Objective: To assess the corneal epithelial remodeling after corneal crosslinking (CXL) and to investigate the relation between topographic parameters and epithelial thickness change. Material and Methods: Sixty-three eyes of 43 keratoconus patients were included in this retrospective study. Keratometry (K) and elevation data were assessed by Scheimpflug topography and corneal and epithelial thickness profile was obtained by anterior segment spectral-domain optical coherence tomography pre-operatively and at the 1st, 6th and 12th months after CXL. Results: Significant decreases were observed in mean K (p=0.014), maximum K (p=0.049), and mean central corneal thickness (p<0.007) after CXL. Superior corneal epithelial thickness was significantly thinner (p<0.001) and the difference between the minimum and maximum epithelial thickness was less at the post-operative first month and didn't change significantly afterwards. Standard deviation of epithelial thickness across the central 5 mm region statistically decreased in the follow-up period (p=0.008). Conclusion: Significant regularization of the epithelial thickness profile was seen in one year after epithelium-off CXL. Demonstrating the normalization of the corneal epithelium and understanding its impact on the post-operative healing process might contribute to the optimization of treatment protocols.
Keywords: Cross-linking, cornea; keratoconus; epithelium, cornea; tomography, optical coherence
Amaç: Çalışmanın amacı, korneal çapraz bağlama sonrası epitelyal yeniden düzenlenmenin topografik veriler ışığında incelenmesidir. Gereç ve Yöntemler: Kırk üç keratokonus hastasının 63 gözü, bu retrospektif çalışmaya dâhil edilmiştir. Korneal çapraz bağlama tedavisi öncesi ve tedavi sonrası 1, 6 ve 12. aylarda keratometri (K) değerleri ve korneal topografi, Scheimpflug topografi ile değerlendirilirken, kornea epitel kalınlığı, ön segment optik koherens tomografi ile değerlendirilmiştir. Bulgular: Korneal çapraz bağlama tedavisi sonrası ortalama santral kornea kalınlığında (p<0,007), ortalama K değerinde (p=0,014) ve maksimum K değerinde (p=0,049) istatistiksel anlamlı azalma izlendi. Korneal çapraz bağlama tedavisinden 1 ay sonra superior korneal epitel kalınlığı, istatistiksel anlamlı olarak daha ince (p<0,001); maksimum ve minimum korneal epitel kalınlığı arasındaki fark daha az idi, takip boyunca değişim olmadı. Korneal çapraz bağlama tedavisi sonrasındaki takip süresince santral 5 mm kornea alanındaki epitel kalınlığının standart sapması, istatistiksel anlamlı olarak daha az idi (p=0,008). Sonuç: Korneal çapraz bağlama tedavisinden 1 yıl sonra, korneal epitel kalınlığında anlamlı bir düzgünleşme izlendi. Korneal epitelin iyileşme sürecinin daha iyi değerlendirilmesi ve korneal çapraz bağlama sonrası iyileşme sürecinin anlaşılması, daha verimli tedavi protokollerinin geliştirilmesine yardımcı olacaktır.
Anahtar Kelimeler: Çapraz bağlama, kornea; keratokonus; epitelyum, kornea; tomografi, optik koherens
- Rico-Del-Viejo L, Garcia-Montero M, Hernández-Verdejo JL, García-Lázaro S, Gómez-Sanz FJ, Lorente-Velázquez A. Nonsurgical procedures for keratoconus management. J Ophthalmol. 2017;2017:9707650. [Crossref] [PubMed] [PMC]
- Mohammadpour M, Masoumi A, Mirghorbani M, Shahraki K, Hashemi H. Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes. J Curr Ophthalmol. 2017;29(4):235-47. [Crossref] [PubMed] [PMC]
- Spoerl E, Seiler T. Techniques for stiffening the cornea. J Refract Surg. 1999;15(6):711-3. [PubMed]
- Hallahan KM, Rocha K, Roy AS, Randleman JB, Stulting RD, Dupps WJ Jr. Effects of corneal cross-linking on ocular response analyzer waveform-derived variables in keratoconus and postrefractive surgery ectasia. Eye Contact Lens. 2014;40(6):339-44. [Crossref] [PubMed] [PMC]
- Randleman JB, Khandelwal SS, Hafezi F. Corneal cross-linking. Surv Ophthalmol. 2015;60(6):509-23. [Crossref] [PubMed]
- Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135(5):620-7. [Crossref] [PubMed]
- Reinstein DZ, Archer TJ, Gobbe M. Corneal epithelial thickness profile in the diagnosis of keratoconus. J Refract Surg. 2009;25(7):604-10. [Crossref] [PubMed]
- Reinstein DZ, Gobbe M, Archer TJ, Youssefi G, Sutton HF. Stromal surface topography-guided custom ablation as a repair tool for corneal irregular astigmatism. J Refract Surg. 2015;31(1):54-9. [Crossref] [PubMed]
