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A Higher-energy Accelerated Corneal Collagen Cross-linking Method for Keratoconus: A Retrospective, Observational Cohort Study

Received: 3 November 2021     Accepted: 17 November 2021     Published: 23 November 2021
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Abstract

Introduction: Primary keratoconus is a non-inflammatory corneal ectasia disease with an unknown cause. Nowadays, the most widely used treatment method is corneal collagen crosslinking based on the Dresden protocol. Due to the long surgery time, we have been searching for a new method which cost less time in surgery. Methods: A retrospective, observational cohort study was used. A total of 31 participants (59 eyes) with primary keratoconus were collected. Twelve of them (24 eyes) used the standard Dresden protocol, and the remaining 19 (35 eyes) used a higher-energy accelerated corneal collagen cross-linking method. Application of riboflavin solution to the de-epithelialized cornea for 10 min, then the cornea is UVA irradiated (wavelength, 365 nm and power, 30 mW/cm2) for another 3.55 min, and the total irradiation energy is 6.4J/cm2. Participants were followed up for 12 months after surgery and underwent complete examinations at 3, 6, and 12 months in predetermined windows of time. The examinations items include routine ophthalmological examination, uncorrected vision acuity (UCVA), best corrected visual acuity (BCVA), refraction, corneal curvature, the elevation of the thinnest point on front surface and back surface (F Ele Th, B Ele Th), the thickness of the thinnest point of the cornea (CT), and the density of the corneal endothelial cells (ECD). The independent sample t-test method was used to compare the changes of the parameters of the standard Dresden protocol and the higher-energy accelerated corneal collagen cross-linking. Results: In the A-CXL treatment group, the maximum keratometry value decreased by 1.48D from baseline, UCVA improved by an average of 0.07 logarithm of the minimum angle of resolution (logMAR) units, BCVA improved by an average of 0.15 logarithm of the minimum angle of resolution (logMAR) units. All of those are similar to standard Dresden protocol group. There were no significant changes in endothelial cell count and thickness of cornea 1 year after treatment. Conclusions: In this study, we found that accelerated corneal collagen cross-linking under 6.4J energy has a similar surgical effect as corneal collagen cross-linking under the Dresden protocol, and did not cause more adverse events.

Published in International Journal of Ophthalmology & Visual Science (Volume 6, Issue 4)
DOI 10.11648/j.ijovs.20210604.18
Page(s) 225-230
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Keratoconus, Higher-energy, Accelerated Cornea Cross-linking

References
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[9] Kanellopoulos AJ, Dupps WJ, Seven I, Asimellis G: Toric topographically customized transepithelial, pulsed, very high-fluence, higher energy and higher riboflavin concentration collagen cross-linking in keratoconus. Case Rep Ophthalmol 2014, 5 (2): 172-180.
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Cite This Article
  • APA Style

    Minhui Wu, Jing Yang, Sheng Zhou. (2021). A Higher-energy Accelerated Corneal Collagen Cross-linking Method for Keratoconus: A Retrospective, Observational Cohort Study. International Journal of Ophthalmology & Visual Science, 6(4), 225-230. https://doi.org/10.11648/j.ijovs.20210604.18

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    ACS Style

    Minhui Wu; Jing Yang; Sheng Zhou. A Higher-energy Accelerated Corneal Collagen Cross-linking Method for Keratoconus: A Retrospective, Observational Cohort Study. Int. J. Ophthalmol. Vis. Sci. 2021, 6(4), 225-230. doi: 10.11648/j.ijovs.20210604.18

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    AMA Style

    Minhui Wu, Jing Yang, Sheng Zhou. A Higher-energy Accelerated Corneal Collagen Cross-linking Method for Keratoconus: A Retrospective, Observational Cohort Study. Int J Ophthalmol Vis Sci. 2021;6(4):225-230. doi: 10.11648/j.ijovs.20210604.18

