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CXL thin cornea

Bia Z Kim, Charlotte A Jordan, Charles N J McGhee, Dipika V Patel
PURPOSE: To analyze corneal haze after corneal collagen crosslinking (CXL) for progressive keratoconus using Scheimpflug densitometry. SETTING: Auckland District Health Board, Auckland, New Zealand. DESIGN: Prospective randomized controlled study. METHODS: Both eyes of all patients were examined preoperatively and 1, 3, 6, and 12 months postoperatively. One eye of each patient was treated with corneal CXL, with the contralateral eye serving as the control...
July 2016: Journal of Cataract and Refractive Surgery
Karim Mohamed-Noriega, Karla Butrón-Valdez, Jeronimo Vazquez-Galvan, Jibran Mohamed-Noriega, Humberto Cavazos-Adame, Jesús Mohamed-Hamsho
PURPOSE: To report the case of a 50-year-old woman with diabetes that presented with corneal melting and perforation 6 weeks after collagen cross-linking (CxL) for keratoconus (KC) and postoperative use of nepafenac eye drops, a nonsteroidal anti-inflammatory drug (NSAID). METHODS: This is a case report of a patient with diabetes, KC and a thin cornea that had undergone left eye corneal CxL at a different hospital followed by postoperative use of nepafenac eye drops for 6 weeks...
January 2016: Case Reports in Ophthalmology
Cosimo Mazzotta, Soosan Jacob, Amar Agarwal, Dhivya Ashok Kumar
PURPOSE: To study in vivo confocal microscopy (IVCM) after contact lens-assisted corneal collagen cross-linking (CACXL) in keratoconic eyes with thin corneas. METHODS: This prospective interventional case series included patients with progressive keratoconus with minimum corneal thickness less than 400 µm after removing epithelium. CACXL was done once functional corneal thickness was confirmed to be 400 µm or greater after applying a riboflavin-soaked, ultraviolet barrier-free contact lens...
May 1, 2016: Journal of Refractive Surgery
Elan Rosenblat, Peter S Hersh
PURPOSE: To determine intraoperative changes in corneal thickness and outcomes of corneal collagen crosslinking (CXL) using 2 intraoperative regimens: riboflavin-dextran or hypotonic riboflavin. SETTING: Cornea and refractive surgery practice, Teaneck, New Jersey, USA. DESIGN: Prospective randomized case series. METHODS: Eyes with keratoconus or corneal ectasia were treated. All eyes received preloading with riboflavin 0...
April 2016: Journal of Cataract and Refractive Surgery
Nurullah Cagil, Ozge Sarac, Gamze Dereli Can, Emine Akcay, Mehmet Erol Can
The purpose of the study was to evaluate the outcomes and possible complications of CXL performed with customized epithelial debridement technique to keratoconic corneas with the thinnest pachymetry values less than 400 µm. Nineteen eyes of 19 patients were included. The uncorrected (UCVA) and best corrected visual acuity (BCVA), flattest and steepest keratometric (K) readings, central corneal thickness at the thinnest point (t-CCT), endothelial cell density (ECD) were assessed before and 12 months after CXL...
April 21, 2016: International Ophthalmology
Mustafa Koç, Mehmet Murat Uzel, Yaran Koban, Irfan Durukan, Kemal Tekin, Pelin Ylmazbaş
PURPOSE: To evaluate the effect of accelerated corneal cross-linking (CXL) according to corneal thickness in keratoconus. METHODS: Patients undergoing corneal CXL (9 mW/cm(2)) with hypo-osmolar riboflavin solution were included in this study. The patients were divided into 2 groups. Group 1 included patients with corneal thickness below 400 μm (50 eyes from 45 patients), and group 2 included patients with corneal thickness above 400 μm (50 eyes from 47 patients)...
February 2016: Cornea
Sabine Kling, Olivier Richoz, Arthur Hammer, David Tabibian, Soosan Jacob, Amar Agarwal, Farhad Hafezi
PURPOSE: To compare the currently available ultraviolet-A (UV-A) corneal cross-linking (CXL) treatment protocols for thin corneas with respect to oxygen, UV fluence, and osmotic pressure. METHODS: Freshly enucleated murine (n = 16) and porcine (n = 16) eyes were used. The dependency on oxygen and the amount of UV absorption were evaluated using different CXL protocols, including standard CXL, contact lens-assisted CXL (caCXL), and CXL after corneal swelling. The CXL protocol was adapted from the treatment parameters of the human cornea to fit the thickness of murine and porcine corneas...
