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International Ophthalmology

Published in:

01-04-2019 | Original Paper

Corneal densitometry after accelerated corneal collagen cross-linking in progressive keratoconus

Authors: Myriam Böhm, Mehdi Shajari, Matthias Remy, Thomas Kohnen

Published in: International Ophthalmology | Issue 4/2019

Abstract

Purpose

To analyze changes in corneal densitometry 3 months after accelerated corneal collagen cross-linking (CXL) measured with Scheimpflug tomography.

Methods

In this study we reviewed charts and anterior segment data of patients who had undergone accelerated pulsed epithelium-off CXL (30 mW/cm² for 4 min, 8 min total radiation time) for treatment of progressive keratoconus in the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Visual, topographic, pachymetric and densitometric data were extracted before surgery and at the 3-month follow-up. Corneal densitometry measurements from different corneal layers and zones obtained using Scheimpflug tomography (Pentacam HR, Oculus).

Results

The study investigated 12 eyes of 12 patients. The anterior (120 μm) stromal layer within the 0.0 to 2.0 mm and 2.0 to 6.0 mm concentric zones showed a significant elevation of mean densitometry 3 months post-surgery (P = 0.045; P = 0.015) compared to baseline. A mean stromal demarcation line was apparent at a depth of 203.00 μm ± 13.53 (SD). After accelerated CXL, no change in mean corrected distance visual acuity (LogMAR) was observed but a thinning of the cornea measured by a significant reduction in central pachymetry (μm).

Conclusion

Accelerated CXL results in an increase in corneal densitometry, particularly in the anterior stromal layer within the two central concentric zones (0.0 to 2.0 mm and 2.0 to 6.0 mm) of the cornea at 3 months postoperatively. The changes in corneal densitometry of the anterior stromal layer did not correlate with postoperative visual acuity or central pachymetry.

Sykakis E, Karim R, Evans JR, Bunce C, Amissah-Arthur KN, Patwary S, McDonnell PJ, Hamada S (2015) Corneal collagen cross-linking for treating keratoconus. The Cochrane database of systematic reviews (3):Cd010621. https://doi.org/10.1002/14651858.cd010621.pub2

Raiskup F, Lenk J, Herber R, Gatzioufas Z, Sporl E (2017) Therapeutic options in keratoconus. Klin Monbl Augenheilkd. https://doi.org/10.1055/s-0043-111797 CrossRefPubMed

Raiskup F, Velika V, Vesela M, Sporl E (2015) Cross-linking in keratoconus: “Epi-off” or “Epi-on”? Klin Monbl Augenheilkd 232(12):1392–1396. https://doi.org/10.1055/s-0035-1546155 CrossRefPubMed

Wollensak G, Spoerl E, Seiler T (2003) Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 135(5):620–627CrossRefPubMed

Wernli J, Schumacher S, Spoerl E, Mrochen M (2013) The efficacy of corneal cross-linking shows a sudden decrease with very high intensity UV light and short treatment time. Invest Ophthalmol Vis Sci 54(2):1176–1180. https://doi.org/10.1167/iovs.12-11409 CrossRefPubMed

Zygoura V, Alio del Barrio J, Gatzioufas Z, Saw V, Raiskup F (2015) Evaluation of corneal stromal demarcation line depth following standard and a modified-accelerated collagen cross-linking protocol. Am J Ophthalmol 159(1):211–212. https://doi.org/10.1016/j.ajo.2014.10.018 CrossRefPubMed

Kymionis GD, Tsoulnaras KI, Grentzelos MA, Liakopoulos DA, Tsakalis NG, Blazaki SV, Paraskevopoulos TA, Tsilimbaris MK (2014) Evaluation of corneal stromal demarcation line depth following standard and a modified-accelerated collagen cross-linking protocol. Am J Ophthalmol 158(4):671CrossRefPubMed

Webb JN, Su JP, Scarcelli G (2017) Mechanical outcome of accelerated corneal crosslinking evaluated by Brillouin microscopy. J Cataract Refract Surg 43(11):1458–1463. https://doi.org/10.1016/j.jcrs.2017.07.037 CrossRefPubMedPubMedCentral

Males JJ, Viswanathan D (2018) Comparative study of long-term outcomes of accelerated and conventional collagen crosslinking for progressive keratoconus. Eye 32(1):32–38. https://doi.org/10.1038/eye.2017.296 CrossRefPubMed

10.

