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Derakhshan A, Heravian J, Abdolahian M, Bamdad S. Long-term Outcomes of Collagen Crosslinking for Early Keratoconus. JOVR [Internet]. 2021Apr.29 [cited 2024Jun.30];16(2):151–157. Available from: https://knepublishing.com/index.php/JOVR/article/view/9077
https://doi.org/10.18502/jovr.v16i2.9077
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authors
-
Akbar Derakhshan
Akbar Derakhshan
Cornea Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
-
Javad Heravian
Javad Heravian
Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
-
Milad Abdolahian
Milad Abdolahian
Department of Optometry, School of Paramedical Science, Mashhad University of Medical Sciences, Mashhad, Iran
-
Shahram Bamdad
Shahram Bamdad
Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Published Date
- Apr 29, 2021
Long-term Outcomes of Collagen Crosslinking for Early Keratoconus
Abstract
Purpose: To evaluate the long-term outcomes of collagen crosslinking in early keratoconus.
Methods: Thirty eyes of twenty patients with early keratoconus were enrolled. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), objective refraction, subjective refraction, corneal topography and pachymetry were assessed before and 3, 6, 12 months and 9 years after performing collagen crosslinking surgery.
Results: The patients’ mean age was 31.2 ± 5.59 years at nine-year follow-up (range, 25–44 years). The means of preoperative UCVA and BSCVA were 0.57 ± 0.34 and 0.15 ± 0.12 logMAR, respectively, and these values remained stable at the final follow-up (P = 0.990 and P = 0.227, respectively). The mean objective spherical equivalent decreased considerably from –6.00 ± 4.05 D preoperatively to –5.22 ± 3.71 D at the final follow-up (P < 0.05). The mean subjective spherical equivalent was –4.25 ± 2.87 D preoperatively and this value was stable at the last follow-up (P = 0.92). No considerable difference was found between the post- and preoperative mean objective cylinder values (P = 0.34). The mean subjective cylinder value changed significantly from –4.05 ± 1.85 D preoperatively to –3.1 ± 1.42 D at the final follow-up (P < 0.05). The mean central corneal thickness was 496.97 ± 45.95 μm preoperatively and this value was stable at nine-year follow-up (P = 0.183). No significant difference was found between the pre- and postoperative mean maximum and mean minimum corneal curvature values (P = 0.429 and P = 0.248, respectively). There were no significant postoperative complications.
Conclusion: Corneal crosslinking in early keratoconus seems to be a safe procedure that can effectively stabilize UCVA, BSCVA, subjective SE and CCT, while improving objective spherical equivalent.
Keywords:
Cornea, Collagen Crosslinking, Keratoconus
References
1. Mrazovac D, Barišić Kutija M, Vidas S, Kuzman T, Petriček I, Jandroković S, et al. Contact Lenses as the best Conservative Treatment of Newly Diagnosed Keratoconus–Epidemiological Retrospective Study. Coll Antropol 2014;38:1115–1118.
2. Cannon D, Foster C. Collagen crosslinking in keratoconus. Invest Ophthalmol Vis Sci 1978;17:63–65.
3. Hellstedt T, Mäkelä J, Uusitalo R, Emre S, Uusitalo R. Treating keratoconus with Intacs corneal ring segments. J Refract Surg 2005;21:236–246.
4. Richard JM, Paton D, Gasset AR. A comparison of penetrating keratoplasty and lamellar keratoplasty in the surgical management of keratoconus. Am J Ophthalmol 1978;86:807–811.
5. Wood TO. Lamellar transplants in keratoconus. Am J Ophthalmol 1977;83:543–545.
6. Spoerl E, Mrochen M, Sliney D, Trokel S, Seiler T. Safety of UVS-riboflavin cross-linking of the cornea. Cornea 2007;26:385–389.
7. Wollensak G, Spoerl E, Seiler T. Stress-strain measurements of human and porcine corneas after riboflavin–Ultraviolet-A-induced cross-linking. J Cataract Refract Surg 2003;29:1780–1785.
8. Greenstein SA, Fry KL, Hersh PS. In vivo biomechanical changes after corneal collagen cross-linking for keratoconus and corneal ectasia: 1-year analysis of a randomized, controlled, clinical trial. Cornea 2012;31:21– 25.
9. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet- A–induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 2003;135:620–627.
10. Wollensak G, Wilsch M, Spoerl E, Seiler T. Collagen fiber diameter in the rabbit cornea after collagen crosslinking by Riboflavin/UVA. Cornea 2004;23:503–507.