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  • @article{10.11648/j.ijovs.20210604.18,
      author = {Minhui Wu and Jing Yang and Sheng Zhou},
      title = {A Higher-energy Accelerated Corneal Collagen Cross-linking Method for Keratoconus: A Retrospective, Observational Cohort Study},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {6},
      number = {4},
      pages = {225-230},
      doi = {10.11648/j.ijovs.20210604.18},
      url = {https://doi.org/10.11648/j.ijovs.20210604.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20210604.18},
      abstract = {Introduction: Primary keratoconus is a non-inflammatory corneal ectasia disease with an unknown cause. Nowadays, the most widely used treatment method is corneal collagen crosslinking based on the Dresden protocol. Due to the long surgery time, we have been searching for a new method which cost less time in surgery. Methods: A retrospective, observational cohort study was used. A total of 31 participants (59 eyes) with primary keratoconus were collected. Twelve of them (24 eyes) used the standard Dresden protocol, and the remaining 19 (35 eyes) used a higher-energy accelerated corneal collagen cross-linking method. Application of riboflavin solution to the de-epithelialized cornea for 10 min, then the cornea is UVA irradiated (wavelength, 365 nm and power, 30 mW/cm2) for another 3.55 min, and the total irradiation energy is 6.4J/cm2. Participants were followed up for 12 months after surgery and underwent complete examinations at 3, 6, and 12 months in predetermined windows of time. The examinations items include routine ophthalmological examination, uncorrected vision acuity (UCVA), best corrected visual acuity (BCVA), refraction, corneal curvature, the elevation of the thinnest point on front surface and back surface (F Ele Th, B Ele Th), the thickness of the thinnest point of the cornea (CT), and the density of the corneal endothelial cells (ECD). The independent sample t-test method was used to compare the changes of the parameters of the standard Dresden protocol and the higher-energy accelerated corneal collagen cross-linking. Results: In the A-CXL treatment group, the maximum keratometry value decreased by 1.48D from baseline, UCVA improved by an average of 0.07 logarithm of the minimum angle of resolution (logMAR) units, BCVA improved by an average of 0.15 logarithm of the minimum angle of resolution (logMAR) units. All of those are similar to standard Dresden protocol group. There were no significant changes in endothelial cell count and thickness of cornea 1 year after treatment. Conclusions: In this study, we found that accelerated corneal collagen cross-linking under 6.4J energy has a similar surgical effect as corneal collagen cross-linking under the Dresden protocol, and did not cause more adverse events.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - A Higher-energy Accelerated Corneal Collagen Cross-linking Method for Keratoconus: A Retrospective, Observational Cohort Study
    AU  - Minhui Wu
    AU  - Jing Yang
    AU  - Sheng Zhou
    Y1  - 2021/11/23
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijovs.20210604.18
    DO  - 10.11648/j.ijovs.20210604.18
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
    SP  - 225
    EP  - 230
    PB  - Science Publishing Group
    SN  - 2637-3858
    UR  - https://doi.org/10.11648/j.ijovs.20210604.18
    AB  - Introduction: Primary keratoconus is a non-inflammatory corneal ectasia disease with an unknown cause. Nowadays, the most widely used treatment method is corneal collagen crosslinking based on the Dresden protocol. Due to the long surgery time, we have been searching for a new method which cost less time in surgery. Methods: A retrospective, observational cohort study was used. A total of 31 participants (59 eyes) with primary keratoconus were collected. Twelve of them (24 eyes) used the standard Dresden protocol, and the remaining 19 (35 eyes) used a higher-energy accelerated corneal collagen cross-linking method. Application of riboflavin solution to the de-epithelialized cornea for 10 min, then the cornea is UVA irradiated (wavelength, 365 nm and power, 30 mW/cm2) for another 3.55 min, and the total irradiation energy is 6.4J/cm2. Participants were followed up for 12 months after surgery and underwent complete examinations at 3, 6, and 12 months in predetermined windows of time. The examinations items include routine ophthalmological examination, uncorrected vision acuity (UCVA), best corrected visual acuity (BCVA), refraction, corneal curvature, the elevation of the thinnest point on front surface and back surface (F Ele Th, B Ele Th), the thickness of the thinnest point of the cornea (CT), and the density of the corneal endothelial cells (ECD). The independent sample t-test method was used to compare the changes of the parameters of the standard Dresden protocol and the higher-energy accelerated corneal collagen cross-linking. Results: In the A-CXL treatment group, the maximum keratometry value decreased by 1.48D from baseline, UCVA improved by an average of 0.07 logarithm of the minimum angle of resolution (logMAR) units, BCVA improved by an average of 0.15 logarithm of the minimum angle of resolution (logMAR) units. All of those are similar to standard Dresden protocol group. There were no significant changes in endothelial cell count and thickness of cornea 1 year after treatment. Conclusions: In this study, we found that accelerated corneal collagen cross-linking under 6.4J energy has a similar surgical effect as corneal collagen cross-linking under the Dresden protocol, and did not cause more adverse events.
    VL  - 6
    IS  - 4
    ER  - 

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Author Information
  • State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China

  • State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China

  • State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China

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