Original Article
Accelerated transepithelial corneal collagen cross-linking for progressive keratoconus with a thin cornea: one-year results
Zhirong Lin, Huping Wu, Shunrong Luo, Zhaosheng Liu, Nuo Dong, Xumin Shang, Zhiwen Xie, Lei Yan, Xie Fang
Published 2017-09-11
Cite as Chin J Ophthalmol, 2017, 53(9): 694-700. DOI: 10.3760/cma.j.issn.0412-4081.2017.09.011
Abstract
ObjectiveTo evaluate the clinical results of keratoconic eyes with a thin cornea treated with accelerated transepithelial corneal collagen cross-linking (A-TE-CXL) within 1 year.
MethodsNineteen eyes of 19 patients with progressive keratoconus with a minimum corneal thickness from 380 μm to 420 μm (including the epithelium) were included in this prospective, nonrandomized clinical study and treated with A-TE-CXL. Scoring of pain and foreign body sensation, slit lamp examination, uncorrected visual acuity, best corrected distance visual acuity, corneal topography, anterior segment optical coherence tomography, in vivo corneal confocal microscopy and endothelial cell count were assessed before surgery and at 1, 3, 6 and 12 months postoperatively. Paired t test was applied for statistical analysis.
ResultsMild pain and moderate foreign body sensation were reported by most patients within postoperative 24 hours, but rapidly disappeared on day 2. Extremely mild epithelial damage was observed within postoperative 24 hours, and the epithelium fully recovered on day 2. Improvement of visual acuity was recorded at 3 and 12 months. Pentacam corneal topography revealed a significant reduction of the thickness of the thinnest location from(395.2±13.8)μm preoperatively to (378.9±17.1)μm at 1 month postoperatively (t=2.982, P<0.01). Front curvature values were reduced postoperatively. KMAX was significantly decreased at 12 months (55.67±4.91) compared with (57.35±5.54) preoperatively, while K2 was also significantly decreased at 12 months (52.18±3.70) compared with (52.70±3.56) preoperatively (KMAX, t=3.044, P<0.01. K2, t=2.384, P<0.05) . Within 1 month postoperatively, optical coherence tomography exhibited an increase of reflectance with a demarcation line in the anterior stroma. In vivo confocal microscopy also showed significant thickening and increased connections of collagen fibers with a maximal depth at about 90 to 120 μm. The corneal endothelial cell density remained stable (t=0.692, P>0.05). None of the patients showed postoperative complications such as corneal infection, scarring and ulceration.
ConclusionsWithin 1 year postoperatively, A-TE-CXL was effective and safe for the management of progressive keratoconus with a thin cornea. A-TE-CXL showed the advantages of very short time consuming in surgery, rapid recovery and very few complications, and had the potential to become a valid alternative for the treatment of keratoconus. (Chin J Ophthalmol, 2017, 53: 694-700)
Key words:
Keratoconus; Riboflavin; Cross-linking reagents; Collagen; Epithelium, corneal; Treatment outcome
Contributor Information
Zhirong Lin
Department of Ocular Surface and Corneal Diseases, Eye Institute &
Affiliated Xiamen Eye Center of Xiamen University, Xiamen 361001, China
Huping Wu
Shunrong Luo
Zhaosheng Liu
Nuo Dong
Xumin Shang
Zhiwen Xie
Lei Yan
Xie Fang