Outcomes of Corneal Collagen Crosslinking in Pseudophakic Bullous Keratopathy

ArticleinCornea 33(3) · January 2014with29 Reads
DOI: 10.1097/ICO.0000000000000004 · Source: PubMed
Abstract
The aim was to evaluate the outcomes of corneal collagen crosslinking (CXL) in symptomatic pseudophakic bullous keratopathy (PBK). In a retrospective noncomparative, interventional case series, we reviewed the records of 50 eyes (50 patients) with symptomatic PBK who underwent CXL. Central corneal thickness (CCT), pain score, best corrected visual acuity (BCVA), and corneal transparency were recorded at baseline; at day 7, day 15; and 1, 3, and 6 months after the CXL. The mean pain score decreased from 8.1 ± 0.6 at presentation to 2.1 ± 0.7 on day 7 (P = 0.0001). A subsequent regression was seen in pain scores over 6 months (5.3 ± 1.5). The mean CCT decreased from a preoperative value of 724.8 ± 78.4 to 694.9 ± 77.9 μm by the end of the first month (P = 0.0001). The CCT remained stable at subsequent follow-up. The BCVA improved from logarithm of the minimum angle of resolution (log MAR) 2.0 ± 0.5 preoperatively to log MAR 1.8 ± 0.5 by the end of the first month (P = 0.001). The subsequent follow-up showed a progressive deterioration in the BCVA to the preoperative levels at 6 months. Corneal bullae recurred in 44% (22 eyes) at 6 months after an initial disappearance. A significant improvement in the BCVA and a lack of recurrence of bullae were significantly associated with a thinner CCT on presentation. CXL in symptomatic PBK temporarily improves pain without providing long-term improvement in the BCVA. Case selection is important with more effect seen in patients with a thinner CCT at presentation.
    • "Clinical studies evaluating the effectiveness of corneal CXL in the treatment of PBK reported a significant improvement in corneal transparency, corneal thickness, and ocular pain one month postoperatively. However, CXL did not seem to have a long-lasting effect over six months in decreasing pain and maintaining corneal transparency [141, 142]. "
    [Show abstract] [Hide abstract] ABSTRACT: Since the late 1990s corneal crosslinking (CXL) has been proposed as a new possibility to stop progression of keratoconus or secondary corneal ectasia, with the promising aim to prevent progressive visual loss due to the evolution of the pathology and to delay or avoid invasive surgical procedures such as corneal transplantation. The possibility of strengthening corneal tissue by means of a photochemical reaction of corneal collagen by the combined action of Riboflavin and ultraviolet A irradiation (UVA), radically modified the conservative management of progressive corneal ectasia. This is a review of the state of the art of CXL, reporting basic and clinical evidence. The paper describes basic principles, advantages and limits of different CXL techniques and possible future evolution of the procedure.
    Full-text · Article · Nov 2015
    • "The reason for ineffectivity of CXL with both the standard protocol and the protocol suggested by Hafezi and coauthors in our study may be due to differences in patient characteristics or surgical techniques. As suggested previously, efficacy of CXL in bullous keratopathy may tend to be less pronounced in advanced keratoconus [9, 10]. Our first patient was an advanced case. "
    [Show abstract] [Hide abstract] ABSTRACT: Four eyes of 2 patients with corneal edema due to Fuchs' endothelial dystrophy were treated with CXL using the standard protocol. Since no improvement in visual acuity, corneal clarity, thickness, or pain sensation was evident in any eye at month 12, 2 eyes of the 2 patients were retreated, this time, following intraoperative corneal dehydration with glycerol 70% drops. This retreatment also failed to produce any significant effect on vision, corneal clarity, thickness, or pain in either eye. Collagen crosslinking with the current protocols may not be effective in the management of eyes with corneal edema due to Fuchs' endothelial dystrophy. Further studies are required to establish the efficacy of CXL and optimize the technique and/or dehydration method utilized in these cases.
    Full-text · Article · Nov 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Corneal transplantation remains the gold-standard treatment for bullous keratopathy patients as it provides symptomatic relief and visual rehabilitation. As corneas are not always available for transplant, alternative treatments have to be considered for alleviation of discomfort and pain. Various treatment options available in such cases include conjunctival flaps, anterior stromal puncture, amniotic membrane transplantation, phototherapeutic keratectomy, bandage contact lenses, and hypertonic saline eye drops. A combination of the above treatments can be employed depending upon the severity of bullous keratopathy and co-existing corneal edema. New potential treatments include collagen cross-linking (CXL), cultured endothelial cell injection, and topical treatment with Rho-associated kinase (ROCK) inhibitor. There is a lack of clinical trials comparing the safety and efficacy of the currently available treatment options for the management of bullous keratopathy. The effect of these treatments on subsequent corneal transplant has not been observed. CXL seems to offer short-term benefit for relief of pain. Newer potential treatment modalities such as ROCK inhibitors are claimed to be useful for the reversal of early edema associated with corneal endothelial dysfunction; however, long-term clinical trials are awaited.
    Article · May 2014
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