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Rasool Sufi A, Soundaram M, Gohil N, D. Keenan J, Prajna NV. Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy. JOVR [Internet]. 2021Jul.29 [cited 2024Apr.18];16(3):325–337. Available from: https://knepublishing.com/index.php/JOVR/article/view/9429

https://doi.org/10.18502/jovr.v16i3.9429

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authors

  • Aalia Rasool Sufi

    Aalia Rasool Sufi

    Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India
  • M. Soundaram

    M. Soundaram

    Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India
    https://orcid.org/0000-0002-5823-4470
  • Nilam Gohil

    Nilam Gohil

    Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India
  • Jeremy D. Keenan

    Jeremy D. Keenan

    Francis I. Proctor Foundation, University of California, San Francisco
  • N. Venkatesh Prajna

    N. Venkatesh Prajna

    Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India

Published Date

  • Jul 29, 2021
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy

Journal of Ophthalmic and Vision Research (JOVR) / July–September 2021, Volume 16, Issue 3 / Pages 325–337

Abstract

Purpose: To report structural changes observable in in vivo confocal microscopy (IVCM) in keratoconic corneas <400 μm treated with hypotonic riboflavin and collagen crosslinking (CXL).


Method: Ten eyes of ten patients with progressive keratoconus and corneal thickness between 350 and 399 μm underwent CXL with hypotonic riboflavin. IVCM was performed preoperatively and at one month, three months, and six months after the procedure.


Results: IVCM analysis one month postoperatively showed complete absence of the subepithelial nerve plexus with gradual regeneration over six months in 8 of the 10 eyes, and poor regeneration in the remaining 2 eyes. The anterior stroma showed extracellular lacunae and hyper-reflective cytoplasm in a honeycomb appearance signifying edema at one month which gradually decreased over six months post CXL. Stromal keratocyte apoptosis was evident in the anterior stroma in all cases and extended to the posterior stroma in four eyes with gradual regeneration evident at three and six months. The specular endothelial count decreased by 8% (P = 0.005) post-CXL, but no corneas developed clinical signs of endothelial trauma.


Conclusion: IVCM analysis of thin corneas after hypotonic CXL showed posterior corneal structural changes. Posterior stromal changes were accompanied by a decrease in the endothelial cell count. This case series was a preliminary feasibility study that might necessitate conducting a well-designed controlled study.

Keywords:

Collagen Crosslinking, Hypotonic Riboflavin, In Vivo Confocal Microscopy, Keratoconus

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