Philip Maier1, Thomas Reinhard, Markus Kohlhaas. 1. Eye Center at the University of Freiburg Medical Center, Albert Ludwig University Freiburg; Department of Ophthalmology, St. Johannes Hospital, Dortmund.
Abstract
BACKGROUND: Keratoconus is a slowly progressive ectatic deformity of the cornea with a prevalence of 200 to 400 cases per 100 000 persons. The cornea is thinner than normal and irregularly warped; irregular astigmatism and myopia result. Riboflavin-UVA crosslinking (collagen cross-linking) makes corneal tissue more rigid through a photochemical effect and can stop the progression of the disease. METHODS: This review is based on relevant publications retrieved by a selective search in Medline, as well as on meta-analyses, Cochrane Reviews, and reports of national and international health care institutions. RESULTS: Pertinent randomized controlled trials (RCTs) have shown that cross-linking prevents the progression of keratoconus to a statistically significant extent, as determined by measurement of topographic parameters. In the largest RCT to date (fol- low-up of 100 eyes for three years), the maximal corneal refractive power increased by 1.75 ± 0.38 diopters in the control group and decreased by -1.03 ± 0.19 diopters in the cross-linking group (p <0.001). This was also the only trial in which data were reported on the patient-relevant endpoint of uncorrected visual acuity, which mildly improved in the cross-linking group (-0.15 ± 0.06 logMAR, p = 0.009). Serious complications of cross-linking are known to date only from a few reports of individual cases. Cohort studies with follow-up times of up to ten years have shown that the condition can continue to progress after cross-linking, especially in younger patients. CONCLUSION: Cross-linking is the first available treatment for keratoconus that can improve the natural course of the disease.
BACKGROUND: Keratoconus is a slowly progressive ectatic deformity of the cornea with a prevalence of 200 to 400 cases per 100 000 persons. The cornea is thinner than normal and irregularly warped; irregular astigmatism and myopia result. Riboflavin-UVA crosslinking (collagen cross-linking) makes corneal tissue more rigid through a photochemical effect and can stop the progression of the disease. METHODS: This review is based on relevant publications retrieved by a selective search in Medline, as well as on meta-analyses, Cochrane Reviews, and reports of national and international health care institutions. RESULTS: Pertinent randomized controlled trials (RCTs) have shown that cross-linking prevents the progression of keratoconus to a statistically significant extent, as determined by measurement of topographic parameters. In the largest RCT to date (fol- low-up of 100 eyes for three years), the maximal corneal refractive power increased by 1.75 ± 0.38 diopters in the control group and decreased by -1.03 ± 0.19 diopters in the cross-linking group (p <0.001). This was also the only trial in which data were reported on the patient-relevant endpoint of uncorrected visual acuity, which mildly improved in the cross-linking group (-0.15 ± 0.06 logMAR, p = 0.009). Serious complications of cross-linking are known to date only from a few reports of individual cases. Cohort studies with follow-up times of up to ten years have shown that the condition can continue to progress after cross-linking, especially in younger patients. CONCLUSION: Cross-linking is the first available treatment for keratoconus that can improve the natural course of the disease.
Authors: Dimitrios Karamichos; Paulina Escandon; Brenda Vasini; Sarah E Nicholas; Lyly Van; Deanna H Dang; Rebecca L Cunningham; Kamran M Riaz Journal: Prog Retin Eye Res Date: 2021-11-02 Impact factor: 19.704
Authors: B Seitz; L Daas; L Hamon; K Xanthopoulou; S Goebels; C Spira-Eppig; S Razafimino; N Szentmáry; A Langenbucher; E Flockerzi Journal: Ophthalmologe Date: 2021-06-28 Impact factor: 1.174