December 2015: Journal of Refractive Surgery
Nacim Bouheraoua, Lea Jouve, Vincent Borderie, Laurent Laroche
Keratoconus is a bilateral and progressive corneal ectasia. In order to slow down its progression, corneal collagen cross-linking (CXL) has recently been introduced as an efficient treatment option. In biological and chemical sciences, crosslinking refers to new chemical bonds formed between reactive molecules. Hence, the aim of corneal collagen CXL is to synthetically increase the formation of crosslinks between collagen fibrils in the corneal stroma. Despite the fact that the efficiency of the conventional CXL (C-CXL) protocol has already been shown in several clinical studies, it might benefit from improvements in duration of the procedure and removal of corneal epithelium...
2015: Journal of Visualized Experiments: JoVE
Xiangjun Chen, Aleksandar Stojanovic, Jon Roger Eidet, Tor Paaske Utheim
Corneal collagen cross-linking (CXL) is a therapeutic procedure aiming at increasing the corneal stiffness in the keratoconus eyes by induction of cross-links within the extracellular matrix. It is achieved by ultraviolet-A (370 nm) irradiation of the cornea after saturation with the photosensitizer riboflavin. In the conventional CXL protocol, a minimum de-epithelialized corneal thickness of 400 μm is recommended to avoid potential irradiation damage to the corneal endothelium. In advanced keratoconus, however, stromal thickness is often lower than 400 μm, which limits the application of CXL in that category...
2015: Eye and Vision (London, England)
Igor Knezović, Mirna Belovari Višnjić, Hrvoje Raguž
Aim. To report a case of 40-year-old male with progressive bilateral keratoconus who had undergone transepithelial phototherapeutic keratectomy (TE-PTK) and corneal collagen cross-linking (CXL) using hypoosmolar riboflavin solution in a same day procedure. Methods. Eye examination showed that UCDVA on both eyes was 0,01 according to Snellen charts, and slit lamp biomicroscopy showed paracentral diffuse intrastromal corneal haze. Anterior OCT marked stromal hyperreflective zones and localized paracentral thinning of the cornea...
2015: Case Reports in Ophthalmological Medicine
Mahipal S Sachdev, Deepa Gupta, Gitansha Sachdev, Ritika Sachdev
We describe a technique for stromal expansion of thin and ultrathin corneas in keratoconus patients that uses refractive stromal lenticules of patients having small-incision lenticule extraction for myopic correction. The stromal lenticule is placed and spread over the host cornea following epithelial debridement so the thickest area of the 6.2 mm diameter lenticule corresponds to the thinnest area of the cone. The remaining collagen crosslinking (CXL) procedure is carried out in a routine manner. We believe tailored stromal expansion is a safe and effective technique for performing CXL in patients with thin corneas...
May 2015: Journal of Cataract and Refractive Surgery
N Hirji, E Sykakis, F C Lam, R Petrarca, S Hamada, D Lake
PURPOSE: Corneal collagen crosslinking (CXL) is a relatively new technique to reduce the progression of keratoconus. The technique can be performed with or without complete debridement of the corneal epithelium. We describe a novel intermediate technique involving mechanical disruption of the epithelium, and evaluate its safety and efficacy. METHODS: The case notes of 128 eyes with progressive keratoconus or iatrogenic corneal ectasia who had undergone CXL using the epithelial disruption technique were retrospectively reviewed...
June 2015: Eye
Shao-Feng Gu, Zhao-Shan Fan, Li-Hua Wang, Xiang-Chen Tao, Yong Zhang, Chun-Qin Wang, Ya Wang, Guo-Ying Mu
AIM: To report the 3mo outcomes of collagen cross-linking (CXL) with a hypo-osmolar riboflavin in thin corneas with the thinnest thickness less than 400 µm without epithelium. METHODS: Eight eyes in 6 patients with age 26.2±4.8y were included in the study. All patients underwent CXL using a hypo-osmolar riboflavin solution after its de-epithelization. Best corrected visual acuity, manifest refraction, the thinnest corneal thickness, and endothelial cell density were evaluated before and 3mo after the procedure...
