 2: speculum-off during riboflavin instillation stage) during corneal cross-linking /CXL) (9 mW/cm2 for 10 min) in keratoconic patients.MethodsIn this interventional case series, 11 eyes (11 patients) in group 1 and 14 eyes (14 patients) in group 2 were enrolled. Pachymetry measurements by spectral domain OCT was performed at baseline, after epithelial removal, after 30 min of imbibition with riboflavin, and after UV irradiation...
November 24, 2017: Eye
Mortada A Abozaid
Purpose: The purpose of this study was to assess the safety and efficacy of femtosecond laser-assisted Keraring implantation followed by transepithelial accelerated corneal collagen cross-linking (CXL) for the treatment of keratoconus in children with vernal keratoconjunctivitis (VKC). Study design: This is a prospective interventional non-comparative case series. Patients and methods: Eighteen eyes of 11 children with keratoconus and VKC were included in this study...
2017: Clinical Ophthalmology
Yu Meng Wang, Tommy Cy Chan, Marco C Y Yu, Vishal Jhanji
PURPOSE: To compare the rate of disease progression in keratoconus before and after corneal collagen crosslinking (CXL). METHODS: 145 eyes were followed without CXL (no-CXL group) for a median duration of 31 months whereas 45 eyes were followed up for 41 months before (pre-CXL) and after (post-CXL) accelerated, epithelium-off crosslinking. Progression was defined based on significant slope found in linear mixed effect models against time. Swept-source optical coherence tomography was used for measurement of anterior steep keratometry, anterior flat keratometry (Ant Kf), anterior average keratometry (Ant Avg K); posterior steep keratometry, posteriorflat keratometry (Post Kf), posterior average keratometry (Post Avg K) and corneal thickness...
November 9, 2017: British Journal of Ophthalmology
Jyh Haur Woo, Jayant Venkatramani Iyer, Li Lim, M Htoon Hla, Jodhbir S Mehta, Cordelia Ml Chan, Donald Th Tan
OBJECTIVE: The aim was to compare the visual, refractive, topographic and biomechanical outcomes in patients with progressive keratoconus treated with either conventional or accelerated crosslinking at one year follow up. METHODS: It is a prospective, non-randomised interventional study of 76 patients who underwent conventional (CXL; 3mW/cm(2) for 30 minutes) or accelerated cross linking (KXL; 30mW/cm(2) for 4 minutes) for progressive keratoconus. Baseline and postoperative visual acuity, manifest refraction, corneal topography, pachymetry, endothelial cell density and biomechanical parameters of corneal hysteresis and corneal resistance factor were evaluated and compared...
2017: Open Ophthalmology Journal
Liang-Zhu Jiang, Wei Jiang, Shi-Yan Qiu
The aim of the present study was to compare the clinical outcomes of conventional corneal collagen cross-linking (CXL) and pulsed-light accelerated CXL (pl-ACXL) in the eyes of patients with progressive keratoconus. A total of 72 eyes with progressive keratoconus in 58 patients were equally divided into the CXL and pl-ACXL treatment groups. The CXL treatment was performed using the UVX 1000 system with 0.1% riboflavin solution in 20% dextran presoak for 30 min, and 3 mW/cm2 ultraviolet A (UVA) light for 30 min...
November 2017: Experimental and Therapeutic Medicine
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