Search

Investigate trends in keratoconus (KCN) treatment patterns and diagnosis age from 2015 to 2020 and evaluate sociodemographic associations with the treatment approach. Retrospective cohort study. Patients with a new KCN diagnosis from 2015 to 2020 were identified in the Academy IRIS® Registry (Intelligent Research in Sight). Associations between sociodemographic factors and treatment were evaluated using multivariable logistic regression. Outcomes included percentages and rates of each treatment (collagen crosslinking [CXL], keratoplasty, or no procedure) from 2015 to 2020, age at diagnosis during this period, and sociodemographic factors associated with treatment type. A total of 66 199 patients with a new diagnosis of KCN were identified. The percentage of patients undergoing CXL increased from 0.05% in 2015 to 29.5% in 2020 (P = 0.008). The average age (standard deviation) of KCN patients decreased from 44.1 (±16.9) years in 2015 to 39.2 (±16.9) years in 2020 (P < 0.001). In multivariable analyses comparing CXL versus no procedure and keratoplasty versus no procedure, patients undergoing CXL tended to be younger with the odds of having CXL decreasing with increasing age, for example, comparing CXL and no procedure patients, using ages 0–20 years as reference, the odds ratio (OR) (95% confidence interval [CI]) decreased from 0.62 (0.57–0.67; P < 0.0001) for patients aged 21–40 years to 0.03 (0.02–0.04; P < 0.0001) for patients aged > 60 years. Men were more likely than women to have CXL (OR, 1.31; 95% CI, 1.23–1.40; P < 0.0001) and keratoplasty (OR, 1.30; 95% CI, 1.19–1.42; P < 0.0001). Black patients were less likely than White patients to have CXL (OR, 0.70; 95% CI, 0.63–0.77; P < 0.0001) and more likely to have keratoplasty (OR, 2.24; 95% CI, 2.01–2.50; P < 0.0001). Likewise, Hispanic patients had higher odds of CXL (OR, 1.12; 95% CI, 1.00–1.24; P < 0.05) and keratoplasty (OR, 1.29; 95% CI, 1.12–1.50; P < 0.001) compared with non-Hispanic patients. Collagen crosslinking and keratoplasty also varied by region and insurance status. A significant increase in use of CXL was noted from 2015 to 2020. Sociodemographic differences in treatment among KCN patients may reflect differences in access, use, or care patterns, and future studies should aim to identify strategies to improve access for all patients. The author(s) have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsCorneal collagen cross-linking (CXL) can halt corneal ectasia. Leaving corneal epithelium intact during treatment may reduce the incidence of complications. However, it is under debate whether this reduces efficacy and if oxygen supplementation may be necessary to optimize the cross-linking effect. This study aimed to investigate the impact of hyperbaric oxygenation (HBO) on intracorneal oxygen concentrations during epi-off and epi-on CXL.CXL was performed using riboflavin and ultraviolet-A (UV-A) irradiance (3 mW/cm2 for 30 min) on porcine corneas under normobaric and hyperbaric conditions, with and without supplemented oxygen, with and without epithelium. Intracorneal oxygen concentrations were continuously monitored before and during irradiation. Biomechanical properties were assessed through tensile strength testing.HBO alone did not cause perceivable changes in stromal oxygen concentrations. Oxygen supplementation resulted in higher oxygen concentration in corneal stroma during CXL. HBO may cause a further increase in oxygen levels, although this was not statistically significant in this study. Notably, a tendency of oxygen levels to rise continuously during UV-irradiation was observed using HBO. Biomechanical properties showend no statistically significant differences between any groups.In this ex-vivo model, HBO increased stromal oxygen levels during CXL, regardless of the presence of corneal epithelium. The dynamics in oxygen concentrations in corneal stromal tissue during CXL suggest that time is an important factor to consider in modifications of established protocols. Also, we hypothesize that stromal levels of riboflavin and UV-A irradiance may be more critical to the CXL effect when oxygen is supplemented and epithelium is not removed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of transepithelial corneal collagen crosslinking (CXL) treatment on the optical performance of the cornea at 12-month follow-up after CXL in patients with progressive keratoconus. Methods: One hundred and ten eyes of 67 patients were included. The following corneal optical aberrations over the 4-mm-diameter pupil were recorded via Sirius dual-scanning corneal tomography: total, anterior and posterior amount of corneal higher order aberrations [HOAs], vertical coma, horizontal coma, vertical trefoil, oblique trefoil, and spherical aberration, and Strehl ratio of point spread function (PSF). Results: There were significant improvements in mean root mean square error values for corneal total HOA, total coma, anterior HOA, anterior coma, and vertical coma following CXL (P > 0.05, for all). No significant changes were found in the posterior aberometric parameters. PSF value did not change after CXL (P > 0.05). The corneal topographic measurements not revealed a change in the mean simulated keratometry-1, simulated keratometry-2, and maximum keratometry compared with the baseline measurements (P > 0.05, for all). At 12 months, there was a significant improvement in the uncorrected (UCVA) and best corrected (BCVA) visual acuity (P < 0.001, both). Most corneal aberrations correlated significantly with postoperative BCVA, but changes in HOAs were not statistically associated with improvements in visual acuity. Conclusions: Transepithelial CXL was effective in stabilizing the keratometric indices and improving the most corneal aberrations in keratoconic eyes 1 year after the procedure. While the healing effect on aberrations after CXL was in total and anterior parameters, no significant changes were observed in the posterior surface. In addition, it was observed that transepithelial CXL treatment did not cause a significant change in PSF distribution data. [ABSTRACT FROM AUTHOR]

Abstract Purpose To describe visual and refractive outcomes of intrastromal corneal ring segments (ICRS) and toric implantable collamer lenses (TICL) implantation in cases of mild and moderate keratoconus. Methods A prospective descriptive interventional case series. 40 eyes were allocated into two groups. First group (20 eyes) was treated with corneal collagen crosslinking (CXL) 1 month after ICRS implantation and the second group was treated using TICL after 1 year of CXL. Results Both groups showed statistically significant improvement in spherical equivalent, cylindrical refraction, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) over the follow-up period. Conclusion Both ICRS and TICL are effective in treatment of mid and moderate keratoconus with more predictable visual results with TICL.

