Article

Corneal melting after cross-linking and deep lamellar keratoplasty in a keratokonus patient

Augenheilkunde, Universitätsklinik Freiburg.
Klinische Monatsblätter für Augenheilkunde (Impact Factor: 0.67). 02/2008; 225(1):96-8. DOI: 10.1055/s-2008-1027128
Source: PubMed

ABSTRACT We present the case of a 45-year-old patient with severe atopic disease and keratoconus who suffered from corneal melting following cross-linking and deep anterior lamellar keratoplasty (DALK) due to subclinical infection with Herpes simplex virus (HSV). Penetrating keratoplasty and intensive antiviral and immunosuppressive medical treatment were necessary to control the infection. The case demonstrates the difficulties in the treatment of keratoconus in patients with severe atopic disease.

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    • "Several laboratory and clinical studies indicate that standard CXL is effective in increasing the biomechanical rigidity of the cornea and stopping the progression of keratoconus [2, 6–11]. Standard CXL, however, may lead to serious complications like postoperative infection [12], stromal haze [13], and corneal melting [14]. Hence, a CXL technique that does not require epithelial removal may be preferable to increase the safety of the procedure. "
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    ABSTRACT: Purpose. Our main purpose was to compare safety and efficacy in the treatment of progressive keratoconus with "epithelium-on" and "epithelium-off" corneal collagen cross-linking (CXL). Our secondary purpose was to evaluate efficacy of CXL when hypotonic 0.5% riboflavin is used as photosensitizer. Methods. One eye of 20 patients with bilateral progressive keratoconus was randomly treated for "epithelium-on" CXL (group 1) while the fellow eye underwent "epithelium-off" CXL (group 2). Hypotonic 0.5% riboflavin was used in both groups. Visual acuity, refraction, corneal topography, and wavefront aberrometry were evaluated at baseline and after 1, 6, and 12 months. Specular microscopy was performed on 10 patients preoperatively and after 12 months. Postoperative pain was evaluated using a patient questionnaire. Results. Uncorrected and corrected distance visual acuity improved significantly in both groups. Refraction, topography, and aberrometry showed nonsignificant changes from the preoperative status throughout the 12-month follow-up in both groups. Moreover, the outcomes between the groups were comparable at all follow-up points. Endothelial cell-count was stable. Postoperative pain length was shorter in group 1 (P < 0.001). Conclusion. "Epithelium-on" and "epithelium-off" CXL using hypotonic 0.5% riboflavin were equally safe and effective in stabilization of keratoconus. Topography and aberrometry outcomes in both groups failed to show any significant improvements. This study is registered at ClinicalTrials.gov: NCT01181219.
    BioMed Research International 06/2014; 2014:619398. DOI:10.1155/2014/619398 · 2.71 Impact Factor
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    • "This procedure is proved to be effective in increasing corneal stiffness [13], stabilization of keratoconus , and in some cases in improving the refractive and topographic features [14] [15]. Even so, the epithelial removal may lead to serious complications that include infection [16] [17], stromal haze [18], and corneal melting [19] in addition to severe pain and decrease in vision occurring during the first days after the treatment. To avoid such complications, Boxer Wachler et al. suggested a modification of the technique by keeping the epithelium intact (epithelium-on or transepithelial CXL) [20]. "
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    ABSTRACT: Purpose. To evaluate the efficacy and safety of epithelium-on corneal collagen cross-linking (CXL) using a multifactorial approach to achieve proper stromal riboflavin saturation. Methods. This non-randomized retrospective study comprised 61 eyes with progressive keratoconus treated with epithelium-on CXL. Chemical epithelial penetration enhancement (benzalkonium chloride-containing local medication and hypotonic riboflavin solution), mechanical disruption of the superficial epithelium, and prolongation of the riboflavin-induction time until verification of stromal saturation were used before the UVA irradiation. Uncorrected and corrected distance visual acuity (UDVA, CDVA), refraction, corneal topography, and aberrometry were evaluated at baseline and at 1, 3, 6, and 12 months postoperative. Results. At 12-month, UDVA and CDVA improved significantly. None of the eyes lost lines of CDVA, while 27.4% of the eyes gained 2 or more lines. Mean spherical equivalent decreased by 0.74 D, and mean cylindrical reduction was 1.15 D. Irregularity index and asymmetry from Scheimpflug-based topography and Max-K at the location of cone from Placido-based topography showed a significant decrease. Higher-order-aberration data demonstrated a slight reduction in odd-order aberrations S 3, 5,7 (P = 0.04). Postoperative pain without other complications was recorded. Conclusion. Epithelium-on CXL with our novel protocol appeared to be safe and effective in the treatment of progressive keratoconus.
    Journal of Ophthalmology 07/2012; 2012(2):498435. DOI:10.1155/2012/498435 · 1.94 Impact Factor
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    ABSTRACT: Zahlreiche Hornhauterkrankungen führen früher oder später zu der Entscheidung, ob eine Hornhauttransplantation notwendig wird. Im Gegensatz zum bisherigen Goldstandard, der perforierenden Keratoplastik (PKP), lagen die Nachteile ursprünglicher lamellärer Transplantationstechniken in schlechten visuellen Ergebnissen durch Interfaceprobleme. Zahlreiche technische Neuerungen haben in jüngster Vergangenheit zu einer Wiederentdeckung verschiedener lamellärer Operationsverfahren geführt. Bei der Deep Anterior Lamellar Keratoplasty (DALK) wird die Gefahr endothelialer Abstoßungsreaktionen vermieden. Bei unvollständiger Deszemetfreilegung sind die visuellen Ergebnisse jedoch mit denen nach einer PKP nicht vergleichbar. Bei einer Variante der posterioren lamellären Keratoplastik, der sog. Descemet Stripping (Automated) Endothelial Keratoplasty [DS(A)EK], wird am Empfänger ausschließlich das erkrankte Endothel mit Descemet-Membran (Descemetorhexis) entfernt. Anschließend kann das lamelläre, endotheltragende Transplantat über einen korneoskleralen/kornealen Tunnel implantiert werden, wobei kaum Astigmatismus induziert wird. Der Hauptvorteil der DS(A)EK im Vergleich zur PKP liegt in einer rascheren visuellen Rehabilitation bei nahezu unveränderter Refraktion, wobei die Visuswerte häufig etwas schlechter ausfallen. Für diese neu entwickelten Operationstechniken fehlen jedoch noch valide Studienergebnisse, die einen nachhaltigen Vergleich der neuen Verfahren gegen die konventionelle perforierende Keratoplastik erlauben.
    Der Ophthalmologe 06/2009; 106(7):649-663. DOI:10.1007/s00347-009-1943-z · 0.72 Impact Factor
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