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Long term results of a prospective randomized bilateral eye comparison trial of higher fluence, shorter duration ultraviolet A radiation, and riboflavin collagen cross linking for progressive keratoconus



Original Research

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Authors: Kanellopoulos AJ

Published Date January 2012 Volume 2012:6 Pages 97 - 101
DOI: http://dx.doi.org/10.2147/OPTH.S27170

Received: 10 October 2011
Accepted:14 November 2011
Published:11 January 2012

Anastasios John Kanellopoulos1–3
1Laservision.gr Institute, Athens, Greece; 2Manhattan Eye, Ear and Throat Hospital, New York, NY, 3New York University Medical School, New York, NY, USA

Purpose: To evaluate the safety and efficacy of higher fluence cornea collagen cross linking (CXL).
Methods: Twenty-one patients with bilateral keratoconus had randomized CXL in one eye (group A) with 7 mw/cm2 for 15 minutes; the other eye (group B) had the standard 3 mw/cm2 for 30 minutes; 50 um PTK with the Eye-Q 400 Hz Excimer laser (Wavelight, Erlagen, Germany) was used for epithelial removal. The patients were evaluated postoperatively at the following intervals: day 1, day 4, month 1, month 3, and then every 6 months.
Results: For groups A and B respectively, in mean values: uncorrected distance visual acuity (UDVA) improved from 20/60 to 20/38, and 20/62 to 20/40; best corrected visual acuity (BCVA) from 20/30 to 20/25 in both groups; mean sphere was reduced by 2.5 and 2.1 diopters; mean cylinder was reduced by 2.9 and 2.5 diopters on average; Steepest K was reduced from 49.5 to 46.1, and from 48.7 to 45.8 diopters. There was no ectasia progression in any of the cases during the follow-up time studied. There was no change in the endothelial cell count. All patients returned to full activities postoperatively within a month. Four cases from group A and five cases from group B had delayed epithelial healing (completed by postoperative day 9). No other adverse effects were noted in any of the cases studied. Mean follow-up was 46 months (18–56). Corneal optical coherence tomography (OCT) revealed diffused light scattered in anterior two-thirds of the cornea stroma, which was more intense and much broader in diameter in group A than in group B.
Conclusion: This novel technique offers similar clinical results in ectasia stabilization without any adverse effects noted.

Keywords: cornea collagen cross linking (CXL), ectasia management, keratoconus management, higher fluence ultraviolet light

A Letter to the Editor has been received and published for this article.




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Other articles by Professor John Kanellopoulos

Correlation between epithelial thickness in normal corneas, untreated ectatic corneas, and ectatic corneas previously treated with CXL; is overall epithelial thickness a very early ectasia prognostic factor?
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Introduction of quantitative and qualitative cornea optical coherence tomography findings induced by collagen cross-linking for keratoconus: a novel effect measurement benchmark
Laboratory evaluation of selective in situ refractive cornea collagen shrinkage with continuous wave infrared laser combined with transepithelial collagen cross-linking: a novel refractive procedure
Long-term bladeless LASIK outcomes with the FS200 Femtosecond and EX500 Excimer Laser workstation: the Refractive Suite
Long-term safety and efficacy follow-up of prophylactic higher fluence collagen cross-linking in high myopic laser-assisted in situ keratomileusis
The management of cornea blindness from severe corneal scarring, with the Athens Protocol (transepithelial topography-guided PRK therapeutic remodeling, combined with same-day, collagen cross-linking)
Three-dimensional LASIK flap thickness variability: topographic central, paracentral and peripheral assessment, in flaps created by a mechanical microkeratome (M2) and two different femtosecond lasers (FS60 and FS200)
Topography-guided hyperopic and hyperopic astigmatism femtosecond laser-assisted LASIK: long-term experience with the 400 Hz eye-Q excimer platform

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