There have been multiple reports of eye infections caused by antibiotic-resistant bacteria, with increasing evidence of ineffective treatment outcomes from existing therapies. With respect to corneal infections, the most commonly used antibiotics (fluoroquinolones, aminoglycosides, and cephalosporines) are demonstrating reduced efficacy against bacterial keratitis isolates. While traditional methods are losing efficacy, several novel technologies are under investigation, including light-based anti-infective technology with or without chemical substrates, phage therapy, and probiotics. Many of these methods show non-selective antimicrobial activity with potential development as broad-spectrum antimicrobial agents. Multiple preclinical studies and a limited number of clinical case studies have confirmed the efficacy of some of these novel methods. However, given the rapid evolution of corneal infections, their treatment requires rapid institution to limit the impact on vision and prevent complications such as scarring and corneal perforation. Given their rapid effects on microbial viability, light-based technologies seem particularly promising in this regard. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the outcomes of accelerated (A-CXL) and iontophoresis (I-CXL) corneal crosslinking in a large retrospective cohort with progressive keratoconus. Methods: This retrospective observational cohort study included consecutive patients treated by A-CXL (9 mW/5.4 J/cm2) or I-CXL with a minimal follow-up of 12 months. Visual acuity, manifest refraction, topography, specular microscopy, and corneal optical coherence tomography (OCT) were evaluated at baseline and at the last visit. Progression was defined as an increase in the maximum topographic keratometry (Kmax) of 1D. Results: 302 eyes of 241 patients with a mean age of 25.2 ± 7.5 years were included from 2012 to 2019: 231 and 71 eyes in the A-CXL and I-CXL groups, respectively. The mean follow-up was 27.2 ± 13.2 months (maximum: 85.7 months). Preoperatively, the mean Kmax was 51.8 ± 4.0D, with no differences between groups. Mean topographic measurements and spherical equivalent remained stable during the follow-up. At the last visit, CXL failure was reported in 60 eyes (19.9%): 40 (14.7%) versus 20 (28.2%) in A-CXL versus I-CXL, respectively, p = 0.005. The likelihood of progression after CXL was significantly higher following I-CXL: RR = 1.62, CI95 = [1.02 to 2.59], p = 0.04. Demarcation line presence at 1 month was positively correlated with higher efficacy of CXL, p = 0.03. No endothelial damage was reported, especially in 51 thin corneas (range = 342–399 µm). Conclusions: A-CXL seems more effective than I-CXL in stabilizing keratoconus; this is to be taken into account when a therapeutic indication is posed according to the aggressiveness of the keratoconus. [ABSTRACT FROM AUTHOR]

Infectious keratitis is a vision-threatening microbial infection. The increasing antimicrobial resistance and the fact that severe cases often evolve into corneal perforation necessitate the development of alternative therapeutics for effective medical management. Genipin, a natural crosslinker, was recently shown to exert antimicrobial effects in an ex vivo model of microbial keratitis, highlighting its potential to serve as a novel treatment for infectious keratitis. This study aimed to evaluate the antimicrobial and anti-inflammatory effects of genipin in an in vivo model of Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa) keratitis. Clinical scores, confocal microscopy, plate count, and histology were carried out to evaluate the severity of keratitis. To assess the effect of genipin on inflammation, the gene expression of pro- and anti-inflammatory factors, including matrix metalloproteinases (MMPs), were evaluated. Genipin treatment alleviated the severity of bacterial keratitis by reducing bacterial load and repressing neutrophil infiltration. The expression of interleukin 1B (IL1B), interleukin 6 (IL6), interleukin 8 (IL8), interleukin 15 (IL15), tumor necrosis factor-α (TNF-α), and interferon γ (IFNγ), as well as MMP2 and MMP9, were significantly reduced in genipin-treated corneas. Genipin promoted corneal proteolysis and host resistance to S. aureus and P. aeruginosa infection by suppressing inflammatory cell infiltration, regulating inflammatory mediators, and downregulating the expression of MMP2 and MMP9. [ABSTRACT FROM AUTHOR]

Purpose: To report the initial case of microbial keratitis caused by Phialophora chinensis, a rare cause of fungal keratitis. Observations: A 66-year-old gentleman with a complex right eye (OD) ocular history including herpes simplex virus infectious epithelial keratitis with subsequent neurotrophic keratopathy, and prior combined Candida albicans and parapsilosis fungal keratitis presented with pain OD in the absence of an antecedent trauma. The patient was found to have a filamentous fungal keratitis, which was subsequently cultured and identified as Phialophora chinensis by the laboratory. Despite topical and oral antifungal treatment based on sensitivities determined by the lab, the patient ultimately required intrastromal and subconjunctival antifungal injections, corneal crosslinking, and superficial keratectomy with amniotic membrane to clinically improve. The fungal keratitis recurred twice, with each occurrence rapidly progressing to corneal perforation. Months after the second penetrating keratoplasty, the patient's mental status declined due to multiorgan failure. An occult pulmonary malignancy was discovered during this hospital stay, and the patient was lost to follow-up after entering hospice. Conclusions and Importance: We report a unique case of fungal keratitis caused by Phialophora chinensis and the subsequent management, including both medical and surgical interventions. Despite a multimodal treatment regimen, this case demonstrates the recalcitrant and potentially recurrent nature of fungal keratitis caused by P. chinensis.

To evaluate long-term outcomes of corneal collagen crosslinking (CXL) using riboflavin and UV-A irradiation and to determine when to repeat CXL. In this retrospective consecutive interventional case series 131 eyes of 131 patients (95 male, 36 female, mean age 29.7 ± 11.4 years) between 2006 and 2016 received standard CXL (Dresden protocol, epithelium-off) for progressive keratoconus. Corrected distance visual acuity (CDVA) and corneal tomography (K1, K2, Kmax) were repeatedly recorded 1 year (n = 103 eyes) to 10 years (n = 44) postoperatively. Only one eye per patient was included. Paired t-test or Wilcoxon matched-pairs signed rank test was used for parametric and nonparametric data, respectively. 1–3 years preoperatively, median K2 significantly increased by 1.1 D (p < 0.001). Postoperatively, median K2 increased by 0.1 D after 1 year, then decreased over the remaining postoperative period by 0.85 D (p = 0.021). Kmax fluctuated without significant change. Median apical corneal thickness decreased by 16 µm (p = 0.012) after 5 years and then returned to preoperative values. Mean CDVA showed a significant improvement (decrease in logMAR 0.08 after 10 years, p = 0.010). CXL non-responders, defined by a postoperative increase in Kmax>2 D, increased from 16% after 5 to 33% after 10 years. Risk factors for non-response were young age, high astigmatism (>4.3 D), thin cornea (<480 µm), poor initial visual acuity (CDVA ≥0.3 D), and atopic dermatitis. 4 eyes were re-treated 3–4 years after first CXL without complications and keratoconus stabilized thereafter. CXL can slow or stop keratoconus progression. However, as the number of responders declines after 5 years, especially patients with risk factors may require re-treatment. [ABSTRACT FROM AUTHOR]

