Purpose: To report diffuse lamellar keratitis (DLK) occurring in an eye that underwent epithelium-off (epi-off) corneal cross-linking (CXL) as a treatment for post-surgical ectasia and the successful treatment of progressive ectasia with a novel epi-on CXL and conductive keratoplasty (CK) treatment.
Observations: A 42-year-old man presented with corneal ectasia in his right eye 3 years after laser in situ keratomileusis (LASIK) surgery. He underwent epi-off corneal CXL using the Dresden protocol. Grade II DLK was diagnosed within days of CXL. Despite successful treatment of DLK, best-corrected visual acuity in the right eye deteriorated over the next 4 months due to progression of ectasia and remained worse than the patient's pre-operative baseline 1 year after epi-off CXL. Because of apparent disease progression, despite his CXL treatment, the patient underwent a novel, transepithelial CXL (TE-CXL) treatment combined with conductive keratoplasty (CK). This treatment improved his vision and stabilized his ectasia without subsequent DLK. Approximately 3 years after CK and TE-CXL, his eye remains stable with 4 Snellen lines of improved vision and no progression of ectasia.
Conclusion And Importance: Epithelium-off CXL is used increasingly to treat post-LASIK ectasia. First, in this case, DLK occurred after epi-off CXL. We suggest careful scrutiny of such cases as DLK is difficult to identify after epi-off CXL. Second, the epi-off CXL was unsuccessful in stopping the post-LASIK ectasia. Transepithelial CXL successfully treated the ongoing ectasia after resolution of the DLK with no subsequent re-occurrence of DLK. We suggest that TE-CXL may provide a successful initial treatment for post-LASIK ectasia that also minimizes the epithelial disruption that can lead to DLK.
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http://dx.doi.org/10.1016/j.ajoc.2019.01.004 | DOI Listing |
Int Ophthalmol
December 2024
Department of Ophthalmology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey.
Purpose: To assess the safety and the efficacy of the "Sub-400 corneal cross-linking (CXL) protocol" for progressive keratoconus (KC) in ultrathin corneas.
Methods: The study included thirty four patients with progressive KC, who underwent CXL using the "Sub-400" protocol due to intraoperative thinnest corneal pachymetry ranging from 295 to 398 μm after epithelial removal. After the epithelium was removed, the following ultraviolet A irradiation was applied at a fluence of 3 mW/cm and the duration was adjusted based on the specific corneal stromal thickness.
Acta Ophthalmol
December 2024
Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden.
Objective: To evaluate the effects of customized corneal collagen cross-linking (CXL) on higher-order aberrations (HOAs) in keratoconus (KC): vertical coma (VC), horizontal coma (HC), spherical aberration (SA), trefoil (TF) and astigmatism, compared with the same effects in healthy eyes undergoing CXL for low-grade myopia.
Methods: This mixed-designed study included 38 eyes of 38 patients with KC, treated and followed prospectively, who received customized epi-on CXL in high oxygen, and a retrospective control group of 23 eyes from 23 patients who underwent central 4-mm CXL treatment for low-grade myopia. VC, HC, SA, TF and keratometry values were obtained from Pentacam HR® measurements at baseline and at 1, 6, 12 and 24 months post-treatment.
Prog Retin Eye Res
December 2024
ELZA Institute, Webereistrasse 2, CH-8953 Dietikon, Switzerland; Laboratory for Ocular Cell Biology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland; Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1206 Geneva, Switzerland.
Corneal cross-linking (CXL) has profoundly changed the management of keratoconus and other ectatic corneal diseases. Introduced in the late 1990s, CXL marked the first effective intervention to halt disease progression. This chapter describes the history of CXL, beginning with its conceptual foundations and preclinical studies conducted at the University of Dresden.
View Article and Find Full Text PDFJ Cataract Refract Surg
December 2024
ELZA Institute, Dietikon, Switzerland.
Purpose: To investigate the light transmission (LT) of UV-A and green light through infected corneas saturated with riboflavin or rose bengal in an ex vivo porcine model for infectious keratitis.
Setting: University of Zurich and EMPA.
Design: Laboratory study.
Graefes Arch Clin Exp Ophthalmol
December 2024
Instituto de Microcirugía Ocular (IMO) Barcelona Grupo Miranza, Barcelona, Spain.
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