Topographic and Biomechanical Changes after Application of Corneal Cross-Linking in Recurrent Keratoconus

Background: Recurrent keratoconus (RKC) develops as a progressive thinning of the peripheral and the inferior cornea after keratoplasty, in both graft and host, causing secondary astigmatism, refractive instability, and reduced visual acuity. We evaluated the effectiveness of corneal cross-linking (CXL) in patients diagnosed with RKC. Methods: Accelerated-CXL via the epi-off technique was performed in15 patients (18 eyes) diagnosed with RKC. Topographic and biomechanical changes were assessed at 12 months. Results: Differences in maximum keratometry, thinnest corneal thickness, and biomechanical parameters (deformation amplituderatio, inverse concave radius, applanation 1 velocity, and applanation 2 velocity, stiffness A1) versus baseline were statistically significant (p < 0.05).Best corrected visual acuity was improved in 13 eyes and unchanged in 4;manifest refractive spherical equivalent was reduced in 13 eyes, increased in 3,and unchanged in 1 eye; topographic astigmatism was reduced in 9 eyes, remained stable in 1 eye, and increased in 7 eyes. Conclusions: Improved topographic and biomechanic indexes at 1 year after CXL suggest it‘s potential as first-line therapy for RKC, as it is for KC.

[1]  Seyed Mohammadali Rahmati,et al.  Biomechanics of the Healthy and Keratoconic Corneas: A Combination of the Clinical Data, Finite Element Analysis, and Artificial Neural Network. , 2019, Current pharmaceutical design.

[2]  H. Dua,et al.  Correlation of central and peripheral keratometric parameters after corneal collagen cross-linking in keratoconus patients , 2018, International Ophthalmology.

[3]  Hiroshi Murata,et al.  Characteristics and risk factors of recurrent keratoconus over the long term after penetrating keratoplasty , 2018, Graefe's Archive for Clinical and Experimental Ophthalmology.

[4]  S. Priglinger,et al.  Long-term database analysis of conventional and accelerated crosslinked keratoconic mid-European eyes , 2018, Graefe's Archive for Clinical and Experimental Ophthalmology.

[5]  J. L. Hernández-Verdejo,et al.  Nonsurgical Procedures for Keratoconus Management , 2017, Journal of ophthalmology.

[6]  Hassan Razmjoo,et al.  Cornea Collagen Cross-linking for Keratoconus: A Comparison between Accelerated and Conventional Methods , 2017, Advanced biomedical research.

[7]  M. Santhiago,et al.  Accelerated corneal collagen crosslinking: Technique, efficacy, safety, and applications , 2016, Journal of cataract and refractive surgery.

[8]  Bernardo T. Lopes,et al.  Detection of Keratoconus With a New Biomechanical Index. , 2016, Journal of refractive surgery.

[9]  Bernardo T. Lopes,et al.  Influence of Pachymetry and Intraocular Pressure on Dynamic Corneal Response Parameters in Healthy Patients. , 2016, Journal of refractive surgery.

[10]  C. Jayadev,et al.  Current Protocols of Corneal Collagen Cross-Linking: Visual, Refractive, and Tomographic Outcomes. , 2015, American journal of ophthalmology.

[11]  Y. Goldich,et al.  Accelerated (9 mW/cm2) corneal collagen crosslinking for keratoconus--a 1-year follow-up. , 2015, Cornea.

[12]  Y. Goldich,et al.  Accelerated (9-mW/cm2) Corneal Collagen Crosslinking for Keratoconus—A 1-Year Follow-up , 2014, Cornea.

[13]  Sundaram Natarajan,et al.  Keratoconus , 2013, Indian journal of ophthalmology.

[14]  V. Rathi,et al.  Contact lens in keratoconus , 2013, Indian journal of ophthalmology.

[15]  F. Hafezi,et al.  Crosslinking for recurrent keratoconus. , 2012, Ophthalmology.

[16]  D. Musch,et al.  Extended long-term outcomes of penetrating keratoplasty for keratoconus. , 2006, Ophthalmology.

[17]  R. Barraquer,et al.  Long-Term Progression of Astigmatism After Penetrating Keratoplasty for Keratoconus: Evidence of Late Recurrence , 2003, Cornea.

[18]  S. Daya,et al.  Corneal wedge resection to treat progressive keratoconus in the host cornea after penetrating keratoplasty , 2003, Journal of cataract and refractive surgery.

[19]  U. Rehany,et al.  The profile of repeated corneal transplantation. , 2001, Ophthalmology.

[20]  E. Donnenfeld,et al.  Laser in situ keratomileusis for correction of myopia and astigmatism after penetrating keratoplasty. , 1999, Ophthalmology.

[21]  E. Holland,et al.  Iatrogenic Limbal Stem Cell Deficiency , 1998, Transactions of the American Ophthalmological Society.

[22]  N. Tripoli,et al.  Prospective analysis of photokeratoscopy for arcuate keratotomy to reduce postkeratoplasty astigmatism. , 1989, Refractive & corneal surgery.