Introduction. The article considers an objective assessment of the state of morphofunctional status of cornea in keratoconus after a corneal collagen crosslinking procedure.Aim. To assess changes in cornea structure after corneal collagen crosslinking in keratoconus. Materials and methods. The study included 24 patients: 30 eyes with KC stage I–III aged 17 to 42 years. The patients were examined before and after the corneal collagen crosslinking procedure. The postoperative follow-up period was 12 months. The patients underwent anterior segment OCT (AS-OCT) imaging to assess the demarcation line depth. The cornea and cornea nerve fibers were assessed layer-by-layer using сonfocal laser scanning microscopy, followed by the analysis of resulting confocal images through the author’s analysis algorithm.Results and discussion. The epithelialization of the cornea completed on day 3–5 after the procedure. According to OCT findings, the depth of the demarcation line averaged to 260 µm in the center and 140 µm in the periphery. The pronounced edema of the outer stroma was observed during the first-week follow-up, and a decrease in the density and apoptosis of keratocytes was noted during the first month. Over a 3–12-month postoperative follow-up period, the transient lacunar edema regressed and the density of keratocytes was restored to the baseline level. During the first three months, a pronounced disruption of the direction and structure of the cornea nerve fibres is seen.Conclusion. The crosslinking procedure results in changes in the cornea structure, one of which is appearance of the demarcation line in the stroma, which indicates the depth of penetration of the photochemical corneal collagen crosslinking process. The laser corneal confocal microscopy allows to objectively assess the depth of this effect, while the values obtained in the same follow-up periods are comparable with the findings of OCT imaging.

AIM: To evaluate the treatment selections and outcomes of keratoconus and discuss the grading treatment of keratoconus. METHODS: Medical records of 1162 patients (1863 eyes) with keratoconus treated with rigid gas permeable (RGP), corneal collagen crosslinking, and keratoplasty were reviewed. The patients were grouped according to the CLEK Study. The advanced group was further divided into a 60 D group. The best-corrected visual acuity (BCVA) and topographic data before and after treatment were recorded. RESULTS: In the 761 eyes with steep K60 D, surgical management accounted for 90.6%. A total of 618 eyes had improved BCVA at the final follow-up point (>18mo, P52 D, the BCVA and topographic astigmatism outcomes showed no differences among the treatment groups. When steep K was >60 D, the BCVA in eyes treated with LKP was worse than those with steep K

There have been multiple reports of eye infections caused by antibiotic-resistant bacteria, with increasing evidence of ineffective treatment outcomes from existing therapies. With respect to corneal infections, the most commonly used antibiotics (fluoroquinolones, aminoglycosides, and cephalosporines) are demonstrating reduced efficacy against bacterial keratitis isolates. While traditional methods are losing efficacy, several novel technologies are under investigation, including light-based anti-infective technology with or without chemical substrates, phage therapy, and probiotics. Many of these methods show non-selective antimicrobial activity with potential development as broad-spectrum antimicrobial agents. Multiple preclinical studies and a limited number of clinical case studies have confirmed the efficacy of some of these novel methods. However, given the rapid evolution of corneal infections, their treatment requires rapid institution to limit the impact on vision and prevent complications such as scarring and corneal perforation. Given their rapid effects on microbial viability, light-based technologies seem particularly promising in this regard.

Keratoconus is a common pediatric corneal disease, leading to vision impairment and amblyopia. Compared to its adult counterpart, pediatric keratoconus has an advanced presentation, rapid progression, higher incidence of complications such as corneal hydrops, and potential impact on the child's quality of life. It typically manifests during puberty and can evolve rapidly to more severe stages if left untreated. This rapid progression underscores the importance of early diagnosis through regular screening in pediatric populations and vigilant monitoring of pediatric keratoconus suspects. Concomitant ocular allergies, ocular anomalies, systemic diseases (eg. syndromes), and poor compliance with contact lenses might impede prompt intervention and frequently postpone rehabilitation. Corneal collagen crosslinking is a crucial intervention in the management of pediatric keratoconus because it strengthens the corneal microstructure and halts the disease's progression. When conservative measures fail, keratoplasty remains a viable option with generally favorable outcomes, though with unique challenges in post-operative care, including concerns related to sutures, long-term graft survival and need for repeated examinations under anesthesia. A multidisciplinary approach involving ophthalmologists, optometrists, pediatricians, and other healthcare professionals, focusing on early diagnosis and timely intervention, is essential for the comprehensive management of pediatric keratoconus and to mitigate its impact on children's lives., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024. Published by Elsevier Inc.)

Copyright of Türkiye Klinikleri Journal of Ophthalmology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Keratoconus is a progressive noninflammatory ectatic disease of the cornea with onset at puberty in most cases. Both genetic and nongenetic or environmental factors have been implicated. Keratoconus has been associated with numerous genetic systemic disorders. many keratoconus-associated syndromes have a high incidence of eczema and atopy, such as Down syndrome, hyper-IgE syndrome, ichthyosis, and oculodentodigital syndrome, Turner syndrome (conjunctival lymphangiectasia), autographism and Mulvihill-Smith syndrome. In each of these syndromes associated with atopy and eczema, associations are known to include both keratoconus and eye rubbing. Keratocyte density, possibly from IL-1-induced apoptosis, is reduced in keratoconus and can be demonstrated as well with eye rubbing and with contact lens wear. A recently developed treatment for keratoconus is corneal collagen crosslinking (CXL). In CXL, stromal fibers are photopolymerized by the combined action of a photosensitizing substance (riboflavin or vitamin B2) and ultraviolet rays A. [ABSTRACT FROM AUTHOR]

Introduction: The cornea may become infected and perforated after epithelium-on collagen crosslinking. Case presentation: A healthy 33-year-old male who underwent corneal collagen crosslinking in both eyes developed a purulent keratitis and bilateral corneal perforations, requiring bilateral penetrating keratoplasties. He was exposed to methicillin resistant staphylococcus aureus (MRSA) by a family member with a tracheostomy and was treated with MRSA-directed antibiotics. After prolonged recovery and treatment of his infection, he had acceptable but limited uncorrected visual acuity, with excellent corrected visual acuity. Conclusion: While epithelium-on crosslinking is commonly thought to be associated with a lower risk of postoperative infection, this case illustrates that even epithelium-on treatment may present the patient with a risk of infection. Patients in higher risk groups who are exposed to infectious disease may be more predisposed.