2015: International Journal of Ophthalmology
Hasan Razmjoo, Behrooz Rahimi, Mona Kharraji, Nima Koosha, Alireza Peyman
BACKGROUND: Keratoconus is an asymmetric, bilateral, progressive noninflammatory ectasia of the cornea that affects approximately 1 in 2000 of the general population. This may cause a significant negative impact on quality of life. Corneal collagen crosslinking (CXL) is one of the recently introduced methods that have been used to decrease the progression of keratoconus, in particular, as well as other corneal-thinning processes. MATERIALS AND METHODS: A total of 44 keratoconic eyes of 22 patients were enrolled in this randomized prospective study, after obtaining informed consent...
2014: Advanced Biomedical Research
Olivier Richoz, Samuel Arba Mosquera, Sabine Kling, Arthur Hammer, Thomas Magnago, Martina M Bosch, Farhad Hafezi
PURPOSE: To evaluate the need for and quantify the extent of nomogram adjustments to compensate for potential changes in the amount of effective corneal stroma ablated in previously cross-linked corneas. METHODS: Ex vivo porcine corneas were divided into two groups (the corneal cross-linking [CXL] group, n = 30; and the control group, n = 3): these experimental corneas underwent CXL including deepithelialization, instillation of riboflavin solution for 25 minutes, and ultraviolet-A irradiation at 9 mW/cm2 for 10 minutes...
September 2014: Journal of Refractive Surgery
Shaofeng Gu, Zhaoshan Fan, Lihua Wang, Xiangchen Tao, Yong Zhang, Guoying Mu
PURPOSE: To report the 12-month outcomes of corneal collagen cross-linking (CXL) with a hypoosmolar riboflavin and ultraviolet-A (UVA) irradiation in thin corneas. METHODS: Eight eyes underwent CXL using a hypoosmolar riboflavin solution after epithelial removal. The corrected distance visual acuity (CDVA), manifest refraction, the mean thinnest corneal thickness (MTCT), and the endothelial cell density (ECD) were evaluated before and 6 and 12 months after CXL. RESULTS: The MTCT was 413...
2014: BioMed Research International
Cosimo Mazzotta, Vincenzo Ramovecchi
Thin corneas with a minimum corneal thickness less than 400 μm after epithelial removal represent a contraindication to standard epithelium-off cross-linking (CXL) treatment due to a significant endothelial cell density decrease and potentiality of permanent haze development. Preoperative swelling of the cornea with hypoosmolar riboflavin solutions broadens the spectrum of CXL indications to thin corneas. However the iatrogenic swelling effect might not be durable throughout the CXL procedure increasing the risk of postoperative complications...
2014: Clinical Ophthalmology
Arthur Hammer, David Tabibian, Olivier Richoz, Farhad Hafezi
Keratoconus is a disease of the cornea that usually begins during puberty and progressively weakens its biomechanical structure. Keratoconic eyes show a conic shape and progressive thinning, both leading to irregular astigmatism and reduced vision that cannot be corrected by glasses. In early cases, special contact lens can partly compensate for the visual loss while they do not stop disease progression. Until recently, the only treatment option was a corneal transplant. In 1999, a technique called corneal collagen cross-linking (CXL) was used in human corneas suffering from keratoconus for the first time...
June 4, 2014: Revue Médicale Suisse
Jeannette Beckman Rehnman, Anders Behndig, Per Hallberg, Christina Lindén
PURPOSE: To compare refractive changes after corneal crosslinking with and without mechanical compression of the cornea. METHODS: In a prospective, open, randomized case-control study conducted at the Department of Ophthalmology, Umeå University Hospital, Sweden, sixty eyes of 43 patients with progressive keratoconus aged 18-28 years planned for corneal crosslinking and corresponding age- and sex-matched control subjects were included. The patients were randomized to conventional corneal crosslinking (CXL; n = 30) or corneal crosslinking with mechanical compression using a flat rigid contact lens sutured to the cornea during treatment (CRXL; n = 30)...
November 2014: Acta Ophthalmologica
Vanissa W S Chow, Sayantan Biswas, Marco Yu, Victoria W Y Wong, Vishal Jhanji
PURPOSE: To evaluate the role of spectral-domain optical coherence tomography (SDOCT) to measure corneal thickness during accelerated corneal crosslinking (CXL). METHODS: Intraoperative pachymetry was performed using SDOCT and ultrasound pachymetry (USP) in 6 eyes of 6 patients with keratoconus. Pachymetry readings were obtained at baseline, after epithelium removal and after 30 minutes of riboflavin instillation. SDOCT measurements of eyes with and without lid speculum during riboflavin instillation were compared...
2013: BioMed Research International
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