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corneal collagen cross‑linking epithelium‑on ***‑off:a systematic review and meta‑analysis

Eye and Vision 2021年第6期8卷 338-352页

作者： Francesco D’Oria Antonio Palazón Jorge L.Alio Vissum Innovation c/Cabañal103016 AlicanteSpain Division of Ophthalmology Universidad Miguel HernándezAlicanteSpain Section of Ophthalmology Department of Basic Medical ScienceNeuroscience and Sense OrgansUniversity of BariBariItaly Department of Clinical Medicine Miguel Hernández UniversitySan Juan de AlicanteSpain

Background:The purpose of the study was to determine the advantages and disadvantages of epi-on corneal crosslinking(CXL)techniques compared with standard epi-off ***:We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias *** considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment ***-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect ***:A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this *** analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;Pcorneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion:Epi-on CXL is as effective as epi-off *** for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial ***-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.

关键词： corneal collagen cross-linking Keratoconus Transepithelial CXL Epithelium-off CXL Epithelium-on CXL Iontophoresis

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corneal collagen cross-linking and liposomal amphotericin B combination therapy for fungal keratitis in rabbits

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International Journal of Ophthalmology(English edition) 2016年第11期9卷 1549-1554页

作者： Zhao-Qin Hao Jin-Xin Song Shi-Yin Pan Lin Zhang Yan Cheng Xian-Ning Liu Jie Wu Xiang-Hua Xiao Wei Gao Hai-Feng Zhu Department of Ophthalmology the First Hospital of Xi'anShaanxi Ophthalmological Institute Department of Ophthalmology the First Affiliated Hospital of Xi'an Jiaotong University

AIM： To observe the therapeutic effect of corneal collagen cross-linking（CXL） in combination with liposomal amphotericin B in fungal corneal ***： New Zealand rabbits were induced fungal corneal ulcers by scratching and randomly divided into 3groups, i.e. control, treated with CXL, and combined therapy of CXL with 0.25% liposomal amphotericin B（n =5 each）. The corneal lesions were documented with slit-lamp and confocal microscopy on 3, 7, 14, 21 and 28 d after treatment. The corneas were examined with transmission electron microscopy（TEM） at ***： A rabbit corneal ulcer model of Fusarium was successfully established. The corneal epithelium defect areas in the two treatment groups were smaller than that in the control group on 3, 7, 14 and 21d（P 〈0.05）. The corneal epithelium defect areas of the combined group was smaller than that of the CXL group（P 〈0.05） on 7 and 14 d, but there were no statistical differences on 3, 21 and 28 d. The corneal epithelium defects of the two treatment groups have been healed by day 21. The corneal epithelium defects of the control group were healed on 28 d. The diameters of the corneal collagen fiber bundles（42.960 ±7.383 nm in the CXL group and 37.040±4.160 nm in the combined group） were thicker than that of the control group（24.900±1.868 nm）,but there was no difference between the two treatment groups. Some corneal collagen fiber bundles were distorted and with irregular arrangement, a large number of fibroblasts could be seen among them but no inflammatory cells in both treatment groups. CONCLUSION： CXL combined with liposomal amphotericin B have beneficial effects on fungal corneal ulcers. The combined therapy could alleviate corneal inflammattions, accelerate corneal repair, and shorten the course of disease.

关键词： corneal collagen cross-linking liposomalamphotericin B fungal keratitis confocal microscope rabbit

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A short-term study of corneal collagen cross-linking with hypo-osmolar riboflavin solution in keratoconic corneas

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International Journal of Ophthalmology(English edition) 2015年第1期8卷 94-97页

作者： Shao-Feng Gu Zhao-Shan Fan Li-Hua Wang Xiang-Chen Tao Yong Zhang Chun-Qin Wang Ya Wang Guo-Ying Mu Department of Ophthalmology Shandong Provincial Hospital Affiliated to Shandong University