Riboflavin/UV-mediated corneal collagen cross-linking can increase the mechanical strength of the cornea and prevent or delay corneal expansion and keratoconus progression. We performed quantitative analysis of protein iTRAQ in rabbit eye white matter after cross-linking to explore the changes of protein expression in cornea at different times after cross-linking and to understand the process of corneal stroma remodeling after cross-linking. The screening conditions are fold Change≥1.2 and P-value ​

[Display omitted] Corneal collagen crosslinking (CXL) is an effective method to halt the disease progression of keratoconus, a progressive corneal dystrophy leading to cone shaped cornea. Despite the efficacy of standard protocol, the concerning step of this procedure is epithelial debridement performed to facilitate the entry of riboflavin drug. Riboflavin, a key molecule in CXL protocol, is a sparsely permeable hydrophilic drug in corneal tissues. The present study has employed cell penetrating peptide (CPP), Tat 2 , to enhance the penetration of riboflavin molecule, and thereby improve currently followed CXL protocol. This study demonstrates approximately two-fold enhanced uptake of CPP riboflavin conjugate, Tat 2 riboflavin-5′Phosphate (RiTe conjugate), both in vitro and in vivo. Two different CXL protocols (Epi ON and Epi OFF) have been introduced and implemented in rabbit corneas using RiTe conjugate in the present study. The standard and RiTe conjugate mediated CXL procedures exhibited an equivalent extent of crosslinking in both the methods. Reduced keratocyte loss and no endothelial damage in RiTe conjugate mediated CXL further ascertains the safety of the proposed CXL protocols. Therefore, RiTe conjugate mediated CXL protocols present as potential alternatives to the standard keratoconus treatment in providing equally effective, less invasive and patient compliant treatment modality. [ABSTRACT FROM AUTHOR]

Infectious keratitis is a vision-threatening microbial infection. The increasing antimicrobial resistance and the fact that severe cases often evolve into corneal perforation necessitate the development of alternative therapeutics for effective medical management. Genipin, a natural crosslinker, was recently shown to exert antimicrobial effects in an ex vivo model of microbial keratitis, highlighting its potential to serve as a novel treatment for infectious keratitis. This study aimed to evaluate the antimicrobial and anti-inflammatory effects of genipin in an in vivo model of Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa) keratitis. Clinical scores, confocal microscopy, plate count, and histology were carried out to evaluate the severity of keratitis. To assess the effect of genipin on inflammation, the gene expression of pro- and anti-inflammatory factors, including matrix metalloproteinases (MMPs), were evaluated. Genipin treatment alleviated the severity of bacterial keratitis by reducing bacterial load and repressing neutrophil infiltration. The expression of interleukin 1B (IL1B), interleukin 6 (IL6), interleukin 8 (IL8), interleukin 15 (IL15), tumor necrosis factor-α (TNF-α), and interferon γ (IFNγ), as well as MMP2 and MMP9, were significantly reduced in genipin-treated corneas. Genipin promoted corneal proteolysis and host resistance to S. aureus and P. aeruginosa infection by suppressing inflammatory cell infiltration, regulating inflammatory mediators, and downregulating the expression of MMP2 and MMP9.

Purpose: To evaluate the long-term visual, refractive, tomographic, and aberrometric outcomes of corneal collagen crosslinking (CXL) with or without hypoosmolar riboflavin solution in the treatment of progressive keratoconus patients with thin corneas. Methods: Charts of consecutive progressive keratoconus patients with thinnest corneal thickness less than 470 µm who underwent corneal collagen CXL with or without hypoosmolar riboflavin solution and using a standardized protocol for treatment and examinations were analyzed retrospectively. The indication for hypoosmolar riboflavin use was a central corneal thickness less than 400 µm as measured by ultrasound pachymetry after epithelial debridement and before exposure to ultraviolet A (UVA) light. Uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, slit lamp biomicroscopy, corneal tomography, corneal aberrometry, and endothelial cell counts were evaluated at baseline and yearly at all postoperative follow-up examinations until month 36. The outcomes of corneal CXL procedure performed using hypoosmolar riboflavin were compared to those performed using the standard procedure. Results: Twenty-three eyes (19 patients) were treated using hypoosmolar riboflavin application, and 30 eyes (28 patients) were treated using the standard procedure. Compared to baseline, the mean UDVA, CDVA, and keratometric readings improved statistically significantly in both groups at postoperative year 3, without any statistically significant between-group differences. Progression was not observed in any patient eye in either group. No significant endothelial cell loss and no sight threating complication were observed in any patient eye. Conclusion: At 3 years follow-up, the safety and efficacy of CXL using hypoosmolar riboflavin solution seems to be similar to that of standard CXL in progressive keratoconic eyes with thin corneas. The visual, refractive, keratometric, tomographic and aberrometric outcomes of the two procedures were comparable, as well. [ABSTRACT FROM AUTHOR]

Background: Corneal collagen cross-linking (CXL) is considered an effective procedure for slowing down or eliminating the progression of keratoconus. New techniques, in combination with CXL, have been proposed to stop the evolution of keratoconus and improve the visual function. Objective: To evaluate the effectiveness of combined photorefractive keratectomy (PRK) with mitomycin-C (MMC) application and CXL in the management of grade 1–2 keratoconus over a 2-year follow-up. Methods: Fifteen eyes underwent topography-guided PRK with 0.02% MMC application immediately followed by standard CXL. Results: Best corrected visual acuity improved from 0.15 ± 0.11 logMAR to 0.08 ± 0.09 logMAR at 24 months (p < 0.0001) in treated eyes. Mean steepest meridian keratometry reduced from 48.79 ± 3.22 D at baseline to 46.16 ± 3.11 D at 24 months (p < 0.0001). Mean flattest meridian keratometry reduced from 45.18 ± 2.17 D preoperatively to 44.35 ± 2.19 D at 24 months (p < 0.0001). Conclusion: Simultaneous topography-guided PRK with MMC 0.02% application and standard CXL is a safe, promising and effective procedure in the treatment of mild and moderate keratoconus. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aims to compare the long-term outcomes of standard corneal collagen crosslinking with accelerated corneal collagen crosslinking (CXL) for progressive keratoconus. PATIENTS AND METHODS: This prospective, comparative study included 79 eyes with progressive keratoconus, which were randomly assigned: 42 eyes received a standard CXL procedure, and 37 eyes were treated with the accelerated CXL protocol. We evaluated the following parameters, before the procedure and 1 month, 6 months, 12 months and 24 months postoperatively: best corrected visual acuity (BCVA), manifest refraction spherical equivalent (MRSE), cylindrical values, corneal dioptric powers on the steepest meridian (Kmax), central corneal thickness (CCT); demarcation line depth (DLD) preoperatively and 1 month after the CXL procedure. RESULTS: The BCVA, MRSE, cylindrical values, Kmax, CCT improved significantly, after both the accelerated and the standard CXL procedure. Throughout the 24-months follow-up, BCVA improvement was achieved sooner in the accelerated group (after 1 month, vs. after 3 months). However, there were no statistically significant differences between the two groups in these aspects. The DLD-to-CCT was significantly greater in the standard group (66% vs. 62%, p = 0.02). CONCLUSIONS: Standard and accelerated CXL are effective in stabilizing keratoconus progression in the long term. In clinical practice, the accelerated protocol has the added benefit of a faster visual recovery, in addition to the known reduced treatment time and increased comfort. [ABSTRACT FROM AUTHOR]

