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Customized CXL

Ilyse D Haberman, Paul Z Lang, Alvaro Fidalgo Broncano, Sang Woo Kim, Farhad Hafezi, J Bradley Randleman
PURPOSE: To evaluate changes in regional corneal epithelial thickness after corneal crosslinking (CXL) using higher fluence (7.2 J/cm2 ) and accelerated treatment time (4 minutes) in eyes with progressive keratoconus using spectral-domain optical coherence tomography (SD-OCT) and to correlate focal epithelial and focal anterior curvature changes. SETTING: Academic medical center in the United States. DESIGN: Prospective case series. METHODS: Patients had anterior segment SD-OCT (RTVue-100) with focal stromal and epithelial measurements and Scheimpflug imaging before and 1, 3, 6, and 12 months after accelerated CXL...
March 30, 2018: Journal of Cataract and Refractive Surgery
Staffan Schedin, Per Hallberg, Anders Behndig
A numerical 3D ray tracing model was used to evaluate the long-term visual effects of two regimens of corneal crosslinking (CXL) treatment of 48 patients with the corneal degeneration keratoconus. The 3D ray tracing analyses were based on corneal elevation data measured by Scheimpflug photography. Twenty-two patients were treated with standard CXL applied uniformly across the corneal surface, whereas 26 patients underwent a customized, refined treatment only at local zones on the cornea (photorefractive intrastromal CXL; PiXL)...
December 10, 2017: Applied Optics
Samantha M Bradford, Eric R Mikula, Dongyul Chai, Donald J Brown, Tibor Juhasz, James V Jester
The purpose of this study was to develop and test a nonlinear optical device to photoactivate riboflavin to produce spatially controlled collagen crosslinking and mechanical stiffening within the cornea. A nonlinear optical device using a variable numerical aperture objective was built and coupled to a Chameleon femtosecond laser. Ex vivo rabbit eyes were then saturated with riboflavin and scanned with various scanning parameters over a 4 mm area in the central cornea. Effectiveness of NLO CXL was assessed by evaluating corneal collagen auto fluorescence (CAF)...
October 1, 2017: Biomedical Optics Express
Rohit Shetty, Natasha Pahuja, Thimmarayappa Roshan, Rashmi Deshmukh, Mathew Francis, Arkasubhra Ghosh, Abhijit Sinha Roy
PURPOSE: To evaluate the performance of different customized corneal cross-linking (CXL) methods. METHODS: This was a single-center interventional, prospective, longitudinal case series. Four different customized CXL methods were evaluated in keratoconic eyes: (1) uniform (uniform intensity ultraviolet-A [UVA] beam [9 mW/cm(2)] for 10 minutes) (n = 12 eyes); (2) sector axial map (sector-based UVA irradiation) (n = 12 eyes); (3) ring axial map (concentric rings of UVA beam intensity centered at the steepest curvature of the anterior axial map) (n = 12 eyes); and ring tangential map (same as the ring axial map but centered at the steepest curvature of the anterior tangential map) (n = 14 eyes)...
October 1, 2017: Journal of Refractive Surgery
Matthias Elling, Inga Kersten-Gomez, H Burkhard Dick
PURPOSE: To evaluate the safety and efficacy of photorefractive intrastromal corneal crosslinking (CXL) in low myopia. SETTING: Ruhr University Eye Hospital, Bochum, Germany. DESIGN: Prospective case series. METHODS: Healthy eyes with myopia or myopic astigmatism had photorefractive intrastromal CXL using the Mosaic system to apply ultraviolet-A (UVA) 365 nm (30 mW/cm(2)) irradiance (total calculated UVA dose of 10 J/cm(2) or 15 J/cm(2)) with riboflavin 0...
June 2017: Journal of Cataract and Refractive Surgery
Myriam Cassagne, Kévin Pierné, Stéphane D Galiacy, Marie-Pierre Asfaux-Marfaing, Pierre Fournié, François Malecaze
PURPOSE: To compare the efficacy and safety of topography-guided corneal collagen cross-linking (TG-CXL) to conventional corneal CXL (C-CXL) in progressive keratoconus. METHODS: In this prospective, nonrandomized clinical trial, 60 eyes of 60 patients were scheduled to receive either TG-CXL (30 eyes with deepithelialization focused on the cone, riboflavin application for 10 minutes, and 30 mW/cm(2) pulsed ultraviolet-A irradiance pattern according to topography) or C-CXL (30 eyes treated in accordance with the Dresden protocol)...
