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

Minhui Wu; Jing Yang; Sheng Zhou

doi:doi:10.11648/j.ijovs.20210604.18

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

Minhui Wu, Jing Yang, Sheng Zhou

Published in International Journal of Ophthalmology & Visual Science (Volume 6, Issue 4)

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), 2024. Published by Science Publishing Group

Keywords

Keratoconus, Higher-energy, Accelerated Cornea Cross-linking

References

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[2]	Gomes JA, Tan D, Rapuano CJ, Belin MW, Ambrosio R, Jr., Guell JL, Malecaze F, Nishida K, Sangwan VS, Group of Panelists for the Global Delphi Panel of K et al: Global consensus on keratoconus and ectatic diseases. Cornea 2015, 34 (4): 359-369.
[3]	Rabinowitz YS: Keratoconus. Surv Ophthalmol 1998, 42 (4): 297-319.
[4]	Parker JS, van Dijk K, Melles GR: Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015, 60 (5): 459-480.
[5]	Zhao J, Shang J, Zhao Y, Fu D, Zhang X, Zeng L, Xu H, Zhou X: Epikeratophakia using small-incision lenticule extraction lenticule addition combined with corneal crosslinking for keratoconus. J Cataract Refract Surg 2019, 45 (8): 1191-1194.
[6]	Wollensak G, Spoerl E, Seiler T: Riboflavin/ultraviolet-a–induced collagen crosslinking for the treatment of keratoconus. American Journal of Ophthalmology 2003, 135 (5): 620-627.
[7]	Sachdev GS, Sachdev M: Recent advances in corneal collagen cross-linking. Indian J Ophthalmol 2017, 65 (9): 787-796.
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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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[13]	Mazzotta C, Traversi C, Caragiuli S, Rechichi M: Pulsed vs continuous light accelerated corneal collagen crosslinking: in vivo qualitative investigation by confocal microscopy and corneal OCT. Eye (Lond) 2014, 28 (10): 1179-1183.
[14]	Mazzotta C, Traversi C, Paradiso AL, Latronico ME, Rechichi M: Pulsed Light Accelerated Crosslinking versus Continuous Light Accelerated Crosslinking: One-Year Results. J Ophthalmol 2014, 2014: 604731.
[15]	Wernli J, Schumacher S, Spoerl E, Mrochen M: The efficacy of corneal cross-linking shows a sudden decrease with very high intensity UV light and short treatment time. Invest Ophthalmol Vis Sci 2013, 54 (2): 1176-1180.
[16]	Imbornoni LM, McGhee CNJ, Belin MW: Evolution of Keratoconus: From Diagnosis to Therapeutics. Klin Monbl Augenheilkd 2018, 235 (6): 680-688.
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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

Minhui Wu

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

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

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

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Plain Text BibTeX RIS

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

Copy | Download

@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}
}

Copy | Download

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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