Keratoconus is an ectatic corneal disease characterized by progressive stromal thinning, irregular astigmatism, and defective vision. It can be unilateral or bilateral with asymmetric presentation. It starts at puberty and either progresses rapidly to an advanced stage of the disease or stops in case of delayed onset and slow progression. Pediatric keratoconus is more aggressive than in adults and the management protocols differ because of various rationales such as accelerated progression, advanced stage of disease at the time of diagnosis and co-morbidities. It poses a burden to the society as it affects the quality of life, social, and educational development in children. Hence early diagnosis, recognition of progression, and timely intervention with collagen crosslinking is imperative to arrest the worsening. Association with systemic syndromes and ocular comorbidities can be of concern in pediatric keratoconus. Severe ocular allergy when associated hastens progress and complicates timely intervention of crosslinking treatment and compliance to contact lens wear. Keratoplasty in pediatric keratoconus has good outcomes but can encounter frequent suture-related concerns. This article discusses the epidemiology, etiopathogenesis, clinical challenges, and current perspectives of management of pediatric keratoconus.

PURPOSE: The purpose of the study is to compare the short-term outcomes of corneal collagen crosslinking (CXL) using the conventional (Dresden) protocol and an accelerated CXL (ACXL) protocol to stop keratoconus (KC) progression. METHODS: A chart review was performed for all the patients with KC who underwent CXL in the last 7 years. Data were compared at baseline and at all follow-up examinations for uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), keratometry (K), central corneal thickness, and complications of CXL. Pre- and post-intervention values were compared for each group. P < 0.05 was statistically significant. RESULTS: After the treatment, there was a statistically greater improvement in UCVA in the conventional CXL (CCXL) group (49%) compared to the ACXL group (34%) (P = 0.028). The improvement in BCVA was similar between the groups (P = 0.060). Gain of two lines of UCVA and stability were comparable between groups (P = 0.078 and P = 0.060, respectively). The average flat K and steep K values fluctuated remarkably across different follow-up assessments in both the groups. At 3 months of follow-up, there was a statistically significantly faster return to baseline levels of flat and steep Ks in the CCXL group (P = 0.028 and P = 0.002, respectively). CONCLUSION: The findings of the current study confirm the efficacy and safety of accelerated high-fluence CXL compared to CCXL. Both protocols were effective in stabilizing KC at 9th-month and the last follow-up visit. Larger prospective randomized controlled trials and longer follow-up are required to confirm our findings. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of CXL in treating fungal keratitis as an adjuvant therapy.Methods: Detailed clinical examination microbiological investigation was performed. Twenty fungal keratitis patients were recruited and randomized into two groups: group 1 (n= 11, standard antifungal), group 2 (n=9, corneal collagen crosslinking with standard antifungal). Corneal scraping and tear samples collected were subjected to real-time PCR targeting ITS, TLR analysis and cytokine analysis.Results: The mean time for complete resolution of ulcer for group 2 was significantly shorter compared to group 1 and the final mean BCVA was better for group 2. Expression of IL-1β, IL-8, IFN-γ significantly decreased immediately post CXL in group 2 patients. Significant downregulation of TLR 6, TLR-3, TLR-4 was observed 3-days post CXL compared to group 1 patients.Conclusion: Adjuvant effect of CXL was significant in treating fungal keratitis compared to standalone antifungal treatment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of femtosecond laser-assisted MyoRing implantation with concurrent corneal collagen crosslinking (CXL) compared to MyoRing alone for the treatment of progressive keratoconus. Methods: A total of 60 patients were enrolled in this randomized controlled trial. The patients were randomly allocated into two groups. In the first group, MyoRing was implanted, while in the second, it was inserted in the corneal stroma using the same technique, along with simultaneous CXL. Visual, refractive, topographic, and abberometric outcomes were measured preoperatively and at every postoperative visit. Results: Data of 47 patients were available at the end of the study; 28 in the MyoRing group and 19 in the MyoRing + CXL group. The mean uncorrected distance visual acuity (UDVA) improved from 0.79 ± 0.39 logMAR to 0.52 ± 0.31 logMAR (P < 0.05) in the MyoRing + CXL group and from 0.65 ± 0.38 logMAR to 0.62 ± 0.23 logMAR (P = 0.70) in the MyoRing group. CDVA changed from 0.33 ± 0.19 logMAR to 0.25 ± 0.16 logMAR (P = 0.10) in the MyoRing + CXL group and 0.32 ± 0.22 logMAR to 0.33 ± 0.17 logMAR (P > 0.50) in the MyoRing group. The mean keratometry (Km) decreased from 47.5 ± 2.7 D to 43.8 ± 3.2 D (P < 0.001) in the MyoRing group and 49.3 ± 3.4 D to 45.1 ± 3.0 D (P < 0.001) in the MyoRing + CXL group. Besides, horizontal coma was significantly lower in the MyoRing + CXL group (P = 0.022). Conclusion: MyoRing insertion combined with CXL is a safe and effective method for the treatment of keratoconus. The visual and topographic outcomes were comparable to that for MyoRing insertion after 10 months; however, horizontal coma was significantly lower in the MyoRing + CXL group.

