The Independent Effect of Various Cross-Linking Treatment Modalities on Treatment Effectiveness in Keratoconus
| Autor: | Daniel A. Godefrooij, Suzanna L. Roohé, Robert P L Wisse, Nienke Soeters |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Distance visual acuity
Visual acuity Riboflavin Visual Acuity Spherical equivalent law.invention corneal cross-linking Cornea 0302 clinical medicine transepithelial law Prospective Studies Prospective cohort study Child Photosensitizing Agents medicine.diagnostic_test Middle Aged Corneal topography Cross-Linking Reagents Treatment Outcome Collagen medicine.symptom accelerated Adult Keratoconus medicine.medical_specialty Adolescent keratoconus Refraction Ocular 03 medical and health sciences Young Adult Ophthalmology medicine Journal Article Humans riboflavin Keratometer business.industry Corneal Topography medicine.disease ultraviolet-A epithelium-off Photochemotherapy Treatment modality 030221 ophthalmology & optometry business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Cornea, 39(1), 63. Lippincott Williams and Wilkins |
| ISSN: | 1536-4798 0277-3740 |
| Popis: | PURPOSE: To investigate the 1-year outcomes of using various corneal cross-linking (CXL) techniques for treating keratoconus. METHODS: Setting: This is a prospective longitudinal cohort study performed at a tertiary academic medical center. PATIENT POPULATION: Six hundred seventy eyes of 461 patients with progressive keratoconus who underwent CXL were followed up for 1 year. INTERVENTION: Eight combinations of CXL modalities were assessed, including 2 different CXL techniques (transepithelial or epithelium-off), 7 riboflavin formulations, and 2 ultraviolet-A protocols (conventional 3 mW/cm or accelerated 9 mW/cm). Patients treated using the Dresden protocol were used as the reference group. MAIN OUTCOME MEASURES: Primary outcomes were maximum keratometry and mean keratometry 1 year after treatment. Multivariable linear regression was used which provides β coefficients (β). Secondary outcomes were uncorrected and corrected distance visual acuity, manifest refractive spherical equivalent, and corneal thickness 1 year after treatment. RESULTS: Four treatment modalities differed significantly from the reference group regarding both maximum keratometry and mean keratometry: the transepithelial CXL (TE-CXL) group (β = 1.422; P = 0.001), 1 riboflavin formulation (Meran β = 1.210; P = 0.02), and both the 9 mW/cm protocols (Vibex Rapid β = 1.751; P < 0.001 and Collagex β = 1.170, P < 0.001). Overall, the visual outcome, manifest refractive spherical equivalent, and corneal thickness were similar among the treatment modalities. Infections were rare (1.6% of cases); however, re-treatment was required for 33.3% of cases that underwent TE-CXL. CONCLUSIONS: TE-CXL, the use of Meran riboflavin, and applying the accelerated irradiation protocol appeared to be associated with reduced efficacy regarding controlling keratoconus progression. One-third of cases treated using TE-CXL required re-treatment. |
| Databáze: | OpenAIRE |
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