Customized CXL

PURPOSE: To compare clinical outcomes of customized transepithelial (epi-on) corneal crosslinking (CXL) in high oxygen and customized CXL with epithelial removal (epi-off) in room air for keratoconus (KC). SETTING: Umeå University Hospital, Umeå, Sweden. DESIGN: Prospective, randomized, single-masked, intra-individually comparing study. METHODS: Thirty-two participants with bilateral progressive KC were treated with bilateral customized topography-guided CXL, 30 mW/cm2; 7...

PURPOSE: To investigate the effects of customized topography-guided epithelium-on crosslinking (epi-on CXL) with oxygen supplementation on procedural efficacy and corrected distance visual acuity (CDVA) in patients with progressive keratoconus (KC) at 1 year. SETTING: Private eye clinic, Brisbane, Australia. DESIGN: Retrospective, single-center, nonrandomized case series. METHODS: Topography-guided epi-on CXL using the Mosaic system was performed on patients with progressive KC...

PURPOSE: To evaluate the efficiency, safety, and stability of a revised tissue-saving treatment protocol in a cohort having pellucid marginal degeneration (PMD). METHODS: A retrospective cohort study was conducted on patients with PMD and no previous treatments. A revised protocol of topo-guided photorefractive keratectomy to be followed by customized phototherapeutic keratectomy and then corneal crosslinking was evaluated by comparing the pre and postoperative outcomes regarding visual (subjective refraction) and topographic (using data from Sirius CSO topography software) outcomes...

Purpose: Corneal cross-linking (CXL) has recently been used with promising results to positively affect corneal refractive power in the treatment of hyperopia and mild myopia. However, understanding and predicting the optomechanical changes induced by this procedure are challenging. Methods: We applied ambient pressure modulation based optical coherence elastography (OCE) to quantify the refractive and mechanical effects of patterned CXL and their relationship to energy delivered during the treatment on porcine corneas...

PURPOSE: To analyse the temperature of the corneal surface in keratoconus during corneal customized crosslinking (CXL) with a preserved epithelium (epi-on) under oxygen flow, and epi-off CXL in room air, and to assess the effect of pre-heating the oxygen. METHODS: This masked, intra-individual comparing randomized study included 14 participants with bilateral progressive keratoconus treated with bilateral CXL: one eye with epi-on CXL under a flow of 2.5 L/min oxygen; the fellow eye with epi-off CXL in room air...

PURPOSE: To assess 10-year visual and tomographic outcomes of topography-guided custom ablation (T-CAT) with corneal cross-linking (CXL) in eyes with keratoconus. METHODS: T-CAT with CXL was performed in 600 eyes (522 patients). Based on the T-CAT ablation plan, the theoretical maximum ablation depth was 50 µm after epithelium removal. After ablation, accelerated corneal cross-linking (CXL) was performed in the central 8-mm zone (9 mW/cm2 for 10 minutes in "epi-off" mode)...

Objective: To compare the efficacy and safety of a novel customized topography-guided transepithelial corneal collagen cross-linking (TG-CXL) procedure by sequential ultraviolet A irradiation in different diameters and conventional transepithelial corneal collagen cross-linking (TE-CXL) in adult patients with progressive keratoconus. Methods: A prospective cohort study was conducted. Adult patients diagnosed with progressive keratoconus in the Affiliated Xiamen Eye Center of Xiamen University were continuously recruited and randomly assigned to receive the TG-CXL or TE-CXL procedure from March 2020 to March 2021...

BACKGROUND: Keratoconus is a degenerative disorder of the cornea leading to a protrusion and thinning with loss of visual acuity. The only treatment to halt the progression is corneal crosslinking (CXL), which uses riboflavin and UV-A light to stiffen the cornea. Recent ultra-structural examinations show that the disease is regional and does not affect the entire cornea. Treating only the affected zone with CXL could be as good as the standard CXL, that treats the entire cornea. METHODS: We set up a multicentre non-inferiority randomized controlled clinical trial comparing standard CXL (sCXL) and customized CXL (cCXL)...

We developed a novel acoustic radiation force optical coherence elastography (ARF-OCE) based on an ultrasmall ultrasound transducer for quantitative biomechanics evaluations of in vivo cornea. A custom single-sided meta-ultrasonic transducer with an outer diameter of 1.8 mm, focal spot diameter of 1.6 mm, central frequency of 930 kHz, and focal length of 0.8 mm was applied to excite the sample. The sample arm of the ARF-OCE system employed a three-dimensional printed holder that allowed for ultrasound excitation and ARF-OCE detection...

PURPOSE: The aim of the present study was to validate the use of a novel technique that can improve the efficacy of corneal cross-linking (CXL) in cases with post LASIK ectasia. METHODS: This is a retrospective, comparative study that was conducted on patients who sought medical advice at Ain Shams University Hospitals and Maadi Eye Subspeciality Center, Cairo, Egypt. It included two groups of patients with post LASIK ectasia. Group 1 included patients who performed our proposed protocol (topo-guided PRK, followed by customized phototherapeutic keratectomy "PTK" to transmit the laser treatment to the corneal stroma, then CXL)...