AIM: To compare the safety and efficacy of conventional versus accelerated (9 mW/cm2) corneal collagen crosslinking (CXL) in progressive keratoconus at the 2-year follow-up. METHODS: In this prospective study, consecutive progressive keratoconus patients were randomized to receive either conventional CXL (CCXL) or accelerated CXL (ACXL; using hydroxypropyl methylcellulose-assisted riboflavin imbibition for 10min at 9 mW/cm2). Visual, refractive, keratometric, topographic, and aberrometric outcomes and stromal demarcation line depth (DLD) measurements were compared at the end of a 2-year follow-up. RESULTS: Thirty-two eyes from 32 patients in the CCXL and 27 eyes from 27 patients in the ACXL groups completed 2-year follow-up. At 2y post-CXL, both uncorrected and corrected visual acuities improved significantly in both groups. The improvements in keratometric readings, flattening rate (flattening of the maximum keratometry more than 1 D), 3 topographic indices, and vertical coma were significantly better in the CCXL group compared to the ACXL group (P

Abstract Purpose Corneal collagen crosslinking has been proven to be a useful technique to slow the progression of keratoconus. With its increasing use, we are encountering rare complications. We describe a case that developed bilateral viral keratitis after corneal collagen crosslinking with riboflavin and ultraviolet A for progressive keratoconus. Case report An 18-year-old boy underwent corneal collagen crosslinking in both the eyes at the same setting for bilateral progressive keratoconus. He was discharged with a soft bandage contact lens and asked to follow up in 5 days. Seven days later, the patient returned with severe pain, redness, and photophobia for the last 2 days. The bandage contact lens was removed. There was a central corneal lesion in a branching dendritic pattern in both the eyes and the corneal sensation was reduced. Based on the findings, a clinical diagnosis of bilateral viral keratitis was made. The dendrite healed completely in 10 days with oral and topical acyclovir treatment, and the cornea had a faint scar at 1 month follow-up with best-corrected visual acuity of 6/9 in both eyes with a rigid gas permeable lens. Discussion and conclusion Ultraviolet A light could be a stimulus to trigger reactivation of latent HSV infections even in patients with no history of clinically evident herpes virus ocular infections. Early diagnosis and timely treatment can have good visual outcome. Prophylactic antiviral medication may be useful to prevent this complication in individuals with prior history of viral keratitis.

Keratoconus is an ectatic corneal disease characterized by progressive stromal thinning, irregular astigmatism, and defective vision. It can be unilateral or bilateral with asymmetric presentation. It starts at puberty and either progresses rapidly to an advanced stage of the disease or stops in case of delayed onset and slow progression. Pediatric keratoconus is more aggressive than in adults and the management protocols differ because of various rationales such as accelerated progression, advanced stage of disease at the time of diagnosis and co-morbidities. It poses a burden to the society as it affects the quality of life, social, and educational development in children. Hence early diagnosis, recognition of progression, and timely intervention with collagen crosslinking is imperative to arrest the worsening. Association with systemic syndromes and ocular comorbidities can be of concern in pediatric keratoconus. Severe ocular allergy when associated hastens progress and complicates timely intervention of crosslinking treatment and compliance to contact lens wear. Keratoplasty in pediatric keratoconus has good outcomes but can encounter frequent suture-related concerns. This article discusses the epidemiology, etiopathogenesis, clinical challenges, and current perspectives of management of pediatric keratoconus. [ABSTRACT FROM AUTHOR]

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To report early results of combined accelerated corneal collagen crosslinking (CXL) and intrastromal Kerarings implantation by femtosecond laser in a case of advanced superior keratoconus.Methods: The patient was a 27-year-old male with left eye grade 3 keratoconus with superior cone. He was diagnosed by Sirius Scheimpflug corneal topography (CSO, Florence, Italy). The right eye had previously been subjected to penetrating keratoplasty. The uncorrected visual acuity (UCVA) in the right eye (RE) was 1.2 LogMAR, best corrected visual acuity (BCVA) was 0.8 by a refraction of –7.50Ds –3.00Dc @12. The UCVA in the left eye (LE) was 1.2 LogMAR, BCVA was 0.9 by a refraction of –8.50 Ds –5.50Dc @169. Intrastromal Kerarings implantation by femtosecond laser was carried out by IntraLase (iFS, Abbott) along with accelerated transepithelial corneal collagen crosslinking by KXL system (Avedro, USA) in the same session. Follow-up was done for a period of 12 months after surgery. Results: The patient was followed up for 12 months with improvement of visual acuity as regards UCVA and BCVA and improvement of corneal topographic parameters including keratometry and front and back elevations.Conclusion: Combined accelerated corneal collagen crosslinking and intrastromal Kerarings implantation by femtosecond laser is an effective method in the treatment of this uncommon type of keratoconus.

Purpose: to compare clinical, functional and morphological results of treatment of progressing keratoconus by femtosecond, trans-epithelial and standard corneal collagen crosslinking. Material and methods. 114 patients aged 18-35 (148 eyes) with progressing keratoconus of stages I-III and iatrogenic keratectasia were divided into three groups. Group 1 (39 patients, 47 eyes) received femtosecond corneal collagen crosslinking; group 2 (33 patients, 45 eyes) underwent transepithelial crosslinking and group3 underwent crosslinking performed with standard technique. Results. The analysis of data of confocal microscopy performed 1 year after femtosecond and standard corneal collagen crosslinking revealed the effect of cross linkage in the anterior and middle corneal stroma, an increased density of the extracellular matrix, regeneration of subepithelial and stromal nervous fibers, and keratocyte repopulation. 1 year after trans epithelial crosslinking, keratocyte population was restored. Slight folding in the anterior stroma was observed due to the cross linkage effect. Conclusion. The preserved epithelial layer of the cornea reduces the risk of infectious complications on the eroded surface of the cornea, diminishes visual discomfort and sensation of pain in patients in the early postoperative period, and shortens the rehabilitation period. After trans-epithelial corneal collagen crosslinking, no pronounced effect of cross linkage in the stroma was observed. The available weak positive result justifies the recommendation to use this technique in children, patients with thin cornea, those likely to develop complications during reepithelization, and as a preventive measure in cases of slow progression rate // Russian ophthalmological journal. 2017; 10 (2): 47-53. (in Russian). doi: 10.21516/2072-0076-2017-10-2-47-53.

Corneal collagen cross-linking (CXL) with riboflavin and UVA light is a therapeutic procedure to restore the mechanical stability of corneal tissue. The treatment method applies to pathological tissue changes, such as keratoconus. It induces the photochemical formation of new collagen cross-links. Although therapeutic effects are indisputable, the exact molecular process of CXL and how cross-links are formed is still unclear. In this work, Fouriertransform infrared (FT-IR) spectroscopy is used to investigate the cross-linking process. For that purpose, in-situ experiments with porcine corneas are carried out using attenuated total reflection (ATR) spectroscopy. Furthermore, IR micro-spectroscopic imaging in transmission mode is used to investigate thin tissue sections of the cornea and initial approaches for the distinction of cross-linked and untreated tissue by IR microspectroscopic imaging were performed. Multivariate methods are applied to access changes that occur as a result of CXL. It is shown that spectral changes after cross-linking are caused predominantly by an increase of methyl- and methylene groups as well as primary and secondary amines. In addition, a decrease of carbonyl groups could be observed.

