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Comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off CXL) in adult Pakistani population with progressive keratoconus

PURPOSE: The purpose of this study is to compare the safety and efficacy of transepithelial corneal crosslinking (CXL) with epithelium-off crosslinking (epithelium-off CXL) in the treatment of progressive keratoconus in adult Pakistani population. MATERIALS AND METHODS: Sixty-four eyes of 64 consecu...

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Autores principales: Akbar, Bushra, Intisar-ul-Haq, Rana, Ishaq, Mazhar, Fawad, Ayesha, Arzoo, Sabahat, Siddique, Kashif
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747228/
https://www.ncbi.nlm.nih.gov/pubmed/29296550
http://dx.doi.org/10.4103/tjo.tjo_38_17
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author Akbar, Bushra
Intisar-ul-Haq, Rana
Ishaq, Mazhar
Fawad, Ayesha
Arzoo, Sabahat
Siddique, Kashif
author_facet Akbar, Bushra
Intisar-ul-Haq, Rana
Ishaq, Mazhar
Fawad, Ayesha
Arzoo, Sabahat
Siddique, Kashif
author_sort Akbar, Bushra
collection PubMed
description PURPOSE: The purpose of this study is to compare the safety and efficacy of transepithelial corneal crosslinking (CXL) with epithelium-off crosslinking (epithelium-off CXL) in the treatment of progressive keratoconus in adult Pakistani population. MATERIALS AND METHODS: Sixty-four eyes of 64 consecutive patients of progressive keratoconus were included in this quasi-experimental study. Thirty-two eyes received transepithelial CXL with Peschke TE (0.25% riboflavin (Vitamin B2), 1.2% hydroxypropyl methylcellulose (HPMC), 0.01% benzalkonium chloride) and 32 eyes received epithelium-off CXL with Peschke M (0.1% riboflavin (Vitamin B2) 0.1%, HPMC 1.1%.) The cornea was then exposed to ultraviolet A light at an irradiance of 3 mW/cm(2) for 30 min. The primary outcome measure, clinical stabilization of keratoconus was defined as an increase of no more than 1D in K(max) at 1 year. Other parameters evaluated at baseline and 3, 6, 12, and 18 months postoperatively were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), astigmatism (Ast), simulated keratometry, steep keratmetry (steep K), and corneal thickness at thinnest point (pachy thin). RESULTS: Both epithelium-off CXL and transepithelial CXL groups showed a significant reduction in K(max), steep K, simulated K, corneal pachymetry at all test points (P < 0.05) with significantly greater reductions achieved in epithelium-off CXL group at 18 months follow-up. The mean UDVA, CDVA, SE, Ast significantly improved in both groups (P < 0.05). The mean postoperative UDVA and CDVA between the groups were not significant at 12 months (P = 0.650, 0.018, respectively). Clinical stabilization was achieved in 94% of eyes in epithelium-off CXL and 75% of eyes in transepithelial CXL. In epithelium-off CXL, three eyes exhibited stromal haze resolved by corticosteroid treatment. No complication was documented in transepithelial CXL group. CONCLUSION: Transepithelial CXL is not recommended to be replaced completely by standard epithelium-off CXL due to continued ectatic progression in 25% of cases. However, thin corneas, unfit for standard epithelium-off CXL, can benefit from transepithelial CXL.
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spelling pubmed-57472282018-01-02 Comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off CXL) in adult Pakistani population with progressive keratoconus Akbar, Bushra Intisar-ul-Haq, Rana Ishaq, Mazhar Fawad, Ayesha Arzoo, Sabahat Siddique, Kashif Taiwan J Ophthalmol Original Article PURPOSE: The purpose of this study is to compare the safety and efficacy of transepithelial corneal crosslinking (CXL) with epithelium-off crosslinking (epithelium-off CXL) in the treatment of progressive keratoconus in adult Pakistani population. MATERIALS AND METHODS: Sixty-four eyes of 64 consecutive patients of progressive keratoconus were included in this quasi-experimental study. Thirty-two eyes received transepithelial CXL with Peschke TE (0.25% riboflavin (Vitamin B2), 1.2% hydroxypropyl methylcellulose (HPMC), 0.01% benzalkonium chloride) and 32 eyes received epithelium-off CXL with Peschke M (0.1% riboflavin (Vitamin B2) 0.1%, HPMC 1.1%.) The cornea was then exposed to ultraviolet A light at an irradiance of 3 mW/cm(2) for 30 min. The primary outcome measure, clinical stabilization of keratoconus was defined as an increase of no more than 1D in K(max) at 1 year. Other parameters evaluated at baseline and 3, 6, 12, and 18 months postoperatively were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), astigmatism (Ast), simulated keratometry, steep keratmetry (steep K), and corneal thickness at thinnest point (pachy thin). RESULTS: Both epithelium-off CXL and transepithelial CXL groups showed a significant reduction in K(max), steep K, simulated K, corneal pachymetry at all test points (P < 0.05) with significantly greater reductions achieved in epithelium-off CXL group at 18 months follow-up. The mean UDVA, CDVA, SE, Ast significantly improved in both groups (P < 0.05). The mean postoperative UDVA and CDVA between the groups were not significant at 12 months (P = 0.650, 0.018, respectively). Clinical stabilization was achieved in 94% of eyes in epithelium-off CXL and 75% of eyes in transepithelial CXL. In epithelium-off CXL, three eyes exhibited stromal haze resolved by corticosteroid treatment. No complication was documented in transepithelial CXL group. CONCLUSION: Transepithelial CXL is not recommended to be replaced completely by standard epithelium-off CXL due to continued ectatic progression in 25% of cases. However, thin corneas, unfit for standard epithelium-off CXL, can benefit from transepithelial CXL. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5747228/ /pubmed/29296550 http://dx.doi.org/10.4103/tjo.tjo_38_17 Text en Copyright: © 2017 Taiwan J Ophthalmol http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Akbar, Bushra
Intisar-ul-Haq, Rana
Ishaq, Mazhar
Fawad, Ayesha
Arzoo, Sabahat
Siddique, Kashif
Comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off CXL) in adult Pakistani population with progressive keratoconus
title Comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off CXL) in adult Pakistani population with progressive keratoconus
title_full Comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off CXL) in adult Pakistani population with progressive keratoconus
title_fullStr Comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off CXL) in adult Pakistani population with progressive keratoconus
title_full_unstemmed Comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off CXL) in adult Pakistani population with progressive keratoconus
title_short Comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off CXL) in adult Pakistani population with progressive keratoconus
title_sort comparison of transepithelial corneal crosslinking with epithelium-off crosslinking (epithelium-off cxl) in adult pakistani population with progressive keratoconus
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747228/
https://www.ncbi.nlm.nih.gov/pubmed/29296550
http://dx.doi.org/10.4103/tjo.tjo_38_17
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