May 1, 2017: Journal of Refractive Surgery
Sabine Kling, Farhad Hafezi
PURPOSE: To develop an algorithm to predict the stiffening effect of CXL and to verify the accuracy with results obtained from experimental measurements. METHODS: The algorithm considers different variables: the reaction kinetics of riboflavin diffusion and riboflavin photodegradation to determine the effective riboflavin concentration in different stromal layers; the oxygen diffusion and ultraviolet (UV) absorption to determine the amount of reactive oxygen species as a function of time and stromal depth...
February 1, 2017: Journal of Refractive Surgery
David Tabibian, Sabine Kling, Arthur Hammer, Olivier Richoz, Farhad Hafezi
PURPOSE: To study whether repeated collagen cross-linking (CXL) performed in vivo in mice shows an additive effect on mechanical corneal stiffness. METHODS: In this experimental study, epithelium-off CXL was performed in a total of 18 eyes from male C57BL/6 mice, with 0.27%-riboflavin solution applied for 20 minutes, followed by ultraviolet-A (UVA) irradiation (365 nm, 9mW/cm2 ) for 2:50 minutes (fluence 1.53 J/cm2 ). CXL was performed as either a single (1×CXL) or a repeated (2×CXL) treatment...
January 1, 2017: Journal of Refractive Surgery
Daniel A Godefrooij, Kim Boom, Nienke Soeters, Saskia M Imhof, Robert P L Wisse
Previous research suggested that baseline corrected distance visual acuity (CDVA) and maximum keratometry (Kmax) are the predictors for effectiveness of corneal crosslinking (CXL) for keratoconus. The aim of this study was to validate the previously determined predictors in a new treatment cohort. A prospective cohort of 112 eyes in 90 consecutive patients was used to validate the results of 102 eyes in 79 patients from our previous prospective cohort. All patients were treated using epithelium-off corneal CXL in a tertiary hospital setting...
April 2017: International Ophthalmology
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
Theo G Seiler, Isaak Fischinger, Tobias Koller, Daniel Zapp, Beatrice E Frueh, Theo Seiler
PURPOSE: To compare the efficacy of customized corneal cross-linking (CXL) with standard CXL. DESIGN: Prospective, nonrandomized comparative clinical study. METHODS: In a prospective study at the Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland, 40 eyes of 40 patients with documented progressive primary keratoconus were treated with customized CXL (n = 20) or standard CXL (n = 20) and followed for 1 year. Customized irradiation patterns had an energy fluence of 9 mW/cm(2) and total energy levels ranging from 5...
June 2016: American Journal of Ophthalmology
Arthur Hammer, Sabine Kling, Marc-Olivier Boldi, Olivier Richoz, David Tabibian, J Bradley Randleman, Farhad Hafezi
PURPOSE: To establish corneal cross-linking (CXL) with riboflavin and UV-A in in the mouse cornea in vivo and to develop tools to measure the biomechanical changes observed. METHODS: A total of 55 male C57BL/6 wild-type mice (aged 5 weeks) were divided into 14 groups. Standard CXL parameters were adapted to the anatomy of the mouse cornea, and riboflavin concentration (0.1%-0.5%) and fluence series (0.09-5.4 J/cm²) were performed on the assumption of the endothelial damage thresholds...
October 2015: Investigative Ophthalmology & Visual Science
Katie M Hallahan, Karolinne Rocha, Abhijit S Roy, J Bradley Randleman, R Doyle Stulting, William J Dupps
PURPOSE: To assess changes in Ocular Response Analyzer (ORA) waveforms after UVA/riboflavin corneal collagen cross-linking (CXL) using investigator-derived and manufacturer-supplied morphometric variables in patients with keratoconus (KC) and postrefractive surgery ectasia. DESIGN: Prospective randomized trial of a standard epithelium-off CXL protocol. PARTICIPANTS: Patients with progressive KC (24 eyes of 21 patients) or postrefractive surgery ectasia (27 eyes of 23 patients) were enrolled...