Purpose: To evaluate the safety and efficacy of femtosecond laser-assisted MyoRing implantation with concurrent corneal collagen crosslinking (CXL) compared to MyoRing alone for the treatment of progressive keratoconus. Methods: A total of 60 patients were enrolled in this randomized controlled trial. The patients were randomly allocated into two groups. In the first group, MyoRing was implanted, while in the second, it was inserted in the corneal stroma using the same technique, along with simultaneous CXL. Visual, refractive, topographic, and abberometric outcomes were measured preoperatively and at every postoperative visit. Results: Data of 47 patients were available at the end of the study; 28 in the MyoRing group and 19 in the MyoRing + CXL group. The mean uncorrected distance visual acuity (UDVA) improved from 0.79 ±0.39 logMAR to 0.52 ±0.31 logMAR (P <0.05) in the MyoRing + CXL group and from 0.65 ± 0.38 logMAR to 0.62 ± 0.23 logMAR (P = 0.70) in the MyoRing group. CDVA changed from 0.33 ±0.19 logMAR to 0.25 ±0.16 logMAR (P = 0.10) in the MyoRing + CXL group and 0.32 ± 0.22 logMAR to 0.33 ± 0.17 logMAR (P > 0.50) in the MyoRing group. The mean keratometry (Km) decreased from 47.5 ± 2.7 D to 43.8 ± 3.2 D (P < 0.001) in the MyoRing group and 49.3 ± 3.4 D to 45.1 ± 3.0 D (P < 0.001) in the MyoRing + CXL group. Besides, horizontal coma was significantly lower in the MyoRing + CXL group (P = 0.022). Conclusion: MyoRing insertion combined with CXL is a safe and effective method for the treatment of keratoconus. The visual and topographic outcomes were comparable to that for MyoRing insertion after 10 months; however, horizontal coma was significantly lower in the MyoRing + CXL group. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 3-year results of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in keratoconus patients with previous corneal collagen crosslinking (CXL) treatment. Methods: Twenty eyes of 20 keratoconus patients who underwent DALK surgery using the big-bubble technique after CXL treatment between January 2011 and September 2015 were retrospectively reviewed. All patients completed 3 years follow-up. Intraoperative and postoperative complications were recorded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), maximum keratometry, keratometric astigmatism and endothelial cell density (ECD) were analysed. Results: The mean interval between CXL and DALK surgery was 47.5 ± 24.0 months (mean ± SD). DALK was completed in all eyes. Big-bubble was successfully achieved in 16 eyes (80%), and manual dissection was performed in four eyes (20%). Microperforation occurred in three eyes (15%). Postoperatively, persistent epithelial defect occurred in three eyes (15%). The mean UCVA and mean BSCVA values were significantly improved preoperatively to all postoperative visits (p < 0.001). UCVA was 20/100 or lower in all eyes preoperatively and 20/100 or better in 18 eyes (80%) at 3 years; BSCVA was 20/40 or better in all eyes (100%) and 20/20 or better in three eyes (15%), and keratometric astigmatism was lower than 4 dioptres in 14 eyes (70%) at 3 years. The mean ECD loss was 6.3 ± 4.4% at 1 year, 9.0 ± 6.3% at 2 years and 11.2 ± 7.4% at 3 years. Conclusion: Previous CXL treatment in keratoconus patients did not cause a negative impact on the visual, refractive and surgical outcomes of DALK surgery using the big-bubble technique. DALK surgery seems to be a safe and effective surgical approach in these patients. [ABSTRACT FROM AUTHOR]

Purpose: This is the first review article examining literature specific to the use of corneal cross-linking (CXL) to treat pellucid marginal degeneration (PMD). Results: CXL appears to be an effective treatment that may halt the progression of PMD to stabilize vision. This could postpone or eliminate the need for corneal transplantation in the management of these patients. Furthermore, combining CXL with keratorefractive surgery in a single procedure has been shown to be safe and successful in improving vision in PMD patients. Conclusions: The data reported in literature is limited at this time, consisting mostly of retrospective studies with short term follow up. Further research is needed to evaluate refractive effects of combined CXL and excimer laser procedures. [ABSTRACT FROM AUTHOR]

(Lymph)angiogenesis into the cornea prior to and after corneal transplantation is a critical risk factor for allograft rejection. Lymphatic vessels even more than blood vessels seem important in mediating immune responses, as they facilitate allograft sensitization in the draining lymph nodes. Thus, the concept of modulating lymphatic trafficking to promote corneal graft survival seems promising. A variety of approaches has been developed to inhibit progressive lymphangiogenesis in experimental settings. Recently, additionally to pharmacological approaches, clinically available techniques such as UVA-based corneal collagen crosslinking and fine needle diathermy were reported to be effective in regressing lymphatic vessels and to experimentally promote graft survival. Clinical pilot studies also suggest the efficacy of blocking antigen presenting cell trafficking to regional lymph nodes by regressing corneal lymphatic vessels to enhance allograft survival in high-risk eyes. In this article, we will give an overview of current strategies to modulate lymphatic trafficking with a special focus on recently reported strategies, which may be easy to translate into clinical practice. This novel concept of temporary, pretransplant regression of lymphatic vessels at the site of transplantation to promote subsequent corneal transplant survival (“lymphangioregressive preconditioning”) may also be applicable to other transplantation sites later.

AIM: To analyze the clinical factors influencing the human vision corrections via the changing of ocular components of human eye in various applications; and to analyze refractive state via a new effective axial length. METHODS: An effective eye model was introduced by the ocular components of human eye including refractive indexes, surface radius (r1, r2, R1, R2) and thickness (t, T) of the cornea and lens, the anterior chamber depth (S1) and the vitreous length (S2). Gaussian optics was used to calculate the change rate of refractive error per unit amount of ocular components of a human eye (the rate function M). A new criterion of myopia was presented via an effective axial length. RESULTS: For typical corneal and lens power of 42 and 21.9 diopters, the rate function Mj (j=1 to 6) were calculated for a 1% change of r1, r2, R1, R2, t, T (in diopters) M1=+0.485, M2=-0.063, M3=+0.053, M4=+0.091, M5=+0.012, and M6=-0.021 diopters. For 1.0 mm increase of S1 and S2, the rate functions were M7=+1.35, and M8=-2.67 diopter/mm, respectively. These rate functions were used to analyze the clinical outcomes in various applications including laser in situ keratomileusis surgery, corneal cross linking procedure, femtosecond laser surgery and scleral ablation for accommodation. CONCLUSION: Using Gaussian optics, analytic formulas are presented for the change of refractive power due to various ocular parameter changes. These formulas provide useful clinical guidance in refractive surgery and other related procedures.

