1. Customized corneal crosslinking for treatment of progressive keratoconus: Clinical and OCT outcomes using a transepithelial approach with supplemental oxygen.
- Author
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Mazzotta, Cosimo, Sgheri, Arianna, Bagaglia, Simone Alex, Rechichi, Miguel, and Di Maggio, Alessandro
- Subjects
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OXYGEN therapy , *CORNEA , *CORNEAL transplantation , *TREATMENT effectiveness , *PHOTOREFRACTIVE keratectomy , *OPTICAL coherence tomography , *KERATOCONUS - Abstract
Purpose: To evaluate the outcomes of customized corneal crosslinking (CXL) for treatment of progressive keratoconus (KC) using a transepithelial approach with supplemental oxygen. Setting: Siena Crosslinking Center, Siena, Italy. Design: Prospective interventional case series. Methods: Twenty-seven eyes of 24 patients (mean age 29.3 +/- 7.3 years) with progressive KC underwent customized corneal CXL using a transepithelial approach with supplemental oxygen. Ultraviolet (UV)-A irradiation of 365 nm wavelength was delivered in an accelerated (30 mW/cm2) pulsed-light UV light exposure in a 2-zone elliptical pattern. A total dose of 10 J/cm2 was delivered at the KC apex, surrounded by a broadbeam spot of 7.2 J/cm2. After 0.25% riboflavin corneal soaking, the UV-A irradiation was initiated in the presence of additional oxygen (>=90% concentration) delivered through special goggles connected to an oxygen delivery system (flow-rate 2.5 liters per minute). Key outcome measures included corrected distance visual acuity (CDVA), keratometry (AK, K1, K2, and K-average), corneal higher-order aberrations, topographic and manifest cylinder, corneal optical coherence tomography (OCT) demarcation line, and endothelial cell count. Results: Of the 27 eyes studied, a significant improvement of CDVA was recorded at 6-month follow-up visits, from baseline 0.19 +/- 0.06 logarithm of the minimum angle of resolution (logMAR) to 0.11 +/- 0.04 logMAR (P <.05). Significant flattening of steep keratometry (K2) was reported with mean change of -1.9 diopters (D) (P <.05), and coma values improved from 0.47 +/- 0.28 [micro]m to 0.28 +/- 0.16 [micro]m (P <.05). OCT revealed 2 demarcation lines at mean depths of 218.23 +/- 43.32 [micro]m and 325.71 +/- 39.70 [micro]m. Conclusions: In this series, customized CXL using a transepithelial approach with intraoperative supplemental oxygen resulted in clinically meaningful improvements in corneal curvature and CDVA without significant adverse events. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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