Central versus paracentral cone location and outcomes of accelerated cross-linking in keratoconus patients.
Adult
Astigmatism
Collagen
/ therapeutic use
Coma
/ drug therapy
Cornea
Corneal Topography
Cross-Linking Reagents
/ therapeutic use
Humans
Keratoconus
/ drug therapy
Myopia
/ drug therapy
Photochemotherapy
Photosensitizing Agents
/ therapeutic use
Prospective Studies
Riboflavin
/ therapeutic use
Treatment Outcome
Ultraviolet Rays
Visual Acuity
Young Adult
Journal
Eye (London, England)
ISSN: 1476-5454
Titre abrégé: Eye (Lond)
Pays: England
ID NLM: 8703986
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
31
07
2020
accepted:
13
01
2021
revised:
07
12
2020
pubmed:
31
1
2021
medline:
15
4
2022
entrez:
30
1
2021
Statut:
ppublish
Résumé
To compare outcomes 1 year after accelerated cross-linking (CXL) between keratoconus eyes with central cones to those with paracentral cones. In this post hoc analysis of data from a prospective multicentre study, consecutive progressive keratoconus eyes treated with accelerated CXL were included. Preoperative and 1 year post CXL manifest refraction, corneal cylinder, maximal keratometry (Kmax), central corneal thickness and coma were assessed. Central and paracentral cones were defined as cones within the central 3 mm and those between 3 and 5 mm, respectively. Eyes with apical scarring and peripheral cones (>5 mm) were excluded. The primary outcome measures were changes in best spectacle-corrected visual acuity (BSCVA) and Kmax. Overall, 314 eyes (n = 314) with a mean age of 27.5 ± 7.7 years were included. At baseline, the central cone group was younger (p < 0.001), had lower corneal astigmatism (p = 0.03) and coma (p = 0.02). At 1 year post CXL, after adjusting for baseline characteristics (age, BSCVA, corneal astigmatism, Kmax and coma), the central cone group showed a greater reduction in myopia (mean difference 1.27 ± 0.60D, p = 0.04) and more improvement in BSCVA (mean difference 0.08 ± 0.02 logMAR, p < 0.001) compared to the paracentral group. There was no significant difference in progression rates between the central and paracentral groups (ΔKmax > 2D, 6.7% vs. 6.5%, respectively, p = 0.83). This large-scale study of keratoconus eyes 1 year after accelerated CXL indicates that compared to those with paracentral cones, central cones have on average almost one additional line improvement in BCSVA and 1.27 D more reduction in myopia.
Identifiants
pubmed: 33514906
doi: 10.1038/s41433-021-01404-5
pii: 10.1038/s41433-021-01404-5
pmc: PMC8602256
doi:
Substances chimiques
Cross-Linking Reagents
0
Photosensitizing Agents
0
Collagen
9007-34-5
Riboflavin
TLM2976OFR
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
3311-3317Investigateurs
Raymond Stein
(R)
Matthew C Bujak
(MC)
Clara C Chan
(CC)
Hall F Chew
(HF)
Sherif El-Defrawy
(S)
Christoph Kranemann
(C)
Theodore Rabinovitch
(T)
David S Rootman
(DS)
Allan R Slomovic
(AR)
Informations de copyright
© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.
Références
Mathew JH, Goosey JD, Bergmanson JPG. Quantified histopathology of the keratoconic cornea. Optom Vis Sci. 2011;88:988–97.
doi: 10.1097/OPX.0b013e31821ffbd4
Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135:620–7.
doi: 10.1016/S0002-9394(02)02220-1
Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: Long-term results. J Cataract Refract Surg. 2008;34:796–801.
doi: 10.1016/j.jcrs.2007.12.039
Brooks NO, Greenstein S, Fry K, Hersh PS. Patient subjective visual function after corneal collagen crosslinking for keratoconus and corneal ectasia. J Cataract Refract Surg. 2012;38:615–9.
doi: 10.1016/j.jcrs.2011.11.029
Toprak I, Yaylali V, Yildirim C. Factors affecting outcomes of corneal collagen crosslinking treatment. Eye. 2014;28:41–46.
doi: 10.1038/eye.2013.224
Lamy R, Netto CF, Reis RG, Procopio B, Porco TC, Stewart JM, et al. Effects of corneal cross-linking on contrast sensitivity, visual acuity, and corneal topography in patients with keratoconus. Cornea. 2013;32:591–6.
doi: 10.1097/ICO.0b013e31826672e2
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;149:585–93.