Aim: analysis of clinical and functional results, histomorphological changes of corneas in the application of the method of corneal collagen crosslinking with the formation of a femtosecond intrastromal pocket. Material and Methods. We studied 20 patients (20 eyes) that were operated for progressive keratoconus (1-2 stage) with a peripheral zone of maximum ectasia arrangement via corneal collagen cross-linking with femtosecond formation of intrastromal pocket for introduction of a photosensitizerand local ultraviolet radiation. Results. The result was a decrease of surgery duration and reduction of the severity of pain in the early postoperative period. Conclusion. This method allows to increase the safety of the treatment of keratoconus, reducing the risk of postoperative complications.

Bacterial keratitis is a serious ocular infectious disease that can threaten vision. The disease generally progresses rapidly and can lead to corneal scar, stromal abscess formation, perforation, and dissemination to adjacent tissues if not treated properly. Recent studies showed that corneal collagen crosslinking (CCC) using ultraviolet-A/riboflavin is effective in the treatment of bacterial keratitis refractory to topical antibiotic treatment. In addition to being bactericidal, CCC also decreases risk of perforation by strengthening the corneal collagen structure. Herein, we report a male patient with Streptococcus pneumonia keratitis 6 months after a keratoplasty procedure, which did not respond to fortified topical antibiotic therapy and was treated successfully with riboflavin/ultraviolet-A CCC. His pain decreased remarkably in a few days. The corneal epithelial defect healed and infiltration regressed within 2 weeks after CCC. His vision improved significantly from hand movement to 20/400. CCC might be used as adjuvant treatment in bacterial keratitis refractory to medical treatment.

Virgilio Galvis,1–3 Alejandro Tello,1–3 Alvaro I Ortiz,3 Luis C Escaf2 1Centro Oftalmológico Virgilio Galvis, Floridablanca, 2Department of Ophthalmology, Faculty of Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, 3Department of Ophthalmology, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia Abstract: 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. Some predictors of CXL outcome have been identified. We will review the current knowledge on patient selection for CXL, its indications, and options in special cases (such as thin corneas). Keywords: keratoconus, cornea, cross-linking, corneal collagen cross-linking, keratoectasia

The introduction of early diagnostic methods for keratoconus into clinical practice has become the basis for the development of surgical treatment techniques for this pathology, such as corneal collagen crosslinking and interlamellar keratoplasty with implantation of intrastromal segments. The article analyzes the results of research by Russian and foreign specialists in these areas and presents the data on the combination of SMILE surgery and corneal crosslinking, the Rome protocol of corneal crosslinking, modifications of interlamellar keratoplasty, the use of femtosecond laser technologies, and some pilot studies. Modern requirements for ophthalmological care require a personalized approach to each patient, and therefore the surgeon should have a wide range of surgical methods of treatment applicable to different patient cohorts. The described methods of treatment, according to the authors, are the most promising.

Purpose: To compare management of postoperative pain after corneal collagen crosslinking (CXL) with oral gabapentin or ketorolac. Methods: Prospective interventional comparative case series in a single center. Patients undergoing epithelium-off (epi-off) or epithelium-on (epi-on) techniques performed by a single surgeon for progressive keratoconus were enrolled and randomly assigned to the ketorolac (10-mg tablets every 8 h) or the gabapentin (300-mg capsules every 8 h) group and instructed to take the medication for the first 3 postoperative days. Using a numeric scale of pain, scores were assessed for current pain (at the time of applying the questionnaire), and average pain over the preceding 24 h. Eye symptoms and systemic adverse events related to oral medication were also assessed. Results: Thirty-seven patients were included, with 22 (10 epi-on and 12 epi-off) assigned to the ketorolac group and 15 (7 epi-on and 8 epi-off) to the gabapentin group. No statistically significant differences were noted on the pain scale between groups at any point of the study, in the median pain scores of patients at the time of applying the questionnaire, nor in the severity of pain during the 24-h period before the assessment. Also, no differences were found among groups for the eye symptoms and the systemic adverse events. The median regression analysis showed no effect of the type of surgery or gender in the severity of pain. Conclusions: Both oral ketorolac and oral gabapentin can be used with similar results for pain and symptomatic control after epi-on or epi-off CXL procedures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to assess changes in optical performance of the cornea in patients with keratoconus following treatment with corneal collagen crosslinking (CXL). Materials and Methods: One hundred and eleven eyes of 111 consecutive keratoconus patients with 12-month follow-up after CXL were included. The changes in the visual acuity, manifest refractive errors, and corneal topographic parameters were evaluated. Sirius dual-scanning corneal tomography was used to determine the effectiveness of CXL on each patient’s total corneal optical quality; preoperative and 12-month postoperative measurements were analyzed over a 4-mm stimulated pupil and were compared with regards to higher order corneal aberrations (total amount of higher order aberrations [HOAs], vertical coma, horizontal coma, vertical trefoil, oblique trefoil, and spherical aberration), vertical and horizontal modulation transfer function (MTF), and Strehl ratio of point spread function (PSF). Results: At 12 months, there was a significant improvement in mean uncorrected visual acuity (UCVA) (P < 0.001), best corrected visual acuity (BCVA) (P < 0.001), spherical equivalent refraction (P = 0.007), and manifest astigmatic refraction (P < 0.001). The corneal topographic measurements revealed a significant decrease in the mean simulated keratometry-1, simulated keratometry -2, and maximum keratometry compared with the baseline measurements (P < 0.001, for all). In addition, there were significant improvements in mean root mean square error values for corneal total HOA (P < 0.001), vertical coma (P < 0.001), and vertical trefoil (P = 0.008) following CXL. Mean MTF and Strehl ratio did not change after CXL (P > 0.05). The improvement in UCVA significantly correlated with the changes in vertical trefoil (r = −0.191, P = 0.044), and the improvement in BCVA and the changes in manifest astigmatic correction were also significantly correlated (r = −0.247, P = 0.009) 12 months after CXL. Conclusions: CXL treatment for keratoconus led to an improvement in visual, refractive, topographic, and most corneal HOAs outcomes at the 12-month follow-up. However, these improvements were not enough to increase corneal MTF and the Strehl ratio of PSF. [ABSTRACT FROM AUTHOR]