November 2014: Eye & Contact Lens
Ferial M Zeraid, Asma A Jawkhab, Waleed S Al-Tuwairqi, Uchechukwu L Osuagwu
AIM: To present the results of same-day topography-guided photorefractive keratectomy (TG-PRK) and corneal collagen crosslinking (CXL) after previous intrastromal corneal ring segment (ISCR) implantation for keratoconus. METHODS: An experimental clinical study on twenty-one eyes of 19 patients aged 27.1±6.6y (range 19-43y), with low to moderate keratoconus who were selected to undergo customized TG-PRK immediately followed by same-day CXL, 9mo after ISCR implantation in a university ophthalmology clinic...
2014: International Journal of Ophthalmology
Grace Lytle
Corneal cross-linking (CXL) with ultraviolet-A (UVA) and riboflavin was introduced over 15 years ago and has been widely adopted as a treatment for keratoconus. Several studies have demonstrated the safety and efficacy of the procedure performed according to a standard protocol. Recent scientific and technological advances have highlighted the opportunity for optimization of the CXL procedure through modifications to this protocol. Advances in the technology of CXL include new riboflavin formulations, higher irradiance UVA sources, and programmable UVA illumination patterns...
November 2014: Eye & Contact Lens
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
Anastasios John Kanellopoulos, William J Dupps, Ibrahim Seven, George Asimellis
PURPOSE: To report a novel application of toric topographically customized transepithelial collagen cross-linking (CXL) aiming to achieve refractive astigmatic changes in a keratoconic cornea. METHODS: Specially formulated riboflavin transepithelial administration and delivery of high-fluence UVA in a topographically customized pattern was applied in an eye with progressive keratoconus. Visual acuity, cornea clarity, keratometry, topography, and pachymetry with a multitude of modalities, as well as endothelial cell counts were evaluated for >6 months...
May 2014: Case Reports in Ophthalmology
Anders P Søndergaard, Anders Ivarsen, Jesper Hjortdal
PURPOSE: We evaluated whether UVA-riboflavin collagen cross-linking (CXL) increases transverse stromal shear moduli ex vivo, whether the shear moduli are greater in the anterior compared to the posterior stroma, and whether the shear moduli are affected by CXL. METHODS: The resistance to unidirectional transverse shear of human (n = 18) and porcine (n = 42) corneas was measured in a custom engineered biaxial biomechanical setup at different hydrations. The corneas were separated into untreated, riboflavin solution-treated, and CXL-treated groups...
July 26, 2013: Investigative Ophthalmology & Visual Science
Prema Padmanabhan, Aishwaryah Radhakrishnan, Abinaya Priya Venkataraman, Nidhi Gupta, Bhaskar Srinivasan
PURPOSE: To compare the outcome of Collagen cross-linking (CXL) with that following topography-guided customized ablation treatment (T-CAT) with simultaneous CXL in eyes with progressive keratoconus. MATERIALS AND METHODS: This was a prospective, non-randomized single centre study of 66 eyes with progressive keratoconus. Of these, 40 eyes underwent CXL and 26 eyes underwent T-CAT + CXL. The refractive, topographic, tomographic and aberrometric changes measured at baseline, 1, 3 and 6 months post-operatively were compared between both groups...
February 2014: Indian Journal of Ophthalmology
Frederik Raiskup, Eberhard Spoerl
Changes in the biomechanical properties of the human cornea play an important role in the pathogenesis of corneal ectatic diseases. A variety of conditions in primary acquired (keratoconus and pellucid marginal degeneration) or secondary induced (iatrogenic keratectasia after excimer refractive laser surgery) corneal ectatic disorders lead to reduced biomechanical resistance. Corneal collagen crosslinking (CXL) has emerged as a promising technique to slow or even to stop the progression of these corneal ectatic pathologies...
April 2013: Ocular Surface
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