11. Beshtawi IM, O’Donnell C, Radhakrishnan H. Biomechanical properties of corneal tissue after ultraviolet-A–riboflavin crosslinking. J Cataract Refract Surg 2013;39:451–462.
12. Mencucci R, Marini M, Paladini I, Sarchielli E, Sgambati E, Menchini U, et al. Effects of riboflavin/UVS corneal cross−linking on keratocytes and collagen fibres in human cornea. Clin Experiment Ophthalmol 2010;38:49–56.
13. Wollensak G, Spörl E, Mazzotta C, Kalinski T, Sel S. Interlamellar cohesion after corneal crosslinking using riboflavin and ultraviolet A light. Br J Ophthalmol 2011;95:876–880.
14. Jankov II MR, Jovanovic V, Nikolic L, Lake JC, Kymionis G, Coskunseven E. Corneal collagen cross-linking. Middle East Afr J Ophthalmol 2010;17:21.
15. Vinciguerra P, Albè E, Trazza S, Rosetta P, Vinciguerra R, Seiler T, et al. Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. Ophthalmology 2009;116:369–378.
16. Hersh PS, Greenstein SA, Fry KL. Corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 2011;37:149–160.
17. Padmanabhan P, Radhakrishnan A, Venkataraman AP, Gupta N, Srinivasan B. Corneal changes following collagen cross linking and simultaneous topography guided photoablation with collagen cross linking for keratoconus. Indian J Ophthalmol 2014;62:229.
18. Wittig-Silva C, Chan E, Islam FM, Wu T, Whiting M, Snibson GR. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: threeyear results. Ophthalmology 2014;121:812–821.
19. 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;32:591–596.
20. Szczotka LB, Barr JT, Zadnik K. A summary of the findings from the Collaborative Longitudinal Evaluation of Keratoconus (Clek) Study. Clek Study Group. Optometry 2001;72:574–584.
21. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Longterm results of riboflavin ultraviolet A corneal collagen cross-linking for keratoconus in Italy: the Siena Eye Cross Study. Am J Opthalmol 2010;149:585–593.
22. Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal crosslinking. J Cataract Refract Surg 2009;35:1358–1362.
23. 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.
24. Greenstein SA, Fry KL, Hersh MJ, Hersh PS. Higherorder aberrations after corneal collagen crosslinking for keratoconus and corneal ectasia. J Cataract Refract Surg 2012;38:292–302.
25. Greenstein SA, Fry KL, Hersh PS. Corneal topography indices after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 2011;37:1282–1290.
26. Vinciguerra P, Albè E, Trazza S, Epstein D. Intraoperative and postoperative effects of corneal collagen crosslinking on progressive keratoconus. Arch Ophthalmol 2009;127:1258–1265.
27. O’Brart DP, Kwong TQ, Patel P, McDonald RJ, O’Brart NA. Long-term followup of riboflavin/ultraviolet A (370 Nm) corneal collagen cross-linking to halt the progression of keratoconus. Br J Ophthalmol 2013;97:433–437.
28. Hashemi H, Seyedian MA, Miraftab M, Fotouhi A, Asgari S. Corneal collagen cross-linking with riboflavin and ultraviolet A irradiation for keratoconus: long-term results. Ophthalmology 2013;120:1515–1520.
29. Wittig-Silva C, Whiting M, Lamoureux E, Sullivan LJ, Lindsay RG, Snibson GR. A randomized controlled trial of corneal collagen crosslinking in progressive keratoconus: preliminary results. J Refract Surg 2008;24:S720–S725.
30. Grewal DS, Brar GS, Jain R, Sood V, Singla M, Grewal SP. Corneal collagen crosslinking using riboflavin and ultraviolet-A light for keratoconus: one-year analysis using scheimpflug imaging. J Cataract Refract Surg 2009;35:425–432.
31. Caporossi A, Baiocchi S, Mazzotta C, Traversi C, Caporossi T. Parasurgical Therapy for keratoconus by riboflavin– ultraviolet type A rays induced cross-linking of corneal collagen: preliminary refractive results in an Italian study. J Cataract Refract Surg 2006;32:837–845.
32. Arbelaez MC, Sekito MB, Vidal C, Choudhury SR. Collagen cross-linking with riboflavin and ultraviolet-A light in keratoconus: one-year results. Oman J Ophthalmol 2009;2:33.
33. Henriquez MA, Izquierdo Jr L, Bernilla C, Zakrzewski PA, Mannis M. Riboflavin/ultraviolet a corneal collagen crosslinking for the treatment of keratoconus: visual outcomes and Scheimpflug analysis. Cornea 2011;30:281–286.
34. El-Raggal TM. Sequential versus concurrent kerarings insertion and corneal collagen cross-linking for keratoconus. Br J Ophthalmol 2011;95:37–41.
35. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T, Denaro R. Age-related long-term functional results after riboflavin UVA corneal cross-linking. J Ophthalmol 2011;2011.
36. El-Raggal TM. Riboflavin-ultraviolet a corneal crosslinking for keratoconus. Middle East Afr J Ophthalmol 2009;16:256.
37. Asri D, Touboul D, Fournié P, Malet F, Garra C, Gallois A, et al. Corneal collagen crosslinking in progressive keratoconus: multicenter results from the French National Reference Center for Keratoconus. J Cataract Refract Surg 2011;37:2137–2143.
38. Greenstein SA, Shah VP, Fry KL, Hersh PS. Corneal thickness changes after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 2011;37:691–700.
39. Chan CC, Sharma M, Wachler BSB. Effect of inferiorsegment intacs with and without C3-R on keratoconus. J Cataract Refract Surg 2007;33:75–80.
40. Belin MW, Alizadeh R, Torres-Netto EA, Hafezi F, Ambrósio Jr R, Pajic B. Keratoconus expert meeting, London, 2014. J Kerat Ect Cor Dis 2014;3:141–158.
41. Mahmoud AM, Nuñez MX, Blanco C, Koch DD, Wang L, Weikert MP, et al. Expanding the Cone Location and Magnitude Index to include corneal thickness and posterior surface information for the detection of keratoconus. Am J Ophthalmol 2013;156:1102–1111.
2. Cannon D, Foster C. Collagen crosslinking in keratoconus. Invest Ophthalmol Vis Sci 1978;17:63–65.
3. Hellstedt T, Mäkelä J, Uusitalo R, Emre S, Uusitalo R. Treating keratoconus with Intacs corneal ring segments. J Refract Surg 2005;21:236–246.
4. Richard JM, Paton D, Gasset AR. A comparison of penetrating keratoplasty and lamellar keratoplasty in the surgical management of keratoconus. Am J Ophthalmol 1978;86:807–811.
5. Wood TO. Lamellar transplants in keratoconus. Am J Ophthalmol 1977;83:543–545.
6. Spoerl E, Mrochen M, Sliney D, Trokel S, Seiler T. Safety of UVS-riboflavin cross-linking of the cornea. Cornea 2007;26:385–389.
7. Wollensak G, Spoerl E, Seiler T. Stress-strain measurements of human and porcine corneas after riboflavin–Ultraviolet-A-induced cross-linking. J Cataract Refract Surg 2003;29:1780–1785.
8. Greenstein SA, Fry KL, Hersh PS. In vivo biomechanical changes after corneal collagen cross-linking for keratoconus and corneal ectasia: 1-year analysis of a randomized, controlled, clinical trial. Cornea 2012;31:21– 25.
9. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet- A–induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 2003;135:620–627.
10. Wollensak G, Wilsch M, Spoerl E, Seiler T. Collagen fiber diameter in the rabbit cornea after collagen crosslinking by Riboflavin/UVA. Cornea 2004;23:503–507.
11. Beshtawi IM, O’Donnell C, Radhakrishnan H. Biomechanical properties of corneal tissue after ultraviolet-A–riboflavin crosslinking. J Cataract Refract Surg 2013;39:451–462.
12. Mencucci R, Marini M, Paladini I, Sarchielli E, Sgambati E, Menchini U, et al. Effects of riboflavin/UVS corneal cross−linking on keratocytes and collagen fibres in human cornea. Clin Experiment Ophthalmol 2010;38:49–56.
13. Wollensak G, Spörl E, Mazzotta C, Kalinski T, Sel S. Interlamellar cohesion after corneal crosslinking using riboflavin and ultraviolet A light. Br J Ophthalmol 2011;95:876–880.
14. Jankov II MR, Jovanovic V, Nikolic L, Lake JC, Kymionis G, Coskunseven E. Corneal collagen cross-linking. Middle East Afr J Ophthalmol 2010;17:21.
15. Vinciguerra P, Albè E, Trazza S, Rosetta P, Vinciguerra R, Seiler T, et al. Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. Ophthalmology 2009;116:369–378.
16. Hersh PS, Greenstein SA, Fry KL. Corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 2011;37:149–160.
17. Padmanabhan P, Radhakrishnan A, Venkataraman AP, Gupta N, Srinivasan B. Corneal changes following collagen cross linking and simultaneous topography guided photoablation with collagen cross linking for keratoconus. Indian J Ophthalmol 2014;62:229.
18. Wittig-Silva C, Chan E, Islam FM, Wu T, Whiting M, Snibson GR. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: threeyear results. Ophthalmology 2014;121:812–821.
