Theo G Seiler1, Isaak Fischinger2, Tobias Koller3, Daniel Zapp4, Beatrice E Frueh5, Theo Seiler3. 1. Department of Ophthalmology, Inselspital, Universität Bern, Bern, Switzerland; Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Switzerland. Electronic address: theo@seiler.tv. 2. Department of Ophthalmology, Inselspital, Universität Bern, Bern, Switzerland; Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Switzerland. 3. Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Switzerland. 4. Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, TU München, Munich, Germany. 5. Department of Ophthalmology, Inselspital, Universität Bern, Bern, Switzerland.
Abstract
PURPOSE: To compare the efficacy of customized corneal cross-linking (CXL) with standard CXL. DESIGN: Prospective, nonrandomized comparative clinical study. METHODS: In a prospective study at the Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland, 40 eyes of 40 patients with documented progressive primary keratoconus were treated with customized CXL (n = 20) or standard CXL (n = 20) and followed for 1 year. Customized irradiation patterns had an energy fluence of 9 mW/cm(2) and total energy levels ranging from 5.4 J/cm(2) up to 10 J/cm(2) and were centered on the maximum of the posterior float. The control group received homogenous irradiation with a fluence of 9 mW/cm(2) and a total energy of 5.4 J/cm(2). Scheimpflug tomographies, endothelium cell count, best spectacle-corrected visual acuity (BSCVA), and anterior segment optical coherence tomography (OCT) were compared preoperatively and 1 year postoperatively. RESULTS: Pachymetry and ΔKmax showed significant changes 1 year postoperatively within each group. Epithelial healing time, ΔKmax, and regularization index (RI) were significantly better in the customized CXL group. Two out of 19 eyes (11%) in the standard group but 7 out of 19 eyes (37%) in the customized CXL group showed a flattening of 2 or more diopters (P = .03). The RI was 5.2 ± 2.7 D in the customized group vs 4.1 ± 3.1 D in the control group (P = .03). Statistically significant correlations between RI and preoperative Kmax, preoperative pachymetry, and preoperative posterior float were found only in the customized group. CONCLUSIONS: Customized CXL seems to be as safe as standard CXL with stronger flattening in Kmax and RI, and a faster epithelial healing period.
PURPOSE: To compare the efficacy of customized corneal cross-linking (CXL) with standard CXL. DESIGN: Prospective, nonrandomized comparative clinical study. METHODS: In a prospective study at the Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland, 40 eyes of 40 patients with documented progressive primary keratoconus were treated with customized CXL (n = 20) or standard CXL (n = 20) and followed for 1 year. Customized irradiation patterns had an energy fluence of 9 mW/cm(2) and total energy levels ranging from 5.4 J/cm(2) up to 10 J/cm(2) and were centered on the maximum of the posterior float. The control group received homogenous irradiation with a fluence of 9 mW/cm(2) and a total energy of 5.4 J/cm(2). Scheimpflug tomographies, endothelium cell count, best spectacle-corrected visual acuity (BSCVA), and anterior segment optical coherence tomography (OCT) were compared preoperatively and 1 year postoperatively. RESULTS: Pachymetry and ΔKmax showed significant changes 1 year postoperatively within each group. Epithelial healing time, ΔKmax, and regularization index (RI) were significantly better in the customized CXL group. Two out of 19 eyes (11%) in the standard group but 7 out of 19 eyes (37%) in the customized CXL group showed a flattening of 2 or more diopters (P = .03). The RI was 5.2 ± 2.7 D in the customized group vs 4.1 ± 3.1 D in the control group (P = .03). Statistically significant correlations between RI and preoperative Kmax, preoperative pachymetry, and preoperative posterior float were found only in the customized group. CONCLUSIONS: Customized CXL seems to be as safe as standard CXL with stronger flattening in Kmax and RI, and a faster epithelial healing period.
Authors: Fernando Zvietcovich; Achuth Nair; Manmohan Singh; Salavat R Aglyamov; Michael D Twa; Kirill V Larin Journal: Biomed Opt Express Date: 2022-04-05 Impact factor: 3.562