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Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique.

Mazzotta C, Ramovecchi V - Clin Ophthalmol (2014)

Bottom Line: Thin corneas with a minimum corneal thickness less than 400 μm after epithelial removal represent a contraindication to standard epithelium-off cross-linking (CXL) treatment due to a significant endothelial cell density decrease and potentiality of permanent haze development.However the iatrogenic swelling effect might not be durable throughout the CXL procedure increasing the risk of postoperative complications.According to our clinical and in-vivo micro-morphological results the technique results safe, and efficacious in stabilizing progressive keratoconus and may be considered a valid option in the treatment of thin ectatic corneas alone or in combination with hypoosmolar or dextran-free riboflavin solutions.

View Article: PubMed Central - PubMed

Affiliation: Unità Operativa Complessa di Oculistica, Siena University Hospital, Siena, Italy.

ABSTRACT
Thin corneas with a minimum corneal thickness less than 400 μm after epithelial removal represent a contraindication to standard epithelium-off cross-linking (CXL) treatment due to a significant endothelial cell density decrease and potentiality of permanent haze development. Preoperative swelling of the cornea with hypoosmolar riboflavin solutions broadens the spectrum of CXL indications to thin corneas. However the iatrogenic swelling effect might not be durable throughout the CXL procedure increasing the risk of postoperative complications. The transepithelial CXL technique proposed for thin corneas demonstrated poor clinical results and mid- to long-term keratoconus instability. The epithelial island CXL technique with customized pachymetry-guided epithelial debridement was evaluated by means of in vivo laser scanning confocal microscopy, corneal topography, and clinical examination in a 1-year follow-up, in order to assess if it may be considered an alternative surgical option for keratoconic patients with thin corneas undergoing corneal collagen CXL. According to our clinical and in-vivo micro-morphological results the technique results safe, and efficacious in stabilizing progressive keratoconus and may be considered a valid option in the treatment of thin ectatic corneas alone or in combination with hypoosmolar or dextran-free riboflavin solutions.

No MeSH data available.


Related in: MedlinePlus

Epithelial island cross-linking technique for thin ectatic corneas.Notes: Epithelial island (A) white arrow; and (B) white arrow indicating epithelial island during ultra violet-A exposure; the shield effect provided by epithelium in situ is well evident reducing the typical fluorescence of activated riboflavin by the UV-A illumination.Abbreviation: UV-A, ultra violet-A.
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f2-opth-8-1337: Epithelial island cross-linking technique for thin ectatic corneas.Notes: Epithelial island (A) white arrow; and (B) white arrow indicating epithelial island during ultra violet-A exposure; the shield effect provided by epithelium in situ is well evident reducing the typical fluorescence of activated riboflavin by the UV-A illumination.Abbreviation: UV-A, ultra violet-A.

Mentions: The technique in Figure 2 includes the following steps:


Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique.

Mazzotta C, Ramovecchi V - Clin Ophthalmol (2014)

Epithelial island cross-linking technique for thin ectatic corneas.Notes: Epithelial island (A) white arrow; and (B) white arrow indicating epithelial island during ultra violet-A exposure; the shield effect provided by epithelium in situ is well evident reducing the typical fluorescence of activated riboflavin by the UV-A illumination.Abbreviation: UV-A, ultra violet-A.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109632&req=5

f2-opth-8-1337: Epithelial island cross-linking technique for thin ectatic corneas.Notes: Epithelial island (A) white arrow; and (B) white arrow indicating epithelial island during ultra violet-A exposure; the shield effect provided by epithelium in situ is well evident reducing the typical fluorescence of activated riboflavin by the UV-A illumination.Abbreviation: UV-A, ultra violet-A.
Mentions: The technique in Figure 2 includes the following steps:

Bottom Line: Thin corneas with a minimum corneal thickness less than 400 μm after epithelial removal represent a contraindication to standard epithelium-off cross-linking (CXL) treatment due to a significant endothelial cell density decrease and potentiality of permanent haze development.However the iatrogenic swelling effect might not be durable throughout the CXL procedure increasing the risk of postoperative complications.According to our clinical and in-vivo micro-morphological results the technique results safe, and efficacious in stabilizing progressive keratoconus and may be considered a valid option in the treatment of thin ectatic corneas alone or in combination with hypoosmolar or dextran-free riboflavin solutions.

View Article: PubMed Central - PubMed

Affiliation: Unità Operativa Complessa di Oculistica, Siena University Hospital, Siena, Italy.

ABSTRACT
Thin corneas with a minimum corneal thickness less than 400 μm after epithelial removal represent a contraindication to standard epithelium-off cross-linking (CXL) treatment due to a significant endothelial cell density decrease and potentiality of permanent haze development. Preoperative swelling of the cornea with hypoosmolar riboflavin solutions broadens the spectrum of CXL indications to thin corneas. However the iatrogenic swelling effect might not be durable throughout the CXL procedure increasing the risk of postoperative complications. The transepithelial CXL technique proposed for thin corneas demonstrated poor clinical results and mid- to long-term keratoconus instability. The epithelial island CXL technique with customized pachymetry-guided epithelial debridement was evaluated by means of in vivo laser scanning confocal microscopy, corneal topography, and clinical examination in a 1-year follow-up, in order to assess if it may be considered an alternative surgical option for keratoconic patients with thin corneas undergoing corneal collagen CXL. According to our clinical and in-vivo micro-morphological results the technique results safe, and efficacious in stabilizing progressive keratoconus and may be considered a valid option in the treatment of thin ectatic corneas alone or in combination with hypoosmolar or dextran-free riboflavin solutions.

No MeSH data available.


Related in: MedlinePlus