Woo JH, Iyer JV, Lim L, Hla MH, Mehta JS, Chan CM, Tan DT (2017) Conventional versus accelerated collagen cross-linking for keratoconus: a comparison of visual, refractive, topographic and biomechanical outcomes. Open Ophthalmol J 11:262–272. https://doi.org/10.2174/1874364101711010262 CrossRefPubMedPubMedCentral

11.

Raiskup F, Theuring A, Pillunat LE, Spoerl E (2015) Corneal collagen crosslinking with riboflavin and ultraviolet-A light in progressive keratoconus: 10-year results. J Cataract Refract Surg 41(1):41–46. https://doi.org/10.1016/j.jcrs.2014.09.033 CrossRefPubMed

12.

Kohlhaas M, Spoerl E, Schilde T, Unger G, Wittig C, Pillunat LE (2006) Biomechanical evidence of the distribution of cross-links in corneas treated with riboflavin and ultraviolet A light. J Cataract Refract Surg 32(2):279–283. https://doi.org/10.1016/j.jcrs.2005.12.092 CrossRefPubMed

13.

Baumeister M, Klaproth OK, Gehmlich J, Buhren J, Kohnen T (2009) Changes in corneal first-surface wavefront aberration after corneal collagen cross-linking in keratoconus. Klin Monbl Augenheilkd 226(9):752–756. https://doi.org/10.1055/s-0028-1109627 CrossRefPubMed

14.

Koller T, Pajic B, Vinciguerra P, Seiler T (2011) Flattening of the cornea after collagen crosslinking for keratoconus. J Cataract Refract Surg 37(8):1488–1492. https://doi.org/10.1016/j.jcrs.2011.03.041 CrossRefPubMed

15.

Asri D, Touboul D, Fournie P, Malet F, Garra C, Gallois A, Malecaze F, Colin J (2011) Corneal collagen crosslinking in progressive keratoconus: multicenter results from the French national reference center for keratoconus. J Cataract Refract Surg 37(12):2137–2143. https://doi.org/10.1016/j.jcrs.2011.08.026 CrossRefPubMed

16.

Seiler TG, Schmidinger G, Fischinger I, Koller T, Seiler T (2013) Complications of corneal cross-linking. Ophthalmologe 110(7):639–644. https://doi.org/10.1007/s00347-012-2682-0 CrossRefPubMed

17.

Mazzotta C, Balestrazzi A, Baiocchi S, Traversi C, Caporossi A (2007) Stromal haze after combined riboflavin-UVA corneal collagen cross-linking in keratoconus: in vivo confocal microscopic evaluation. Clinical Exp Ophthalmol 35(6):580–582. https://doi.org/10.1111/j.1442-9071.2007.01536.x CrossRef

18.

Raiskup F, Hoyer A, Spoerl E (2009) Permanent corneal haze after riboflavin-UVA-induced cross-linking in keratoconus. J Refract Surg 25(9):S824–S828. https://doi.org/10.3928/1081597x-20090813-12 CrossRefPubMed

19.

Greenstein SA, Fry KL, Bhatt J, Hersh PS (2010) Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: scheimpflug and biomicroscopic analysis. J Cataract Refract Surg 36(12):2105–2114. https://doi.org/10.1016/j.jcrs.2010.06.067 CrossRefPubMed

20.

Lopes B, Ramos I, Ambrosio R Jr (2014) Corneal densitometry in keratoconus. Cornea 33(12):1282–1286. https://doi.org/10.1097/ico.0000000000000266 CrossRefPubMed

21.

Pircher N, Pachala M, Prager F, Pieh S, Schmidinger G (2015) Changes in straylight and densitometry values after corneal collagen crosslinking. J Cataract Refract Surg 41(5):1038–1043. https://doi.org/10.1016/j.jcrs.2014.07.043 CrossRefPubMed

22.

Kohnen T, Neuhann T, Knorz MC (2014) Evaluation and quality assurance of refractive surgical interventions by the German Ophthalmology Society and the German Professional Association of Ophthalmologists (status 2014). Klin Monbl Augenheilkd 231(6):642–650. https://doi.org/10.1055/s-0034-1368481 CrossRefPubMed

23.

Accelerated cross-linking with Pulsed illumination (2013). Clinical Update & Research News Volume 3(1): 1–4

24.

Wollensak G, Wilsch M, Spoerl E, Seiler T (2004) Collagen fiber diameter in the rabbit cornea after collagen crosslinking by riboflavin/UVA. Cornea 23(5):503–507CrossRefPubMed

25.