doi: 10.1016/j.ajo.2009.10.021
Greenstein SA, Hersh PS. Characteristics influencing outcomes of corneal collagen crosslinking for keratoconus and ectasia: Implications for patient selection. J Cataract Refract Surg. 2013;39:1133–40.
doi: 10.1016/j.jcrs.2013.06.007
Wisse RPL, Godefrooij DA, Soeters N, Imhof SM, Van, der Lelij A. A multivariate analysis and statistical model for predicting visual acuity and keratometry one year after cross-linking for keratoconus. Am J Ophthalmol. 2014;157:519–.e2.
doi: 10.1016/j.ajo.2013.11.001
Koc M, Uzel MM, Tekin K, Kosekahya P, Ozulken K, Yilmazbas P. Effect of preoperative factors on visual acuity, corneal flattening, and corneal haze after accelerated corneal crosslinking. J Cataract Refract Surg. 2016;42:1483–9.
doi: 10.1016/j.jcrs.2016.08.017
Sarac O, Caglayan M, Cakmak HB, Cagil N. Factors influencing progression of keratoconus 2 years after corneal collagen cross-linking in pediatric patients. Cornea. 2016;35:1503–7.
doi: 10.1097/ICO.0000000000001051
Hatch W, El-Defrawy S, Ong Tone S, Stein R, Slomovic AR, Rootman DS, et al. Accelerated corneal cross-linking: efficacy, risk of progression, and characteristics affecting outcomes. a large, single-center prospective study. Am J Ophthalmol. 2020;213:76–87.
doi: 10.1016/j.ajo.2020.01.006
Holopigian K, Bach M. A primer on common statistical errors in clinical ophthalmology. Doc Ophthalmol. 2010;121:215–22.
doi: 10.1007/s10633-010-9249-7
Koc M, Tekin K, Inanc M, Kosekahya P, Yilmazbas P. Crab claw pattern on corneal topography: Pellucid marginal degeneration or inferior keratoconus? Eye 2018;32:11–8.
doi: 10.1038/eye.2017.198
Martínez-Abad A, Piñero DP. Pellucid marginal degeneration: detection, discrimination from other corneal ectatic disorders and progression. Contact Lens Anterior Eye. 2019;42:341–9.
doi: 10.1016/j.clae.2018.11.010
Ertan A, Kamburoglu G, Colin J. Location of steepest corneal area of cone in keratoconus stratified by age using Pentacam. J Refract Surg 2009;25:1012–6.
doi: 10.3928/1081597X-20091016-07
Greenstein SA, Fry KL, Hersh PS. Effect of topographic cone location on outcomes of corneal collagen cross-linking for keratoconus and corneal ectasia. J Refract Surg. 2012;28:397–405.
doi: 10.3928/1081597X-20120518-02
Kymionis GD, Kontadakis GA, Hashemi KK. Accelerated versus conventional corneal crosslinking for refractive instability: an update. Curr Opin Ophthalmol. 2017;28:343–7.
Armstrong RA. Statistical guidelines for the analysis of data obtained from one or both eyes. Ophthalmic Physiol Opt. 2013;33:7–14.
doi: 10.1111/opo.12009
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstem AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–9.
doi: 10.1016/S0895-4356(96)00236-3
Lang PZ, Hafezi NL, Khandelwal SS, Torres-Netto EA, Hafezi F, Randleman JB. Comparative functional outcomes after corneal crosslinking using standard, accelerated, and accelerated with higher total fluence protocols. Cornea. 2019;38:433–41.
doi: 10.1097/ICO.0000000000001878
Hersh PS, Lai MJ, Gelles JD, Lesniak SP. Transepithelial corneal crosslinking for keratoconus. J. Cataract Refract. Surg. 2018;44:313–22.
Stulting RD, Trattler WB, Woolfson JM, Rubinfeld RS. Corneal crosslinking without epithelial removal. J Cataract Refract Surg. 2018;44:1363–70.
doi: 10.1016/j.jcrs.2018.07.029
Jafri B, Lichter H, Stulting RD. Asymmetric keratoconus attributed to eye rubbing. Cornea. 2004;23:560–4.
doi: 10.1097/01.ico.0000121711.58571.8d
Hafezi F, Hafezi NL, Pajic B, Gilardoni F, Randleman JB, Gomes JAP, et al. Assessment of the mechanical forces applied during eye rubbing. BMC Ophthalmol. 2020;20:301.
doi: 10.1186/s12886-020-01551-5
Tian M, Ma P, Zhou W, Feng J, Mu G. Outcomes of corneal crosslinking for central and paracentral keratoconus. Medicine. 2017;96:e6247.
doi: 10.1097/MD.0000000000006247