Cornea - ARVO

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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneaproduced the following behavior: 20% Dextran (B) and distilledwater (D) containing formulations led to approximately 60% and30% corneal thinning, respectively; HPMC containing solutions (A,E) resulted in less than 10% corneal thinning; hypotonic salinesolution resulted in 10% corneal swelling.Conclusions: Various applications of CXL require management ofcorneal hydration. The removal or disturbance of corneal epitheliumalters the fluid balance of the cornea, typically causing swelling.Composition and formulation of CXL solutions can predictablymanage corneal hydration.Commercial Relationships: Evan A. Sherr, Avedro, Inc. (E); PavelKamaev, Avedro (E); Sara Rood-Ojalvo, Avedro Inc. (E); Marc D.Friedman, Avedro Inc (E); David Muller, Avedro Inc (E)Program Number: 5275 Poster Board Number: C0194Presentation Time: 2:45 PM - 4:30 PMAssessment the long term effect of corneal cross-linking therapyon corneal ectasia in progressive keratoconusIlles Kovacs, Kinga Kranitz, Andrea Gyenes, Gábor László L.Sándor, Eva Juhasz, Lorant Dienes, Janos Nemeth, Zoltan Z. Nagy.Department of Ophthalmology, Semmelweis University, Budapest,Hungary.Purpose: To evaluate stabilizing effect of cross-linking (CXL)therapy on corneal ectasia in progressive keratoconus withScheimpflug imaging.Methods: In this prospective study corneal CXL was performed in22 progressive keratoconus eyes (CXL group) and 28 clinically nonprogressivekeratoconus eyes served as controls (control group).Anterior keratometry readings at the steepest meridian (Ks), thinnestcorneal thickness (ThCT) and posterior elevation values at thethinnest point of the cornea (PE) were measured using Scheimpflugcameraat baseline and 12-25 months after enrolment. Coxproportional regression model was used to evaluate long term effectof CXL on keratoconus progression taken into account the withinsubjectfluctuations of measurements.Results: At baseline, higher Ks (CXL: 49.87±3.62 D vs. control:46.76±3.25 D; p=0.002), higher PE (CXL: 27.05±17.13 µm vs.control: 14.36±12.54 µm; p=.006) and lower ThCT values (CXL:461.52±24.43 µm vs. control: 497.64±31.68 µm; p0.05) and only 2 of 22 cases showed progressionin keratometry values beyond within-subject fluctuation. In thecontrol group marginally significant increase was measured in meankeratometry (46.90 ± 3.33 D; p=0.06) and keratometry valuesincreased beyond within-subject fluctuation in 11 of 28 cases. TheCox model showed, that after CXL treatment the ratio of furtherkeratometry progression was 0.09 (95% CL: 0.02 - 0.57; p=0.01)compared to controls after adjustment for initial ThCT.Conclusions: CXL decreased the incidence of progression inadvanced keratoconus by 91% after a long term follow-upindependently from initial corneal pachymetry. Steep keratometry isa sensitive parameter to monitor stabilizing effect of corneal crosslinkingtherapy.Commercial Relationships: Illes Kovacs, None; Kinga Kranitz,None; Andrea Gyenes, None; Gábor László L. Sándor, None; EvaJuhasz, None; Lorant Dienes, None; Janos Nemeth, None; ZoltanZ. Nagy, Alcon-LenSx Inc. (C)Program Number: 5276 Poster Board Number: C0195Presentation Time: 2:45 PM - 4:30 PMUse of Zonal Km vs Point Kmax for Analysis of Corneal CrosslinkingPentacam TopographyGrace Lytle 1 , Marc D. Friedman 1 , Peter S. Hersh 2 , David Muller 1 .1 Avedro Inc, Waltham, MA; 2 Hersh Vision Group, Cornea andLASER EYE Institute, Teaneck, NJ.Purpose: To determine whether analysis of topography in a 2 or 3mm zone centered over Kmax provides a more sensitive measure ofchange in corneal curvature in eyes with keratoconus followingcorneal cross-linking than the use of a point Kmax value.Methods: The Pentacam software module (Version 6.03r19, OculusInc.) was used to retrospectively analyze a randomly selected subsetof 28 eyes with a diagnosis of keratoconus treated with corneal crosslinkingas part of a clinical trial in 2008 through 2009. Cross-linkingwas performed by removing the corneal epithelium and thenpretreating the cornea for 30 minutes with 0.1% RiboflavinOphthalmic Solution to saturate the corneal tissue with the riboflavinphotosensitizer. The cornea was then irradiated with UVA (365 nm)at 3 mW/cm 2 for 30 minutes for a total radiant exposure of 5.4 J/cm 2 .Pentacam scans were obtained pre-operatively, and at 1, 3, 6 and 12months following corneal cross-linking. Kmax values and theircorresponding coordinates were identified by the software and wererecorded for each eye at each time point. The Pentacam softwaremodule was used to manually define a 3mm zone centered over thecoordinates of the Kmax value in each eye at each time point onsagittal curvature maps. This procedure was repeated for a 2mm zonecentered over the same coordinates. A number of software generatedparameters from this analysis were recorded, including the mean(Km) of the values contained within this zone. A statistical analysisof these values was conducted.Results: Analysis of the 3mm zonal Km using a two tailed t-testdemonstrated statistically significant improvement in sagittalcurvature from baseline at 3 months (P< 0.15, 85% confidenceinterval). Improvement in Kmax and 2mm zonal Km were notsignificant at this time point, (P=0.635 and P=0.229). All threemeasurements were statistically significant at 12 months (P