AIM: To report the 3mo outcomes of collagen crosslinking(CXL) with a hypo-osmolar riboflavin in thin corneas with the thinnest thickness less than 400 μm without ***: Eight eyes in 6 patients with age 26.2±4.8y were included in the study. All patients underwent CXL using a hypo-osmolar riboflavin solution after its de-epithelization. Best corrected visual acuity, manifest refraction, the thinnest corneal thickness, and endothelial cell density were evaluated before and 3mo after the ***: The mean thinnest thickness of the cornea was 408.5 ±29.0 μm before treatment and reduced to369.8 ±24.8 μm after the removal of epithelium. With the application of the hypo-osmolar riboflavin solution, the thickness increased to 445.0 ±26.5 μm before CXL and recover to 412.5 ±22.7 μm at 3mo after treatment, P =0.659). Before surgery, the mean K-value of the apex of the keratoconus corneas was 57.6 ±4.0 diopters, and slightly decreased(54.7±4.9 diopters) after surgery(P =0.085). Mean best-corrected visual acuity was 0.55 ±0.23 logarithm of the minimal angle of resolution, and increased to 0.53±0.26 logarithm after surgery(P =0.879).The endothelial cell density was 2706.4 ±201.6 cells/mm2 before treatment, and slightly decreased( 2641. 2 ±218.2 cells/mm2) at last fellow up(P =0.002).CONCLUSION: corneal collagen cross-linking with a hypo-osmolar riboflavin in thin corneas seems to be a promising treatment. Further study should be done to evaluate the safety and efficiency of CXL in thin corneas for the long-term.

关键词： corneal collagen cross-linking keratoconus hypo-osmolar riboflavin thin corneas

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Central corneal regularization (CCR): an alternative approach in keratoconus treatment

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Eye and Vision 2019年第1期6卷 338-344页

作者： Giulio Mulè Shihao Chen Jia Zhang Wen Zhou Vasileios Selimis Aleksandar Stojanovic Ioannis M.Aslanides iVis Trento Center San Camillo HospitalTrentoItaly Eye Hospital Wenzhou Medical UniversityWenzhouChina SynsLaser Kirurgi AS Skippergata 7TromsoNorway Emmetropia Mediterranean Eye Institute Plateia Eleftherias 44Heraklion71201 CreteGreece

Background:To evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking(CXL)to strengthen the corneal tissue and stop the progression of *** transepithelial therapeutic ablation applied a novel concept named central corneal regularization(CCR)which could correct the corneal morphological irregularities and the eye’s spherocylindrical refractive error with minimal stromal tissue ***:Retrospective *** that underwent CCR combined with CXL were evaluated preoperatively and up to 12 months postoperatively for visual acuity,subjective refraction,corneal haze,pachymetry and maximum keratometry(Kmax).Results:Twenty four eyes of 24 patients with a mean age of 28.92±9.88 years were *** mean spherical equivalent(SE)refractive error changed from−0.74±1.17 D preoperatively to−1.05±1.52 D at 12 months *** mean uncorrected distance visual acuity(UDVA)and corrected distance visual acuity(CDVA)*** eye lost lines of CDVA,21 had a mean improvement of 3.21 *** mean cylinder error and Kmax value dropped from−3.06±1.83 D and 51.38±3.29 D to−1.04±0.80 D and 48.70±2.58 D,*** mean haze score at 3,6 and 12 months was 0.56,0.19 and 0.06,***:CCR combined with CXL offers promising results as a safe and effective treatment in keratoconic patients.

关键词： Central corneal regularization corneal collagen cross-linking Transepithelial Excimer laser Keratoconus

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Combined corneal CXL and photorefractive keratectomy for treatment of keratoconus: a review

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International Journal of Ophthalmology(English edition) 2019年第12期12卷 1929-1938页

作者： Mansour M.Al-Mohaimeed Department of Ophthalmology College of Medicine Qassim University

Keratoconus and iatrogenic keratectasia are the corneal ectatic disorders occurring due to biomechanical weakening of the cornea resulting in distorted images,myopia, and irregular astigmatism. corneal collagen cross-linking(CXL) is performed to arrest keratoconus successfully. The main aim of this review is to discuss the safety and efficacy of the adjuvant therapies, such as the combination of CXL and photorefractive keratectomy(PRK) for the treatment of corneal ectatic disorders. A comprehensive literature search was performed using PubM ed, MEDLINE, and Scopus using keywords ‘collagen’‘keratoconus’,‘keratectasia’,‘collagen cross-linking’,and ‘photorefractive keratectomy’. Search results were restricted to clinical studies published in English. corneal CXL effectively arrests the progression of keratoconus by enhancing corneal rigidity. However, functional vision is not improved by cross-linking. Combining CXL to refractive surgeries such as topography-guided PRK or transepithelial PRK is found to be a safe and effective method in providing corneal stability as well as significantly improving functional visual acuity with few minor complications. This combined technique also prevents regression of keratoconus and reduce the risk of keratectasia. CXL combined with PRK is a promising therapeutic approach in ophthalmology that can be successfully used to treat progressive keratoconus and other corneal ectatic disorders and to enhance visual acuity.

