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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

Graphic of uncorrected and corrected distance visual acuity after epithelial island cross-linking technique.Note: Graphic shows a statistically insignificant improvement of an equivalent of 1 decimal on average, starting after postoperative month 3, being stable at 1-year follow-up.Abbreviations: UDVA, uncorrected distance visual acuity; CDVA, corrected distance visual acuity.
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f4-opth-8-1337: Graphic of uncorrected and corrected distance visual acuity after epithelial island cross-linking technique.Note: Graphic shows a statistically insignificant improvement of an equivalent of 1 decimal on average, starting after postoperative month 3, being stable at 1-year follow-up.Abbreviations: UDVA, uncorrected distance visual acuity; CDVA, corrected distance visual acuity.

Mentions: UDVA and CDVA at 1 month resembled the baseline average values of 0.3 and 0.5 decimal equivalents respectively, demonstrating a not statistically significant improvement of 1 decimal equivalent on average, starting after the 3rd postoperative month, being stable at 1-year follow-up (Figure 4).


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

Mazzotta C, Ramovecchi V - Clin Ophthalmol (2014)

Graphic of uncorrected and corrected distance visual acuity after epithelial island cross-linking technique.Note: Graphic shows a statistically insignificant improvement of an equivalent of 1 decimal on average, starting after postoperative month 3, being stable at 1-year follow-up.Abbreviations: UDVA, uncorrected distance visual acuity; CDVA, corrected distance visual acuity.
© Copyright Policy
Related In: Results  -  Collection

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

f4-opth-8-1337: Graphic of uncorrected and corrected distance visual acuity after epithelial island cross-linking technique.Note: Graphic shows a statistically insignificant improvement of an equivalent of 1 decimal on average, starting after postoperative month 3, being stable at 1-year follow-up.Abbreviations: UDVA, uncorrected distance visual acuity; CDVA, corrected distance visual acuity.
Mentions: UDVA and CDVA at 1 month resembled the baseline average values of 0.3 and 0.5 decimal equivalents respectively, demonstrating a not statistically significant improvement of 1 decimal equivalent on average, starting after the 3rd postoperative month, being stable at 1-year follow-up (Figure 4).

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