- Fernández Pérez J, Valero Marcos A, Martínez Pe-a FJ. Early diagnosis of keratoconus: what difference is it making? Br J Ophthalmol. 2014;98(11):1465-6. [Crossref] [PubMed] [PMC]
- Li Y, Chamberlain W, Tan O, Brass R, Weiss JL, Huang D. Subclinical keratoconus detection by pattern analysis of corneal and epithelial thickness maps with optical coherence tomography. J Cataract Refract Surg. 2016;42(2):284-95. [Crossref] [PubMed] [PMC]
- Reinstein DZ, Archer T. Combined artemis very high-frequency digital ultrasound-assisted transepithelial phototherapeutic keratectomy and wavefront-guided treatment following multiple corneal refractive procedures. J Cataract Refract Surg. 2006;32(11):1870-6. [Crossref] [PubMed]
- Lautert J, Doshi D, Price FW Jr, Price MO. Corneal epithelial remodeling after standard epithelium-off corneal cross-linking in keratoconic eyes. J Refract Surg. 2018;34(6):408-12. [Crossref] [PubMed]
- Rocha KM, Perez-Straziota CE, Stulting RD, Randleman JB. Epithelial and stromal remodeling after corneal collagen cross-linking evaluated by spectral-domain OCT. J Refract Surg. 2014;30(2):122-7. Erratum in: J Refract Surg. 2014;30(3):171. [Crossref] [PubMed]
- Kanellopoulos AJ, Asimellis G. OCT corneal epithelial topographic asymmetry as a sensitive diagnostic tool for early and advancing keratoconus. Clin Ophthalmol. 2014;8:2277-87. [Crossref] [PubMed] [PMC]
- Kanellopoulos AJ, Aslanides IM, Asimellis G. Correlation between epithelial thickness in normal corneas, untreated ectatic corneas, and ectatic corneas previously treated with CXL; is overall epithelial thickness a very early ectasia prognostic factor? Clin Ophthalmol. 2012;6:789-800. [Crossref] [PubMed] [PMC]
- Reinstein DZ, Archer TJ, Gobbe M, Silverman RH, Coleman DJ. Epithelial thickness in the normal cornea: three-dimensional display with Artemis very high-frequency digital ultrasound. J Refract Surg. 2008;24(6):571-81. [Crossref] [PubMed] [PMC]
- Li Y, Shekhar R, Huang D. Corneal pachymetry mapping with high-speed optical coherence tomography. Ophthalmology. 2006;113(5):792-9.e2. [Crossref] [PubMed] [PMC]
- Li Y, Tan O, Brass R, Weiss JL, Huang D. Corneal epithelial thickness mapping by Fourier-domain optical coherence tomography in normal and keratoconic eyes. Ophthalmology. 2012;119(12):2425-33. [Crossref] [PubMed] [PMC]
- Temstet C, Sandali O, Bouheraoua N, Hamiche T, Galan A, El Sanharawi M, et al. Corneal epithelial thickness mapping using Fourier-domain optical coherence tomography for detection of form fruste keratoconus. J Cataract Refract Surg. 2015;41(4):812-20. [Crossref] [PubMed]
- Reinstein DZ, Gobbe M, Archer TJ, Silverman RH, Coleman DJ. Epithelial, stromal, and total corneal thickness in keratoconus: three-dimensional display with artemis very-high frequency digital ultrasound. J Refract Surg. 2010;26(4):259-71. [Crossref] [PubMed] [PMC]
- Li Y, Meisler DM, Tang M, Lu AT, Thakrar V, Reiser BJ, et al. Keratoconus diagnosis with optical coherence tomography pachymetry mapping. Ophthalmology. 2008;115(12):2159-66. [Crossref] [PubMed] [PMC]
- Zhang X, Sun L, Chen Y, Li M, Tian M, Zhou X. One-year outcomes of pachymetry and epithelium thicknesses after accelerated (45 mW/cm(2)) transepithelial corneal collagen cross-linking for keratoconus patients. Sci Rep. 2016;6:32692. [Crossref] [PubMed] [PMC]
- Haberman ID, Lang PZ, Broncano AF, Kim SW, Hafezi F, Randleman JB. Epithelial remodeling after corneal crosslinking using higher fluence and accelerated treatment time. J Cataract Refract Surg. 2018;44(3):306-12. [Crossref] [PubMed]
- Simon G, Ren Q, Kervick GN, Parel JM. Optics of the corneal epithelium. Refract Corneal Surg. 1993;9(1):42-50. [Crossref] [PubMed]
- Gatinel D, Racine L, Hoang-Xuan T. Contribution of the corneal epithelium to anterior corneal topography in patients having myopic photorefractive keratectomy. J Cataract Refract Surg. 2007;33(11):1860-5. [Crossref] [PubMed]
- Lu NJ, Chen D, Cui LL, Wang L, Chen SH, Wang QM. Repeatability of cornea and sublayer thickness measurements using optical coherence tomography in corneas of anomalous refractive status. J Refract Surg. 2019;35(9):600-5. [Crossref] [PubMed]
.: Process List