PURPOSE: To report the efficacy of customized cross-linking (CXL) in halting progression of keratoconus when combined with photorefractive procedures. METHODS: Seven eyes from 7 patients with documented progressive keratoconus were treated with customized CXL (customized ultraviolet-A irradiance pattern centered on the maximum posterior elevation with total energy levels ranging from 5.4 up to 10 J/cm2 , and an energy fluence of 9 mW/cm2 ) combined with photorefractive procedures...

PURPOSE: This study aims to determine whether customised peripheral corneal cross-linking (P-CXL) can halt keratoconus progression in ultrathin corneas with stage 3 and 4 keratoconus, with thinnest pachymetry well below 400 μm and therefore excluded from most treatment protocols. METHODS: This retrospective study included 21 eyes with progressive keratoconus and thinnest pachymetry ranging from 97 to 399 μm (mean 315 μm), who underwent P-CXL between 2007 and 2020...

PURPOSE: The aim of this study was to compare the evolution of corneal pachymetry after customized corneal crosslinking (CXL) between Scheimpflug-based and optical coherence-based corneal tomography (OCT). METHODS: In this retrospective study, central corneal thickness (CCT), thinnest corneal thickness, and epithelial thickness of 33 eyes of 33 patients with keratoconus were measured preoperatively and 1, 3, and 12 months after customized CXL using the Pentacam HR and the MS-39...

Corneal cross-linking is a photopolymerization technique traditionally used to strengthen corneal tissue. Corneal cross-linking utilizes riboflavin (vitamin B2) as a photosensitizer and ultraviolet-A light (UVA) to create strong covalent bonds within the corneal stroma, increasing tissue stiffness. Multiple studies have demonstrated corneal cross-linking's effectiveness in treating corneal ectasia, a progressive, degenerative, and non-inflammatory thinning disorder, as quantified by key tomographic, refractive, and visual parameters...

Keratoconus (KC) is a noninflammatory cornea disease leading to progressive thinning, causing it to change from its normal dome shape to a cone shape. One of the novel treatments of KC is corneal collagen cross-linking (CXL). Due to its importance, many studies have been conducted to compare corneal cross-linking protocols; this review article aims to discuss corneal cross-linking and compare its different treatment options, including Dresden, accelerated, and customized protocols in patients with progressive KC and their respective long-term outcomes...

PURPOSE: Corneal Crosslinking (CXL) strengthens the keratoconus cornea and prevents further disease progression. Modified crosslinking protocols and different riboflavin solutions have been proposed to optimize the procedure and improve treatment success. METHODS: PubMed research of relevant publications and report of own experiences with different CXL protocols. RESULTS: Accelerated CXL shows comparable efficiency with shorter surgery time and similar complication rates...

Purpose: This study aimed to investigate the relationship between changes in corneal biomechanical properties and changes in anterior segment optical coherence tomography (AS-OCT) parameters preoperatively and following customized corneal cross-linking (C-CXL) in eyes with progressive keratoconus. Patients and Methods: This study included 44 eyes of 44 patients (33 men, 11 women; average age 22.8 ± 6.4 years) who underwent C-CXL for progressive keratoconus. Scheimpflug-based tonometer (SBT) and AS-OCT findings were evaluated preoperatively and 3 months following CXL...

Corneal collagen crosslinking (CXL) is a commonly used minimally invasive surgical technique to prevent the progression of corneal ectasias, such as keratoconus. Unfortunately, riboflavin/UV-A light-based CXL procedures have not been successfully applied to all patients, and result in frequent complications, such as corneal haze and endothelial damage. We propose a new method for corneal crosslinking by using a Ruthenium (Ru) based water-soluble photoinitiator and visible light (430 nm). Tris(bipyridine)ruthenium(II) ([Ru(bpy)3 ]2+ ) and sodium persulfate (SPS) mixture covalently crosslinks free tyrosine, histidine, and lysine groups under visible light (400-450 nm), which prevents UV-A light-induced cytotoxicity in an efficient and time saving collagen crosslinking procedure...

Purpose: To evaluate safety and efficacy of customized central corneal regularization (CCR), together with simultaneous accelerated corneal collagen cross-linking (A-CXL) - CCR-CXL protocol, to treat keratoconus-related corneal ectasia. Design: Retrospective, comparative observational case series. Methods: Patients that had undergone combined CCR-CXL protocol. Main inclusion criteria were keratoconus visual acuity deterioration and contact lens intolerance...

Introduction: Refractive stromal lenticules from Small Incision Lenticule Extraction (SMILE), though usually discarded, hold a potential for various ophthalmic applications, including refractive correction, stromal volume expansion, and biomechanical strengthening of the cornea. Objectives: To investigate the effect of lenticule customization on lenticule neurite length profile and the excitatory response (calcium signaling) and the potential of reinnervation. Methods: Human and porcine stromal lenticules were treated by (1) excimer laser reshaping, (2) ultraviolet A-riboflavin crosslinking (CXL), and (3) decellularization by sodium dodecyl sulfate (SDS), respectively...