Changes in the biomechanical properties of the human cornea play an important role in the pathogenesis of corneal ectatic diseases. Many different pathological conditions in the cornea may reduce its biomechanical resistance. Corneal collagen cross-linking (CXL) has emerged as a promising technique to slow or even to stop the progression of ectasia. In this procedure, riboflavin (vitamin B2) is administered in conjunction with ultraviolet A light (UVA, 365 nm). This interaction causes the formation of reactive oxygen species, leading to additional covalent bonds between collagen molecules, with consequent biomechanical stiffening of the cornea. Although this method is not yet accepted as an evidence-based treatment of corneal ectasia, the results of prospective, randomised studies of CXL used in the treatment of this pathological entity show significant changes in the properties of corneal tissue. This procedure is currently the only aetiopathogenetic treatment of ectatic eyes that can delay or stop the process of cornea destabilisation, reducing the necessity for keratoplasty. Despite promising results, CXL is associated with issues that include long-term safety and duration of the stabilising effect.
- MeSH
- fotochemoterapie metody MeSH
- fotosenzibilizující látky aplikace a dávkování MeSH
- keratokonus farmakoterapie MeSH
- lidé MeSH
- medicína založená na důkazech MeSH
- reagencia zkříženě vázaná účinky záření MeSH
- riboflavin aplikace a dávkování MeSH
- rohovka účinky léků účinky záření MeSH
- terapie ultrafialovými paprsky metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Corneal cross-linking can halt the progression of keratoconus, but what is the best approach for treatment? There are a number of treatment options for keratoconus, but only corneal cross-linking (CXL) appears to halt the progression of the disease. To guarantee effective cross-linking, CXL treatment involves removal of the corneal epithelium prior to riboflavin application and ultraviolet light illumination - "epi-off" CXL. Several methods of "epi-on" (transepithelial) CXL have been proposed, such as keeping the corneal epithelium intact which should be less painful and help avoid other CXL-associated adverse events. The evidence so far is that epi-off CXL remains the most effective method of strengthening the cornea and slowing keratoconus progression - but transepithelial methods are gaining ground.
- MeSH
- fotochemoterapie metody MeSH
- fotosenzibilizující látky aplikace a dávkování MeSH
- keratokonus patologie terapie MeSH
- kombinovaná terapie metody MeSH
- lidé MeSH
- medicína založená na důkazech MeSH
- reagencia zkříženě vázaná aplikace a dávkování MeSH
- riboflavin aplikace a dávkování MeSH
- rohovkový epitel chirurgie MeSH
- terapie ultrafialovými paprsky metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
PURPOSE: To analyze the 10-year results of corneal collagen crosslinking (CXL) for keratoconus. SETTING: Department of Ophthalmology, University Hospital, Dresden, Germany. DESIGN: Retrospective interventional case series. METHODS: The study included eyes treated for progressive keratoconus from 2000 to 2004. Corneal collagen crosslinking was performed by applying riboflavin and ultraviolet-A. The corrected distance visual acuity (CDVA), corneal topography, and endothelial cell count (ECC) were recorded preoperatively and 10 years postoperatively. RESULTS: The study enrolled 24 patients (34 eyes). The mean age of the 18 men and 6 women was 28.4 years ± 7.3 (SD) and the mean follow-up, 131.9 ± 20.1 months. The mean apical keratometry (K) value was 61.5 diopters (D) preoperatively and 55.3 D 10 years postoperatively; the decrease was statistically significant (P<.001). The mean values for maximum K (53.2 D and 49.56 D, respectively) and minimum K (47.5 D and 45.5 D, respectively) were also significantly lower (P<.001). The preoperative and postoperative CDVA were statistically significantly different (P=.002). The mean CDVA improved by 0.14 logMAR over preoperatively; the change was statistically significant (P=.002). The ECC was unchanged. CONCLUSIONS: Corneal CXL was effective in treating progressive keratoconus, achieving long-term stabilization of the condition. It was easy to perform, had a good safety profile, and reduced the need for corneal transplantation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
- MeSH
- dospělí MeSH
- fotochemoterapie * MeSH
- fotosenzibilizující látky škodlivé účinky terapeutické užití MeSH
- keratokonus farmakoterapie metabolismus patofyziologie MeSH
- kolagen metabolismus MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- následné studie MeSH
- progrese nemoci MeSH
- reagencia zkříženě vázaná * MeSH
- retrospektivní studie MeSH
- riboflavin škodlivé účinky terapeutické užití MeSH
- stroma rohovky metabolismus MeSH
- ultrafialové záření MeSH
- zraková ostrost fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- biomechanika MeSH
- experimenty na zvířatech MeSH
- formaldehyd analogy a deriváty terapeutické užití MeSH
- fotochemoterapie metody škodlivé účinky MeSH
- glutaraldehyd terapeutické užití MeSH
- keratokonus prevence a kontrola terapie MeSH
- králíci MeSH
- laserová modelace rohovky pod rohovkovou lamelou škodlivé účinky MeSH
- lidé MeSH
- oftalmologické chirurgické výkony metody přístrojové vybavení škodlivé účinky MeSH
- prasata MeSH
- riboflavin terapeutické užití MeSH
- rohovková topografie využití MeSH
- stroma rohovky anatomie a histologie účinky záření MeSH
- techniky in vitro MeSH
- terapie ultrafialovými paprsky metody škodlivé účinky MeSH
- Check Tag
- králíci MeSH
- lidé MeSH