19. 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;32:591–596.
20. Szczotka LB, Barr JT, Zadnik K. A summary of the findings from the Collaborative Longitudinal Evaluation of Keratoconus (Clek) Study. Clek Study Group. Optometry 2001;72:574–584.
21. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Longterm results of riboflavin ultraviolet A corneal collagen cross-linking for keratoconus in Italy: the Siena Eye Cross Study. Am J Opthalmol 2010;149:585–593.
22. Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal crosslinking. J Cataract Refract Surg 2009;35:1358–1362.
23. 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.
24. Greenstein SA, Fry KL, Hersh MJ, Hersh PS. Higherorder aberrations after corneal collagen crosslinking for keratoconus and corneal ectasia. J Cataract Refract Surg 2012;38:292–302.
25. Greenstein SA, Fry KL, Hersh PS. Corneal topography indices after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 2011;37:1282–1290.
26. Vinciguerra P, Albè E, Trazza S, Epstein D. Intraoperative and postoperative effects of corneal collagen crosslinking on progressive keratoconus. Arch Ophthalmol 2009;127:1258–1265.
27. O’Brart DP, Kwong TQ, Patel P, McDonald RJ, O’Brart NA. Long-term followup of riboflavin/ultraviolet A (370 Nm) corneal collagen cross-linking to halt the progression of keratoconus. Br J Ophthalmol 2013;97:433–437.
28. Hashemi H, Seyedian MA, Miraftab M, Fotouhi A, Asgari S. Corneal collagen cross-linking with riboflavin and ultraviolet A irradiation for keratoconus: long-term results. Ophthalmology 2013;120:1515–1520.
29. Wittig-Silva C, Whiting M, Lamoureux E, Sullivan LJ, Lindsay RG, Snibson GR. A randomized controlled trial of corneal collagen crosslinking in progressive keratoconus: preliminary results. J Refract Surg 2008;24:S720–S725.
30. Grewal DS, Brar GS, Jain R, Sood V, Singla M, Grewal SP. Corneal collagen crosslinking using riboflavin and ultraviolet-A light for keratoconus: one-year analysis using scheimpflug imaging. J Cataract Refract Surg 2009;35:425–432.
31. Caporossi A, Baiocchi S, Mazzotta C, Traversi C, Caporossi T. Parasurgical Therapy for keratoconus by riboflavin– ultraviolet type A rays induced cross-linking of corneal collagen: preliminary refractive results in an Italian study. J Cataract Refract Surg 2006;32:837–845.
32. Arbelaez MC, Sekito MB, Vidal C, Choudhury SR. Collagen cross-linking with riboflavin and ultraviolet-A light in keratoconus: one-year results. Oman J Ophthalmol 2009;2:33.
33. Henriquez MA, Izquierdo Jr L, Bernilla C, Zakrzewski PA, Mannis M. Riboflavin/ultraviolet a corneal collagen crosslinking for the treatment of keratoconus: visual outcomes and Scheimpflug analysis. Cornea 2011;30:281–286.
34. El-Raggal TM. Sequential versus concurrent kerarings insertion and corneal collagen cross-linking for keratoconus. Br J Ophthalmol 2011;95:37–41.
35. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T, Denaro R. Age-related long-term functional results after riboflavin UVA corneal cross-linking. J Ophthalmol 2011;2011.
36. El-Raggal TM. Riboflavin-ultraviolet a corneal crosslinking for keratoconus. Middle East Afr J Ophthalmol 2009;16:256.
37. Asri D, Touboul D, Fournié P, Malet F, Garra C, Gallois A, et al. Corneal collagen crosslinking in progressive keratoconus: multicenter results from the French National Reference Center for Keratoconus. J Cataract Refract Surg 2011;37:2137–2143.
38. Greenstein SA, Shah VP, Fry KL, Hersh PS. Corneal thickness changes after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 2011;37:691–700.
39. Chan CC, Sharma M, Wachler BSB. Effect of inferiorsegment intacs with and without C3-R on keratoconus. J Cataract Refract Surg 2007;33:75–80.
40. Belin MW, Alizadeh R, Torres-Netto EA, Hafezi F, Ambrósio Jr R, Pajic B. Keratoconus expert meeting, London, 2014. J Kerat Ect Cor Dis 2014;3:141–158.
41. Mahmoud AM, Nuñez MX, Blanco C, Koch DD, Wang L, Weikert MP, et al. Expanding the Cone Location and Magnitude Index to include corneal thickness and posterior surface information for the detection of keratoconus. Am J Ophthalmol 2013;156:1102–1111.