关键词： corneal collagen cross-linking photorefractive keratectomy keratoconus

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Topography versus non-topography-guided photorefractive keratectomy with corneal cross-linking variations in keratoconus

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International Journal of Ophthalmology(English edition) 2022年第5期15卷 721-727页

作者： Sana Niazi Jorge Alio del Barrio Azad Sanginabadi Farideh Doroodgar Cyrus Alinia Alireza Baradaran-Rafii Feaizollah Niazi Hossein Mohammad-Rabei Mohammad Mehdi Sadoughi Jorge L.Alio Department of Ophthalmology Shahid Beheshti University of Medical SciencesTehran 3113Iran Vissum Alicante 03016Spain Division of Ophthalmology Universidad Miguel HernándezAlicante 03016Spain Department of Optometry Iran University of Medical SciencesTehran 4599Iran Negah Specialty Ophthalmic Research Center Shahid Beheshti University of Medical ScienceTehran 4599Iran Department of Public Health School of Public HealthUrmia University of Medical SciencesUrmiaWest Azerbaijan 3734Iran Department of ophthalmology University of South FloridaTampaFlorida 33617USA

AIM:To compare the visual results of non-topographyguided and topography-guided photorefractive keratectomy(PRK)applying sequential and simultaneous corneal crosslinking(CXL)treatment for ***:Interventional and comparative prospective ***-nine eyes(36 patients)suffering from keratoconus(stages 1 Amsler-Krumeich classification)were divided into four groups:sequential topography-guided photorefractive keratectomy with CXL,simultaneous topography-guided photorefractive keratectomy with CXL,simultaneous nontopography guided photorefractive keratectomy with CXL,and sequential non-topography guided photorefractive keratectomy with *** main outcome measures were pre-and postoperative uncorrected distance visual acuity(UDVA),best corrected distance visual acuity(CDVA),manifest refraction,contrast sensitivity,and ***:All analyzed visual,contrast sensitivity,and refractive parameters showed a significant improvement in the four groups(all P<0.05).A noticeable improvement was seen in keratometry in all the groups,and a remarkable difference was observed between topography-guided groups in comparison to non-topography-guided groups(P<0.05).Interestingly,the improvement in all parameters showed a degree of stability to the end of the ***:The treatment priorities in all four groups are safety,efficacy,and predictability in the correction of the sphero-cylindrical errors in mild and moderate *** significant differences among groups in the recorded objective outcomes were found.

关键词： photorefractive keratectomy corneal collagen cross-linking keratoconus

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Consideration of corneal biomechanics in the diagnosis and management of keratoconus: is it important?

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Eye and Vision 2016年第1期3卷 141-146页

作者： FangJun Bao Brendan Geraghty QinMei Wang Ahmed Elsheikh The Affiliated Eye Hospital of Wenzhou Medical University Wenzhou City 325027China The Institution of Ocular Biomechanics Wenzhou Medical UniversityWenzhou City 325027China School of Engineering University of LiverpoolLiverpool City L693GHUK NIHR Biomedical Research Centre for Ophthalmology Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondon CityUK

Keratoconus is a bilateral,non-inflammatory,degenerative corneal *** occurrence and development of keratoconus is associated with corneal thinning and conical protrusion,which causes irregular *** the disruption of the collagen organization,the cornea loses its shape and function resulting in progressive visual ***,corneal topography is the most important tool for the diagnosis of keratoconus,which may lead to false negatives among the patient population in the subclinical ***,it is now hypothesised that biomechanical destabilisation of the cornea may take place ahead of the topographic evidence of keratoconus,hence possibly assisting with disease diagnosis and *** article provides a review of the definition,diagnosis,and management strategies for keratoconus based on corneal biomechanics.