Wollensak G, Spoerl E, Wilsch M, Seiler T (2004) Keratocyte apoptosis after corneal collagen cross-linking using riboflavin/UVA treatment. Cornea 23(1):43–49CrossRefPubMed

26.

Wilson SE, Kim WJ (1998) Keratocyte apoptosis: implications on corneal wound healing, tissue organization, and disease. Invest Ophthalmol Vis Sci 39(2):220–226PubMed

27.

Vinciguerra P, Albe E, Trazza S, Rosetta P, Vinciguerra R, Seiler T, Epstein D (2009) Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. Ophthalmology 116(3):369–378. https://doi.org/10.1016/j.ophtha.2008.09.048 CrossRefPubMed

28.

Netto MV, Mohan RR, Ambrosio R Jr, Hutcheon AE, Zieske JD, Wilson SE (2005) Wound healing in the cornea: a review of refractive surgery complications and new prospects for therapy. Cornea 24(5):509–522CrossRefPubMed

29.

Kim BZ, Jordan CA, McGhee CNJ, Patel DV (2016) Natural history of corneal haze after corneal collagen crosslinking in keratoconus using Scheimpflug analysis. J Cataract Refract Surg 42(7):1053–1059. https://doi.org/10.1016/j.jcrs.2016.04.019 CrossRefPubMed

30.

Steven P, Hovakimyan M, Guthoff RF, Huttmann G, Stachs O (2010) Imaging corneal crosslinking by autofluorescence 2-photon microscopy, second harmonic generation, and fluorescence lifetime measurements. J Cataract Refract Surg 36(12):2150–2159. https://doi.org/10.1016/j.jcrs.2010.06.068 CrossRefPubMed

31.

Kamaev P, Friedman MD, Sherr E, Muller D (2012) Photochemical kinetics of corneal cross-linking with riboflavin. Invest Ophthalmol Vis Sci 53(4):2360–2367. https://doi.org/10.1167/iovs.11-9385 CrossRefPubMed

32.

Marshall J HP, Muller D (2013) Corneal collagen cross-linking; past, present, future [ebook]

33.

Koller T, Schumacher S, Fankhauser F 2nd, Seiler T (2013) Riboflavin/ultraviolet a crosslinking of the paracentral cornea. Cornea 32(2):165–168. https://doi.org/10.1097/ICO.0b013e318269059b CrossRefPubMed

34.

Moramarco A, Iovieno A, Sartori A, Fontana L (2015) Corneal stromal demarcation line after accelerated crosslinking using continuous and pulsed light. J Cataract Refract Surg 41(11):2546–2551. https://doi.org/10.1016/j.jcrs.2015.04.033 CrossRefPubMed

35.

Moineau N, Sauvan L, Benichou J, Ho Wang Yin G, Hoffart L (2017) High-irradiance accelerated corneal collagen crosslinking for the treatment of keratoconus: a retrospective study. J Fr Ophtalmol 40(4):319–328. https://doi.org/10.1016/j.jfo.2016.11.014 CrossRefPubMed

36.

Toker E, Cerman E, Ozcan DO, Seferoglu OB (2017) Efficacy of different accelerated corneal crosslinking protocols for progressive keratoconus. J Cataract Refract Surg 43(8):1089–1099. https://doi.org/10.1016/j.jcrs.2017.05.036 CrossRefPubMed

37.

Mita M, Waring GOt, Tomita M (2014) High-irradiance accelerated collagen crosslinking for the treatment of keratoconus: six-month results. J Cataract Refract Surg 40(6):1032–1040. https://doi.org/10.1016/j.jcrs.2013.12.014 CrossRefPubMed

38.

Greenstein SA, Shah VP, Fry KL, Hersh PS (2011) Corneal thickness changes after corneal collagen crosslinking for keratoconus and corneal ectasia: 1-year results. J Cataract Refract Surg 37(4):691–700. https://doi.org/10.1016/j.jcrs.2010.10.052 CrossRefPubMed

39.

Koller T, Iseli HP, Hafezi F, Vinciguerra P, Seiler T (2009) Scheimpflug imaging of corneas after collagen cross-linking. Cornea 28(5):510–515. https://doi.org/10.1097/ICO.0b013e3181915943 CrossRefPubMed

40.

Grewal DS, Brar GS, Jain R, Sood V, Singla M, Grewal SP (2009) Corneal collagen crosslinking using riboflavin and ultraviolet-A light for keratoconus: 1-year analysis using Scheimpflug imaging. J Cataract Refract Surg 35(3):425–432. https://doi.org/10.1016/j.jcrs.2008.11.046 CrossRefPubMed

41.

