Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaBelquiz A. Nassaralla 1 , Anelise M. Lago 1 , Larissa Rossana S. Stival 1 ,Joao J. Nassaralla 2 . 1 Cataract Cornea & Refractive Surgery, Institutode Olhos de Goiania, Goiania, Brazil; 2 Retina and Vitreous, Institutode Olhos de Goiania, Goiania, Brazil.Purpose: To evaluate corneal sensitivity changes following cornealcross-linking (CXL) in patients with progressive lower stagekeratoconus.Methods: Thirty eight eyes of 19 patients (11 women, 8 men) wereincluded in a prospective, nonrandomized clinical study. Meanpatient age was 22 years (range, 18-26 years). Inclusion criteria werelow stage bilateral progressive keratoconus, transparent cornea andthinnest corneal thickness ≥ 440 µm. Using the Cochet-Bonnetesthesiometer central corneal sensitivity was measuredpreoperatively, after 7 days, and once a month after surgery untilrecovery of the baseline preoperative level. Normal levels of centralcorneal sensitivity were considered above 40mm.Results: Corneal sensitivity gradually returned to preoperative levelsin all treated eyes. Mean central corneal sensitivity was 52.2, 24.0,38.2, 42.4, 50.0, and 52.4 mm before surgery, at 7 days, and at 1, 2, 3and 4 months after surgery, respectively. Normal levels of cornealsensation, but not baseline preoperative levels, were noted 2 monthsafter surgery. Preoperative levels were observed 3 months aftersurgery.Conclusions: Our results suggest that after CXL for progressivelower stage keratoconus, central corneal sensitivity is decreased foras long as 3 months.Commercial Relationships: Belquiz A. Nassaralla, None; AneliseM. Lago, None; Larissa Rossana S. Stival, None; Joao J.Nassaralla, NoneClinical Trial: NCT01743443Program Number: 5261 Poster Board Number: C0180Presentation Time: 2:45 PM - 4:30 PMImpact of corneal cross-linking on drug penetration in humansChristoph Tappeiner, Markus Tschopp, Kaspar Schuerch, Beatrice E.Frueh. Department of Ophthalmology, Inselspital, UniversityHospital of Bern, Bern, Switzerland.Purpose: To analyze the influence of corneal cross-linking (CXL)with ultraviolet-A and riboflavin on drug permeability using topicallyapplied pilocarpine.Methods: Keratoconus patients (n=10) undergoing standard CXLprocedure with ultraviolet-A (5.4 J/cm2, 30 minutes) and riboflavinon one eye were included in the study. Pupillary diameter measuredbefore and every 3 minutes for 30 minutes after the topicalapplication of one drop of pilocarpine was used as an indirectmeasure for corneal permeability. Pupillary diameter was measuredwith an infrared pupillometer device (Colvard, Oasis Glendora, CA)before (baseline) and 4 months after CXL.Results: Prior to pilocarpine application no significant difference inpupillary diameter was found before CXL and 4 months later(p>0.05). Mean decrease of pupillary diameter 30 minutes after theapplication of pilocarpine was significantly higher at baselinecompared to 4 months follow-up examination (mean decrease of 4.3vs. 3.5 mm; p=0.03).Conclusions: CXL reduces corneal permeability for pilocarpine inhumans.Commercial Relationships: Christoph Tappeiner, None; MarkusTschopp, None; Kaspar Schuerch, None; Beatrice E. Frueh, NoneProgram Number: 5262 Poster Board Number: C0181Presentation Time: 2:45 PM - 4:30 PMApparent progression in children after corneal cross-linking forkeratoconusBeatrice E. Frueh, Christoph Tappeiner. Ophthalmology, Univ ofBern Inselspital, Bern, Switzerland.Purpose: To analyze progression after corneal cross-linking (CXL)in children with keratoconus.Methods: Retrospective evaluation of tomographies (Pentacam) andtopographies (TMS) of prospectively collected data after CXL inchildren younger than 18 years. Examinations were conducted priorto surgery at regular intervals during the first postoperative year, andat 2, 3, and 4 years after the procedure. Twenty-five patients (33eyes) were included in the study. Mean follow-up was 27.3 months,and the minimum follow-up 1 year. Mean age at the time of surgerywas 14.9 years. Progression was defined as an increase in Kmax(Pentacam) of at least one diopter (D) in 1 year.Results: 669 KMax comparisons were made, resulting in theidentification of 4 cases of progression. In one case, the keratoconuswas extremely advanced prior to CXL (Kmax 78.2D before surgeryand 79.3D at 1 year). One case showed marked steepening of 3.4D inthe Pentacam between 3 and 4 years after CXL, but the TMSparameters were unchanged. Because of this discrepancy, thePentacam exam was repeated and showed that Kmax was actuallystable, i.e. no progression after all (50.8D at 3 years and 50.7D at 4years). Two children with active limbal vernal keratoconjunctivitisworsened dramatically (46.4D at 1 year and 48.3D at 2 years; 53.6Dat 1 year and 54.9D at 2 years). This progression was also seen intopography. After resolution of the limbal inflammation, the Kmaxvalues returned to 46.3D and 54.2D, respectively.Conclusions: Our results confirms that CXL is very effective instabilizing keratoconus in children. True progression after CXL couldonly be verified in 1 out of 33 eyes, but that eye had alreadyprogressed to such an extreme extent prior to CXL, that it wasprobaby unrealistic to expect that CXL could arrest progression atsuch a late stage. Further, in assessing possible progression, the useof 2 different measuring devices can help detect discrepancies andthus prevent false conclusions. Moreover, limbal vernal changes canpresent a clinical picture of progression. However, this is actually apseudo-progression, that can be reversed with anti-inflammatorytreatment.Commercial Relationships: Beatrice E. Frueh, None; ChristophTappeiner, NoneProgram Number: 5263 Poster Board Number: C0182©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.