Corneal crosslinking without epithelial removal.

MedStar author(s):
Citation: Journal of Cataract & Refractive Surgery. 44(11):1363-1370, 2018 Nov.PMID: 30228014Institution: MedStar Washington Hospital CenterDepartment: OphthalmologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Collagen/me [Metabolism] | *Keratoconus/dt [Drug Therapy] | *Photochemotherapy/mt [Methods] | Adult | Cross-Linking Reagents/tu [Therapeutic Use] | Epithelium, Corneal/su [Surgery] | Female | Humans | Male | Middle Aged | Photosensitizing Agents/tu [Therapeutic Use] | Prospective Studies | Riboflavin/tu [Therapeutic Use]Year: 2018Local holdings: Available online through MWHC library: 1999 - 2010, Available in print through MWHC library:1999-2007ISSN:
  • 0886-3350
Name of journal: Journal of cataract and refractive surgeryAbstract: CONCLUSION: Epithelium-on CXL using this new protocol halted the progression of keratoconus and ectasia after LASIK. It was safer and provided more rapid visual recovery than CXL with epithelial removal, allowing routine bilateral, simultaneous treatment.Copyright (c) 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.DESIGN: Prospective observational study.METHODS: Patients were treated with a new riboflavin formulation without epithelial removal, then exposed to UV light (365 nm) at 4 mW/cm<sup>2</sup> with on-off cycling for 30 minutes. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, maximum corneal curvature (maximum keratometry [Kmax]), total higher-order aberrations (HOAs), and coma were measured at 3, 6, 12, and 24 months postoperatively. Progression was defined as an increase of more than 1 diopter (D) in Kmax and loss of more than 1 line of CDVA.PURPOSE: To evaluate the effect of riboflavin-ultraviolet (UV)-A corneal crosslinking (CXL) without epithelial removal on ectatic corneal disease.RESULTS: Five hundred twelve eyes of 308 patients with keratoconus or forme fruste keratoconus and 80 eyes of 55 patients with ectasia after laser in situ keratomileusis (LASIK) were treated with the new riboflavin formulation without epithelial removal; 229 patients received bilateral treatments, 95 of which were simultaneous. The mean UDVA and CDVA improved by 1 to 1.5 Snellen lines at 1 and 2 years postoperatively (P < .0001). Mean Kmax decreased by 0.48 D at 2 years postoperatively (P = .0002). Mean total HOAs and coma decreased by 36% (P < .0001) and 37% (P = .0002), respectively, at 2 years postoperatively. Kmax decreased more than 1 D in three times as many eyes as it increased more than 1 D (P < .0001). No eyes progressed, and there was no loss of effect between 1 and 2 years postoperatively. No vision-threatening events were observed. Pain typically resolved within 24 hours, and visual acuity returned to preoperative levels in 1 to 2 days.SETTING: Woolfson Eye Institute, Atlanta, Georgia, USA.All authors: Rubinfeld RS, Stulting RD, Trattler WB, Woolfson JMOriginally published: Journal of Cataract & Refractive Surgery. 2018 Sep 15Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2018-09-28
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30228014 Available 30228014

Available online through MWHC library: 1999 - 2010, Available in print through MWHC library:1999-2007

CONCLUSION: Epithelium-on CXL using this new protocol halted the progression of keratoconus and ectasia after LASIK. It was safer and provided more rapid visual recovery than CXL with epithelial removal, allowing routine bilateral, simultaneous treatment.

Copyright (c) 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

DESIGN: Prospective observational study.

METHODS: Patients were treated with a new riboflavin formulation without epithelial removal, then exposed to UV light (365 nm) at 4 mW/cm<sup>2</sup> with on-off cycling for 30 minutes. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, maximum corneal curvature (maximum keratometry [Kmax]), total higher-order aberrations (HOAs), and coma were measured at 3, 6, 12, and 24 months postoperatively. Progression was defined as an increase of more than 1 diopter (D) in Kmax and loss of more than 1 line of CDVA.

PURPOSE: To evaluate the effect of riboflavin-ultraviolet (UV)-A corneal crosslinking (CXL) without epithelial removal on ectatic corneal disease.

RESULTS: Five hundred twelve eyes of 308 patients with keratoconus or forme fruste keratoconus and 80 eyes of 55 patients with ectasia after laser in situ keratomileusis (LASIK) were treated with the new riboflavin formulation without epithelial removal; 229 patients received bilateral treatments, 95 of which were simultaneous. The mean UDVA and CDVA improved by 1 to 1.5 Snellen lines at 1 and 2 years postoperatively (P < .0001). Mean Kmax decreased by 0.48 D at 2 years postoperatively (P = .0002). Mean total HOAs and coma decreased by 36% (P < .0001) and 37% (P = .0002), respectively, at 2 years postoperatively. Kmax decreased more than 1 D in three times as many eyes as it increased more than 1 D (P < .0001). No eyes progressed, and there was no loss of effect between 1 and 2 years postoperatively. No vision-threatening events were observed. Pain typically resolved within 24 hours, and visual acuity returned to preoperative levels in 1 to 2 days.

SETTING: Woolfson Eye Institute, Atlanta, Georgia, USA.

English

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