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaKinga Kranitz, Illes Kovacs, Andrea Gyenes, Gábor László L.Sándor, Eva Juhasz, Lorant Dienes, Janos Nemeth, Zoltan Z. Nagy.Department of Ophthalmology, Semmelweis University, Budapest,Hungary.Purpose: To evaluate characteristics of corneal flattening after crosslinking(CXL) therapy in progressive keratoconus with Scheimpflugimaging.Methods: In this prospective study corneal CXL was performed in23 progressive keratoconus eyes (CXL group) and 15 nonprogressivekeratoconus eyes served as controls (control group).Posterior elevation values (PE) were measured at the thinnest point ofthe cornea, at the corneal vertex, 2 and 3 mm paracentrally (superior,inferior, temporal and nasal from the corneal vertex) by fixed spherereference surface with Scheimpflug-camera (Pentacam: OculusOptikgeräte GmbH) before and 1 year after CXL.Student t-test on paired samples, and multivariable regressionanalysis using general estimating equation model were applied forstatistical comparisons of corneal changes after CXL therapy.Results: Thinnest corneal thickness and PE values measured at thethinnest point of the cornea decreased significantly in the CXL group(from 457.78±23.81µm to 432.52±30.29 μm, P.05) in the CXL group. All PE values remained stable in controleyes (P>.05).Change in PE values significantly correlated with initial ThCT in theCXL group (r=0.48 P=0.02).General estimating equation model also showed that CXL treatmentsignificantly decreased PE only at the thinnest point of the cornea(with a mean 6.2 µm, P0.05 for all variables). Forstage II, the mean pre-CXL UDVA was 1.20±0.64 logMar, whichwas changed to 0.72±0.33 logMar after CXL (p=0.03). The meanpre-CXL steepest meridian K and apical K were 53.26±2.33 D and61.97±5.64 D respectively. They were significantly decreased to52.912±.20 D and 60.804±.69 D respectively (p=0.03, p=0.013,respectively). The mean pre-CXL and post-CXL CDVA, flattestmeridian K, and average K did not show any significant difference(p>0.05 for all variables). For stage III, the mean pre-CXL flattestmeridian K, steepest meridian K, average K and apical K weresignificantly decreased from 53.21±1.16 D, 58.40±2.66 D,55.661±.62 D, 66.05±3.81 D to 52.48±1.30 D, 57.262±.75 D,54.851±.78 D, 65.15±3.35 D after CXL respectively (p=0.001,p=0.001, p=0.001, p=0.001). There were no significant changebetween the pre and post-CXL UDVA and CDVA (p>0.05 for bothvariables).Conclusions: One year postoperatively, the effects of CXL on visionwas more significant in early and moderate stages of keratoconus,while the topographic improvement was more prominent in advancedstage.Commercial Relationships: Nurullah Cagil, None; Ozge Sarac,None; Emine Akcay, None; Nagihan Ugurlu, None; Erol Can,None; Gamze Can, NoneProgram Number: 5279 Poster Board Number: C0198Presentation Time: 2:45 PM - 4:30 PMShorter UVA Light Exposure Protocol for Crosslinking inKeratoconus in Children Without Progression CriteriaAndres Codriansky 1, 2 , Maria Carolina Aravena 1, 2 , Marcelo Coria 1, 2 .1 Cornea and Refractive Surgery, Hospital Sotero del Rio / IOPA,Santiago, Chile; 2 Cataract Surgery, Hospital Sotero del Rio, Santiago,Chile.Purpose: To report the safety and efficacy of a shorter UVA lightexposure crosslinking treatment Protocol in children withkeratoconus without progression criteria.Methods: Case series of patients with keratoconus who wereassumed to be progressive based on age of presentation.Patients were treated with crosslinking procedure as follows: 7mmcentral epithelium mechanical debridement, instillation of isotonicriboflavin 0,1% with dextran 20% solution every 3 minutes for 30minutes, verification of riboflavin in the anterior chamber wasperformed with a slit lamp microscope, then exposure to 3mw/cm2UVA Light for 20 minutes while instilling riboflavin drops every 3minutes. Patients were patched and seen the day after, at day 3, 7, 30,3- 6 months, at one year and then accordingly to the physiciancriteria. Clinical charts were review in a retrospective manner.Results: 10 eyes of 7 patients, 1 woman, 6 men, mean age 15,8 years,(range12 to 18), mean follow up 18,9 months (range: 9 to 33months).No adverse events nor drop in best corrected visual acuity werereported.Topography remained stable, with a mean flattening of the steepestKeratometry of 0,12 D and a mean steepening of the mean K of 0,2D.There were 3 cases of treatment failure, defined as steepening on themean Keratometry of 1D or more during follow up.Conclusions: Shorter UVA light exposure protocol seems to be safein Children who were assumed to be progressing. However, it mightnot be as effective as the standard 30 minute protocol, since we had a30% failure rate in this group of patients.A randomize, prospective, clinical trial with more patients isnecessary to draw more definitive conclusions.Commercial Relationships: Andres Codriansky, None; MariaCarolina Aravena, None; Marcelo Coria, None©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.
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