Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Accelerated Corneal Cross-linking Treatment in Keratoconus Patients: Three-Years Results
Keratokonus Hastalarında Hızlandırılmış Kornea Çapraz Bağlama Tedavisi: Üç Yıllık Sonuçlar
Emre AYDEMİRa, Mustafa KOÇb, Hasan KIZILTOPRAKc, Kemal TEKİNd, Gözde AKSOY AYDEMİRa, Hacı Hasan ÖZKANe
aDepartment of Ophthalmology, Adıyaman University Training and Research Hospital, Adıyaman, TURKEY
bClinic of Ophthalmology, Kayseri Mayagöz Hospital, Kayseri, TURKEY
cClinic of Ophthalmology, Bingol Women's Health and Children's Hospital, Bingöl, TURKEY
dClinic of Ophthalmology, Erciş State Hospital, Van, TURKEY
eClinic of Ophthalmology, Ankara Occupational and Environmental Diseases Hospital, Ankara, TURKEY
Turkiye Klinikleri J Ophthalmol. 2021;30(2):97-106
doi: 10.5336/ophthal.2020-78105
Article Language: EN
Full Text
ABSTRACT
 Objective: To evaluate the three-year results of accelerated corneal collagen crosslinking treatment in keratoconus patients. Material and Methods: Fifty eyes of 50 keratoconus patients were retrospectively reviewed. An accelerated corneal crosslinking treatment procedure was performed on the patients who exposed 9 mW/cm2 irradiance ultraviolet-A with riboflavin for 10 minutes. All cases were evaluated with best corrected visual acuity (BCVA), topographic, tomographic, and topometric parameters, along with corneal densitometry, using the Scheimpflug imaging system (Pentacam® HR, Oculus Inc., Wetzlar, Germany) preoperatively and postoperatively at the sixth month and first, second, and third years. Results: The mean age of the patients was 21.7±5.1 years. BCVA was statistically significantly improved at the sixth month and first, second, and third years when compared to preoperative values (p<0.001, for all). Anterior Kmax values decreased statistically significantly at the postoperative first, second, and third years (p<0.001, for all). The thinnest corneal thickness decreased statistically significantly at the sixth month and first, second, and third years when compared to preoperative values (p<0.001, for all). Anterior elevation values decreased statistically significantly at the sixth month and first, second, and third years when compared to preoperative values (p<0.001, for all). No significant corneal densitometric change was found on the 10-12 mm zone at all layers (p>0.05, for all). The mean vertical coma, spherical aberration, high-order aberration, and total corneal aberration values were significantly decreased at the first, second, and third years when compared to preoperative values (p<0.05, for all). Conclusion: Accelerated corneal crosslinking treatment reduces the risk of keratoconus progression and provides visual, topographic, and aberrometric improvement in some patients. Therefore, accelerated corneal crosslinking treatment is an effective treatment method to prevent progression in progressive keratoconus patients.

Keywords: Keratoconus; corneal topography; riboflavin
ÖZET
 Amaç: Keratokonus hastalarında hızlandırılmış korneal kollajen çapraz bağlama (KKÇB) tedavisinin 3 yıllık sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Progresif keratokonusu olan 50 hastanın 50 gözü retrospektif olarak incelendi. Hastalara 10 dk 9 mW/cm2 ultraviyole-A ile hızlandırılmış KKÇB tedavisi uygulandı. Tüm olguların operayon öncesi ve sonrası 6. ay, 1. yıl, 2. yıl, 3. yıldaki, en iyi düzeltilmiş görme keskinliği (EİDGK), topografik, tomografik, topometrik ve dansitometrik parametreleri (Pentacam® HR, Oculus Inc., Wetzlar, Almanya) değerlendirildi. Bulgular: Çalışmaya katılan hastaların yaş ortalaması 21,7±5,1 yıl idi. Operasyon sonrası 6. ay, 1, 2 ve 3. yıldaki EİDGK değerinde operasyon öncesine göre istatistiksel olarak anlamlı artış saptandı (sırasıyla; p=0,001; p<0,001; p<0,001; p<0,001). Operasyon sonrası 1, 2 ve 3. yıldaki anterior maksimum keratometri değerinde istatistiksel olarak anlamlı azalma saptandı (sırasıyla p<0,001; p<0,001; p<0,001). Tüm takiplerde en ince kornea kalınlığında, operasyon öncesine göre istatistiksel olarak anlamlı azalma olduğu saptandı (sırasıyla p<0,001; p<0,001; p<0,001; p<0,001). Operasyon sonrası 6. ay, 1, 2 ve 3. yıldaki ön elevasyon değerlerinde istatistiksel olarak anlamlı azalma olduğu saptandı (sırasıyla p<0,001; p<0,001; p<0,001; p<0.001). Tüm tabakalarda 10-12 mm zonda korneal dansitometride tedavi sonrası anlamlı değişiklik saptanmadı (Tüm takipler için p>0,05). Ortalama vertikal koma, sferik aberasyon, yüksek sıralı aberasyon, total aberasyon değerlerinde 1, 2 ve 3. yılda istatistiksel olarak anlamlı azalma saptandı (Tüm takipler için p<0,05). Sonuç: Hızlandırılmış KKÇB tedavisi keratokonus progresyonunu durdurmakta ve bazı hastalarda görsel, topografik ve aberometrik düzelme sağlamaktadır. Bu nedenle hızlandırılmış KKÇB, ilerleyici keratokonus hastalarında ilerlemeyi önlemek amacıyla uygulanabilecek etkin bir tedavi yöntemidir.

Anahtar Kelimeler: Keratokonus; kornea topografisi; riboflavin
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