关键词： Keratoconus In vivo corneal biomechanics corneal collagen cross-linking

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Higher incidence of steroid-induced ocular hypertension in keratoconus

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Eye and Vision 2016年第1期3卷 29-36页

作者： Anastasios John Kanellopoulos Emerson M.Cruz Robert Edward T.Ang George Asimellis Laservision.gr Clinical and Research Eye Institute 17 Tsocha StreetAthens Postal Code:11521Greece NYU Medical School New YorkNYUSA Asian Eye Institute MakatiPhilippines

Background:To compare intraocular pressure(IOP)changes following topical dexamethasone administration for 1 month in keratoconic versus normal ***:This is a retrospective,single-center,non-randomized case series evaluation of 350 *** groups were formed:normal/control Group A(n_(A)=73),eyes that underwent excimer laser photorefractive keratectomy;and keratoconic(KCN)Group B(n_(B)=277),eyes that were subjected to partial laser photorefractive keratectomy combined with collagen cross-linking(The Athens Protocol).All eyes received the same post-operative regimen of topical dexamethasone 0.1%for at least 1 *** applanation tonometry IOP readings and central corneal thickness(CCT)measurements were *** with induced ocular hypertension(OHT,defined as post-operative IOP higher than 21 mmHg),were identified and correlated to refractive procedure,gender,and corneal ***:At 4 weeks postoperatively,OHT was noted on 27.4%(20/73 eyes)in Group A,and 43.7%(121/277 eyes)in KCN Group B,(p<0.01).Six months post-operatively(following 5-months of discontinuing topical dexamethasone treatment and commencing treatment of IOP-lowering medications),OHT rate was 1.8%in Group A and 3.9%in the KCN Group ***:This study demonstrates a potentially significant pre-disposition of keratoconic eyes to the development of steroid-induced OHT.

关键词： Keratoconus Intraocular pressure Corticosteroid induced ocular hypertension IOP spike corneal collagen cross-linking CXL The Athens protocol Topography-guided Photorefractive keratectomy Dexamethasone topical ophthalmic solution

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Paediatric cornea crosslinking current strategies:A review

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Advances in Ophthalmology Practice and Research 2023年第2期3卷 55-62页

作者： Pawan Prasher Ashok Sharma Rajan Sharma Vipan K.Vig Verinder S.Nirankari Department of Ophthalmology Sri Guru Ram Das Institute of Medical Sciences and ResearchAmritsarPunjabIndia Cornea Centre SCO 2463-2464Sector 22 C160022ChandigarhIndia Amritsar Eye Hospital GNDU Shopping ComplexAmritsarPunjabIndia Department of Ophthalmology University of MarylandUSA

Background:In the general population,1 in 2000 people has *** and other people from Southeast Asia have a higher incidence of *** with keratoconus typically present earlier in life and with a more severe *** the eyes has been identified as a risk *** have a higher incidence and a faster rate of keratoconus *** rehabilitation in children with keratoconus is *** have a low compliance with contact lens *** of these children require penetrating keratoplasty at an early ***,stopping the progression of keratoconus in children is of paramount *** text:Compared to treatment,keratoconus progression prophylaxis is not only preferable,but also *** collagen cross-linking has been shown to be safe and effective in stopping its progression in *** Dresden protocol,which involves central corneal deepithelization(7-9 mm),saturation of the stroma with riboflavin(0.25%),and 30 min UV-A exposure,has proven to be the most *** significant disadvantages of the typical Dresden regimen are the prolonged operating time and the significant post-operative ***-CXL(9 mW/cm^(2) x 10 min)has been studied to reduce operative time and has been shown to be equally effective in some *** to accelerated CXL or traditional CXL,epi-off procedures,transepithelial treatment without the need for de-epithelialization and without postoperative discomfort,have been shown to be safer but less *** crosslinking should only be performed after treating children with active vernal *** opacity,chronic corneal edema,sterile infiltrates,and microbial keratitis have been reported after cross-linking of corneal ***:The"Dresden protocol",also known as the conventional corneal cross-linking approach,should be used to halt the progression of keratoconus in young ***,if the procedure needs to

关键词： Keratoconus corneal collagen cross-linking corneal transplant Pediatric keratoconus

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