Customized corneal crosslinking for treatment of progressive keratoconus: Clinical and OCT outcomes using a transepithelial approach with supplemental oxygen.

Autor:	Mazzotta C; From the Department of Medicine (Mazzotta, Sgheri, Bagaglia, Di Maggio), Surgery and Neurosciences, Ophthalmology Unit, Post-Graduate Ophthalmology School, University of Siena, Siena, Departmental Ophthalmology Unit (Mazzotta), Alta Val D'Elsa Hospital, Campostaggia, Siena, Siena Crosslinking Center (Mazzotta), Siena, Centro Polispecialistico Mediterraneo (Rechichi), Sellia Marina, Italy., Sgheri A, Bagaglia SA, Rechichi M, Di Maggio A
Jazyk:	angličtina
Zdroj:	Journal of cataract and refractive surgery [J Cataract Refract Surg] 2020 Dec; Vol. 46 (12), pp. 1582-1587.
DOI:	10.1097/j.jcrs.0000000000000347
Abstrakt:	Purpose: To evaluate the outcomes of customized corneal crosslinking (CXL) for treatment of progressive keratoconus (KC) using a transepithelial approach with supplemental oxygen. Setting: Siena Crosslinking Center, Siena, Italy. Design: Prospective interventional case series. Methods: Twenty-seven eyes of 24 patients (mean age 29.3 ± 7.3 years) with progressive KC underwent customized corneal CXL using a transepithelial approach with supplemental oxygen. Ultraviolet (UV)-A irradiation of 365 nm wavelength was delivered in an accelerated (30 mW/cm) pulsed-light UV light exposure in a 2-zone elliptical pattern. A total dose of 10 J/cm was delivered at the KC apex, surrounded by a broadbeam spot of 7.2 J/cm. After 0.25% riboflavin corneal soaking, the UV-A irradiation was initiated in the presence of additional oxygen (≥90% concentration) delivered through special goggles connected to an oxygen delivery system (flow-rate 2.5 liters per minute). Key outcome measures included corrected distance visual acuity (CDVA), keratometry (AK, K1, K2, and K-average), corneal higher-order aberrations, topographic and manifest cylinder, corneal optical coherence tomography (OCT) demarcation line, and endothelial cell count. Results: Of the 27 eyes studied, a significant improvement of CDVA was recorded at 6-month follow-up visits, from baseline 0.19 ± 0.06 logarithm of the minimum angle of resolution (logMAR) to 0.11 ± 0.04 logMAR (P < .05). Significant flattening of steep keratometry (K2) was reported with mean change of -1.9 diopters (D) (P < .05), and coma values improved from 0.47 ± 0.28 µm to 0.28 ± 0.16 µm (P < .05). OCT revealed 2 demarcation lines at mean depths of 218.23 ± 43.32 µm and 325.71 ± 39.70 µm. Conclusions: In this series, customized CXL using a transepithelial approach with intraoperative supplemental oxygen resulted in clinically meaningful improvements in corneal curvature and CDVA without significant adverse events.
Databáze:	MEDLINE
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