A STUDY ON EFFICACY OF CORNEAL COLLAGEN CROSS LINKING IN PROGRESSIVE KERATOCONUS
AbstractBackground: Keratoconus is a progressive, noninflammatory, bilateral ectatic corneal disease, characterized by paraxial stromal thinning and weakening that leads to corneal surface distortion. The objective of this research was to determine the effectiveness and safety of collagen crosslinking in progressive keratoconus, with keratometry (Kmax) value of 50 diopters or above. It was a retrospective study, conducted at Bodla Eye Care (BEC) and Multan Medical and Dental College, Multan (MMDC) from May 2018 to November 2019. Methods: In this research 52 eyes were studied. The best-corrected visual acuity, uncorrected visual acuity, maximum keratometry, mean keratometry value, and thinnest corneal thickness before surgery and 12 months after Cross-linking were observed. A Galeili G6 by Zeimer ophthalmic system was used to measure the clinical parameters. Dresden protocol was followed in this study. A written ethical approval was obtained and research was conducted under the light of declaration of Helsinki. Results: The average logarithm of the minimum angle of resolution (logMAR) of the uncorrected visual acuity decreased from 0.66±0.41 D to 0.49±0.40 D (p=0.012), while the mean thinnest point thickness of the cornea decreased from 435.31 37.91 μm to 419.41±70.12 μm (p=0.004) after 12 months. The decreases in the mean logMAR of the BCVA, Kmax and Kmean values were not analytically important (p>0.05) at the 12-month follow-up 94.2% positive results were obtained. Conclusion: Collagen cross-linking treatment was safe and maintained both the visual acuity and tomographic parameters at the one-year follow-up in eyes.
McGhee CN. 2008 Sir Norman McAlister Gregg lecture: 150 years of practical observations on the conical cornea -- What have we learned? Clin Exp Ophthalmol 2009;37(2):160–76.
Cankaya C, Gunduz A, Cumurcu T, Demirel S, Savaci SS, Cavdar M. Familial association of keratoconus and granular corneal dystrophy: The familial case series. North Clin Istanb 2018;6(2):176–83.
Pearson AR, Soneji B, Sarvananthan N, Sandford-Smith JH. Does ethnic origin influence the incidence or severity of keratoconus? Eye (Lond) 2000;14(Pt 4):625–8.
Georgiou T, Funnell CL, Cassels-Brown A, O'Conor R. Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asians and white patients. Eye (Lond) 2004;18(4):379–83.
Jonas JB, Nangia V, Matin A, Kulkarni M, Bhojwani K. Prevalence and associations of keratoconus in rural Maharashtra in central India: the central India Eye Medical Study. Am J Ophthalmol 2009;148(5):760–5.
Hashemi H, Khabazkhoob M, Yazdani N, Ostadimoghaddam H, Norouzirad R, Amanzadeh K, et al. The prevalence of keratoconus in a young population in Mashhad, Iran. Ophthalmic Physiol Opt 2014;34(5):519–27.
Rabinowitz YS. Keratoconus. Surv Opthalmol 1998;42(4):297–319.
Spoerl E, Huhle M, Seiler T. Induction of cross-links in corneal tissue. Exp Eye Res 1998;66(1):97–103.
Arntz A, Durán JA, Pijoán JI. Subclinical keratoconus diagnosis by elevation topography. Arch Soc Esp Oftalmol 2003;78(12):659–64.
Vazirani J, Basu S. Keratoconus: Current perspectives. Clin Ophthalmol 2013;7:2019–30.
Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-A–induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 2003;135(5):620–7.
Caporossi A, Baiocchi S, Mazzotta C, Traversi C, Caporossi T. Parasurgical therapy for keratoconus by riboflavin-ultraviolet type A rays induced cross-linking of corneal collagen. Preliminary refractive results in an Italian study. J Cataract Refract Surg 2006;32(5):837–45.
Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena eye cross study. Am J Ophthalmol 2010;149(4):585–93.
Hashemi H, Beiranvand A, Khabazkhoob M. Prevalence of keratoconus in a population-based study in Shahroud. Cornea 2013;32(11):1441–5.
Kymionis GD, Grentzelos MA, Liakopoulos DA, Paraskevopoulos TA, Klados NE, Tsoulnaras KI, et al. Long-term follow-up of corneal collagen cross-linking for keratoconus–the Cretan study. Cornea 2014;33(10):1071–9.
O'Brart DP, Patel P, Lascaratos G, Wagh VK, Tam C, Lee J, et al. Corneal cross-linking to halt the progression of keratoconus and corneal ectasia: seven-year follow-up. Am J Ophthalmol 2015;160(6):1154–63.
Sharma N, Maharana P, Singh G, Titiyal JS. Pseudomonas keratitis after collagen crosslinking for keratoconus: Case report and review of literature. J Cataract Refract Surg 2010;36(3):517–20.
Pérez-Santonja JJ, Artola A, Javaloy J, Alió JL, Abad JL. Microbial keratitis after corneal collagen crosslinking. J Cataract Refract Surg 2009;35(6):1138–40.
Rama P, Di Matteo F, Matuska S, Paganoni G, Spinelli A. Acanthamoeba keratitis with perforation after corneal crosslinking and bandage contact lens use. J Cataract Refract Surg 2009;35(4):788–91.
Bagga B, Pahuja S, Murthy S, Sangwan VS. Endothelial failure after collagen cross-linking with riboflavin and UV-A: Case report with literature review. Cornea 2012;31(10):1197–200.
Sharma A, Nottage JM, Mirchia K, Sharma R, Mohan K, Nirankari VS, et al. Persistent corneal edema after collagen cross-linking for keratoconus. Am J Ophthalmol 2012;154(6):922–60.
Spoerl E, Mrochen M, Sliney D, Trokel S, Seiler T. Safety of UVA-riboflavin cross-linking of the cornea. Cornea 2007;26(4):385–9.
Spoerl E, Hoyer A, Pillunat LE, Raiskup F. Corneal cross-linking and safety issues. Open Ophthalmol J 2011;5:14–6.
Spörl E, Raiskup-Wolf F, Pillunat LE. [Biophysical principles of collagen cross-linking]. Klin Monbl Augenheilkd 2008;225(2):131–7.
Moghadam RS, Akbari M, Alizadeh Y, Medghalchi A, Dalvandi R. The Outcomes of Corneal Collagen Cross-linking in Patients with Advanced Progressive Keratoconus: A 2-year follow-up Study. Middle East Afr J Opthalmol 2019;26(1):11–6.