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CXL thin cornea

Virgilio Galvis, Alejandro Tello, Alvaro I Ortiz, Luis C Escaf
Corneal cross-linking (CXL) is an option that in the last decade has demonstrated its efficacy and safety in halting the progression of keratoconus (KCN) and other corneal ectasias. Its indication has been extended beyond the classic definition that required evidence of KCN progression, especially in the presence of some risk factors for a possible progression (particularly the younger age). However, the results can be still somewhat variable today. There are several protocols, each with its own advantages and disadvantages...
2017: Clinical Ophthalmology
Youssef Abdelmassih, Sylvain El-Khoury, Ali Dirani, Rafic Antonios, Ali Fadlallah, Carole G Cherfan, Elias Chelala, Elias F Jarade
PURPOSE: To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by crosslinking in pediatric keratoconus patients. DESIGN: Retrospective interventional case series METHODS: This retrospective study included pediatric patients (≤14 years) with keratoconus and poor corrected distance visual acuity (CDVA) that underwent ICRS implantation and crosslinking (CXL). ICRS were inserted under topical anesthesia after creating a corneal tunnel with an Intralase femtosecond laser...
March 21, 2017: American Journal of Ophthalmology
Hasan Razmjoo, Alireza Peyman, Ali Rahimi, Hoda Jafari Modrek
BACKGROUND: Keratoconus is a progressive degenerative disorder of the cornea in which structural changes in the cornea cause it to become thin and conical in shape. Recently, collagen cross-linking (CXL) has been introduced as an effective intervention in management of progressive keratoconus. Accelerated CXL is a new protocol of this procedure which reduces corneal ultraviolet irradiation exposure time to 5 min. This study aimed to compare visual acuity, keratometry and topographic criteria of keratoconic eyes after conventional and accelerated CXL with a six-month follow-up...
2017: Advanced Biomedical Research
Tommy C Y Chan, Alex L K Ng, Karen K W Chan, George P M Cheng, Ian Y H Wong, Vishal Jhanji
Laser in-situ keratomileusis (LASIK) is safe and effective laser refractive procedures in treating refractive errors. However, regression of treatment and iatrogenic keratectasia remain to be a major concern, especially in treating thin cornea with high ametropia. Collagen cross-linking (CXL) is an effective method in stopping keratoconus progression through increasing the biomechanical strength of the cornea. Adjuvant cross-linking to refractive procedures can theoretically help prevent regression and reduce the risk of keratectasia development by increasing the mechanical stability of cornea...
December 2, 2016: Acta Ophthalmologica
R P L Wisse, N Soeters, D A Godefrooij, N G de Koning-Tahzib
Keratoconus is a corneal disease with onset typically occurring during puberty or early adulthood. The cornea progressively thins and acquires a cone-like shape which negatively affects visual acuity. In the early stages, visual acuity can be corrected with glasses or contact lenses. In more advanced cases, a corneal transplant is ultimately indicated to restore visual acuity. Corneal cross-linking (CXL) is a treatment given at a relatively early stage that protects patients against deterioration of visual acuity and further corneal deformation in progressive cases of keratoconus...
2016: Nederlands Tijdschrift Voor Geneeskunde
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...
February 2017: 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...
November 12, 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
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