International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 7 , ISSUE 2 ( July-December, 2018 ) > List of Articles

Original Article

Epithelium-on Corneal Cross-linking for Progressive Keratoconus: Two-year Outcomes

Arthur B Cummings, Parker J Shaw, Gabrielle Kelly

Keywords : Blurred vision, Corneal cross-linking, Corneal ectasia, Corneal tomography, Corneal topography, Corneal transplant, Eye rubbing, Femtosecond- laser assisted DALK, Keratoconus, Quality of vision, Steep corneas, Vogt\'s striae,Accelerated corneal cross-linking

Citation Information : Cummings AB, Shaw PJ, Kelly G. Epithelium-on Corneal Cross-linking for Progressive Keratoconus: Two-year Outcomes. Int J Kerat Ect Cor Dis 2018; 7 (2):110-114.

DOI: 10.5005/jp-journals-10025-1166

License: CC BY-NC 4.0

Published Online: 00-12-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Corneal cross-linking (CXL) has been established as a successful treatment tool for the treatment of progressive keratoconus in terms of slowing or halting progressive corneal steepening and thinning and even on some occasions, reversing the steepening. To date the Dresden epithelium-off protocol is regarded as the gold standard and the epithelium-on (epi-on) approaches have met with less success. Both doctors and patients would welcome an epi-on CXL procedure that provided good outcomes as the morbidity with epi-on CXL is so much less and the safety is enhanced. Patient comfort is greater with the epi-on techniques when compared to epi-off. This study looked at 82 eyes that had documented progression of keratoconus and then underwent epi-on CXL using the CXLO system. The results show that corneal steepening can be halted and even reversed over a 2-year follow-up period with no complications noted. Over the 24 months post treatment on average there was a decrease in all keratometry values, BAD and ISV when compared to before treatment with IHD being marginally increased. Further studies over a longer follow-up period are required but recent publications using the same approach are validating the findings seen in this study.


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  1. Raiskup F, Spoerl E. Corneal crosslinking with riboflavin and ultraviolet A. Part II. Clinical indications and results. Ocul Surf 2013;11(2):93-108.
  2. Hassan Z, Szalai E, Módis L et al. Assessment of corneal topography indices after collagen crosslinking for keratoconus. Eur J Ophthalmol 2013;23(5):635-640.
  3. Jouve L, Borderie V, Temstet C, et al. Corneal collagen crosslinking in keratoconus. J Fr Ophtalmol 2015;38(5): 445-462.
  4. Li G, Fan ZJ, Peng XJ et al. Corneal collagen cross-linking in the treatment of progressive keratoconus-preliminary results. 2013;49(10):896-901.
  5. Cummings AB, McQuaid R, Naughton S, et al. Optimizing Corneal Cross-Linking in the Treatment of Keratoconus: A Comparison of Outcomes After Standard- and High-Intensity Protocols. Cornea. 2016;35(6):814-822.
  6. Rubinfeld RS, Stulting RD, Glenwood GG, et al. Quantitative analysis of corneal stromal riboflavin concentration without epithelial removal. J Cataract Refract Surg 2018;44:237-242.
  7. Stulting RD, Trattler WB, Woolfson JM, et al. Corneal cross linking without epithelial removal. J Cataract Refract Surg. 2018 Sep 15. pii: S0886-3350(18)30638-2.
  8. Hatch KM. Part of Chapter 6. Corneal Collagen Cross linking by Mazen M. Sinjab and Arthur B. Cummings (Editors). Springer International Publishing. 2016.
  9. Nawaz S, Gupta S, Gogia V, et al. Trans-epithelial versus conventional corneal collagen crosslinking: A randomized trial in keratoconus. Oman J Ophthalmol 2015;8(1):9-13.
  10. Yuksel E, Novruzlu S, Ozmen MC, et al. A Study Comparing Standard and Transepithelial Collagen Cross-Linking Riboflavin Solutions: Epithelial Findings and Pain Scores. J Ocul Pharmacol Ther 2015.
  11. Pollhammer M, Curseifen C. Bacterial keratitis early after corneal crosslinking with riboflavin and ultraviolet-A. Cataract Refract Surg 2009;35(3):588-589.
  12. Angunawela RI, Arnalich-Montiel F, Allan BD. Peripheral sterile corneal infiltrates and melting after collagen crosslinking for keratoconus. Cataract Refract Surg 2009;35(3):606-607.
  13. Kymionis GD, Portaliou DM, Bouzoukis DI, et al. Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus. J Cataract Refract Surg 2007;33(11):1982-4.
  14. Kymionis GD, Portaliou DM, Pallikaris IG. Additional complications of corneal crosslinking. J Cataract Refract Surg 2010;36(1):185
  15. Kymionis GD, Portaliou DM. Corneal collagen crosslinking and herpetic keratitis. J Cataract Refract Surg 2013;39(8):1281.
  16. Vinciguerra P, Randleman JB, Romano V, et al. Transepithelial iontophoresis corneal collagen cross-linking for progressive keratoconus: initial clinical outcomes. J Refract Surg 2014;30(11):746-753.
  17. Torricelli AA, Ford MR, Singh V, et al. BAC-EDTA transepithelial riboflavin-UVA crosslinking has greater biomechanical stiffening effect than standard epithelium-off in rabbit corneas. Exp Eye Res 2014;125:114-117.
  18. Majumdar S, Hippalgaonkar K, Repka MA. Effect of chitosan, benzalkonium chloride and ethylenediaminetetraacetic acid on permeation of acyclovir across isolated rabbit cornea. Int J Pharm 2008;348(1-2):175-178.
  19. Rathore MS, Majumdar DK. Effect of formulation factors on in vitro transcorneal permeation of gatifloxacin from aqueous drops. AAPS Pharm Sci Tech 2006;7(3):57.
  20. McCall AS, Kraft S, Edelhauser HF, et al. Mechanisms of corneal tissue cross-linking in response to treatment with topical riboflavin and long-wavelength ultraviolet radiation (UVA). Invest Ophthalmol Vis Sci 2010;51(1):129-138
  21. De Bernardo M, Capasso L, Tortori, et al. Trans epithelial corneal collagen crosslinking for progressive keratoconus: 6 months follow up. Cont Lens Anterior Eye 2014;37(6):438-441.
  22. Lombardo M, Serrao S, Rosati M, et al. Biomechanical changes in the human cornea after transepithelial corneal crosslinking using iontophoresis. J Cataract Refract Surg 2014;40(10):1706-1715.
  23. Koller T1, Mrochen M, Seiler T. Complication and failure rates after corneal crosslinking. J Cataract Refract Surg. 2009;35(8):1358-1362.
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