Vinciguerra P, Albe E, Romano MR, Sabato L, Trazza S (2012) Stromal opacity after cross-linking. J Refract Surg 28(3):165. https://doi.org/10.3928/1081597x-20120301-04 CrossRefPubMed

42.

Seiler T, Hafezi F (2006) Corneal cross-linking-induced stromal demarcation line. Cornea 25(9):1057–1059. https://doi.org/10.1097/01.ico.0000225720.38748.58 CrossRefPubMed

43.

Bottos KM, Dreyfuss JL, Regatieri CV, Lima-Filho AA, Schor P, Nader HB, Chamon W (2008) Immunofluorescence confocal microscopy of porcine corneas following collagen cross-linking treatment with riboflavin and ultraviolet A. J Refract Surg 24(7):S715–719CrossRef

44.

Wollensak G, Aurich H, Pham DT, Wirbelauer C (2007) Hydration behavior of porcine cornea crosslinked with riboflavin and ultraviolet A. J Cataract Refract Surg 33(3):516–521. https://doi.org/10.1016/j.jcrs.2006.11.015 CrossRefPubMed

45.

Dohlman CH, Hedbys BO, Mishima S (1962) The swelling pressure of the corneal stroma. Investig Ophthalmol 1:158–162

46.

Wollensak G, Iomdina E, Dittert DD, Herbst H (2007) Wound healing in the rabbit cornea after corneal collagen cross-linking with riboflavin and UVA. Cornea 26(5):600–605. https://doi.org/10.1097/ICO.0b013e318041f073 CrossRefPubMed

47.

Mazzotta C, Traversi C, Baiocchi S, Caporossi O, Bovone C, Sparano MC, Balestrazzi A, Caporossi A (2008) Corneal healing after riboflavin ultraviolet-A collagen cross-linking determined by confocal laser scanning microscopy in vivo: early and late modifications. Am J Ophthalmol 146(4):527–533. https://doi.org/10.1016/j.ajo.2008.05.042 CrossRefPubMed

48.

Mazzotta C, Baiocchi S, Caporossi O, Buccoliero D, Casprini F, Caporossi A, Balestrazzi A (2008) Confocal microscopy identification of keratoconus associated with posterior polymorphous corneal dystrophy. J Cataract Refract Surg 34(2):318–321. https://doi.org/10.1016/j.jcrs.2007.09.028 CrossRefPubMed

49.

Michelacci YM (2003) Collagens and proteoglycans of the corneal extracellular matrix. Braz J Med Biol Res 36(8):1037–1046CrossRefPubMed

50.

Koc M, Uzel MM, Tekin K, Kosekahya P, Ozulken K, Yilmazbas P (2016) Effect of preoperative factors on visual acuity, corneal flattening, and corneal haze after accelerated corneal crosslinking. J Cataract Refract Surg 42(10):1483–1489. https://doi.org/10.1016/j.jcrs.2016.08.017 CrossRefPubMed

51.

Wollensak G, Hammer T, Herrmann CI (2008) Haze or calcific band keratopathy after crosslinking treatment? Ophthalmologe 105(9):864–865. https://doi.org/10.1007/s00347-008-1831-y CrossRefPubMed

52.

Corbett MC, Prydal JI, Verma S, Oliver KM, Pande M, Marshall J (1996) An in vivo investigation of the structures responsible for corneal haze after photorefractive keratectomy and their effect on visual function. Ophthalmology 103(9):1366–1380CrossRefPubMed

53.

Shetty R, Agrawal A, Deshmukh R, Kaweri L, Rao HL, Nagaraja H, Jayadev C (2017) Effect of post crosslinking haze on the repeatability of Scheimpflug-based and slit-scanning imaging devices. Indian J Ophthalmol 65(4):305–310. https://doi.org/10.4103/ijo.IJO_690_16 CrossRefPubMedPubMedCentral

Title: Corneal densitometry after accelerated corneal collagen cross-linking in progressive keratoconus
Authors: Myriam Böhm
Mehdi Shajari
Matthias Remy
Thomas Kohnen
Publication date: 01-04-2019
Publisher: Springer Netherlands
Published in: International Ophthalmology / Issue 4/2019
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-018-0876-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Corneal densitometry after accelerated corneal collagen cross-linking in progressive keratoconus

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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