Assessment of accelerated cross-linking with different energy protocols
A comparative study
Keywords:
corneal collagen cross-linking, corneal densitometry, corneal demarcation line, KeratoconusAbstract
To evaluate the safety and the efficacy of accelerated corneal cross-linking with two different energy protocols. Design Prospective, randomized, interventional study. Patients and Methods: 48 eyes of 26 patients aged 18-38 years with progressive keratoconus. Group A underwent accelerated cross-linking (24 eyes, 5.4 J/cm2), Group B treated with higher ultraviolet-A irradiance (24 eyes, 7.2 J/cm2). Changes in corrected distance visual acuity (CDVA), keratometric data, densitometric data, and specular microscopy were recorded preoperatively and at the 1st, 3rd, and 6th month postoperatively. One month postoperatively, the demarcation line was measured using anterior segment optical coherence tomography. Results: A mean corneal demarcation line was 231.43±27.18 μm in group A and 282.3±21.4 μm in group B and was significantly deeper in group B (P<0.05). Corneal densitometry in the anterior corneal layers was peaked at the 3rd month follow up in both groups. In contrast, middle and posterior stromal layers peaked at the 6th month in both groups (P<0.05). There were no statistically significant changes in CDVA, keratometric values, and endothelial cells in the two groups. Conclusion: We found that accelerated and modified accelerated cross-linking protocols were effective and safe in halting keratoconus progression after a follow-up period of 6 months.
Downloads
References
Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen cross-linking for the treatment of keratoconus. Am J Ophthalmol. 2003 May;135(5):620–7.
Ziaei M, Barsam A, Shamie N, Vroman D, Kim T, Donnenfeld ED, et al. Reshaping procedures for the surgical management of corneal ectasia. J Cataract Refract Surg. 2015 Apr;41(4):842–72.
Tomita M, Mita M, Huseynova T. Accelerated versus conventional corneal collagen crosslinking. J Cataract Refract Surg. 2014 Jun;40(6):1013–20.
Kymionis GD, Tsoulnaras KI, Grentzelos MA, Plaka AD, Mikropoulos DG, Liakopoulos DA, et al. Corneal stroma demarcation line after standard and high-intensity collagen crosslinking determined with anterior segment optical coherence tomography. J Cataract Refract Surg. 2014 May;40(5):736–40.
Greenstein SA, Fry KL, Bhatt J, Hersh PS. Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: Scheimpflug and biomicroscopic analysis. J Cataract Refract Surg. 2010 Dec;36(12):2105–14.
Wollensak G, Spoerl E, Wilsch M, Seiler T. Keratocyte apoptosis after corneal collagen cross-linking using riboflavin/UVA treatment. Cornea. 2004 Jan;23(1):43–9.
Lopes B, Ramos I, Ambrósio R. Corneal densitometry in keratoconus. Cornea. 2014;33(12):1282–6.
Hashemi H, Miraftab M, Seyedian MA, Hafezi F, Bahrmandy H, Heidarian S, et al. Long-term Results of an Accelerated Corneal Cross-linking Protocol (18 mW/cm2) for the Treatment of Progressive Keratoconus. Am J Ophthalmol. 2015;160(6):1164-1170.e1.
Hashemi H, Fotouhi A, Miraftab M, Bahrmandy H, Seyedian MA, Amanzadeh K, et al. Short-term comparison of accelerated and standard methods of corneal collagen crosslinking. J Cataract Refract Surg. 2015 Mar;41(3):533–40.
Mazzotta C, Traversi C, Caragiuli S, Rechichi M. Pulsed vs continuous light accelerated corneal collagen crosslinking: in vivo qualitative investigation by confocal microscopy and corneal OCT. Eye (Lond). 2014/07/25. 2014 Oct;28(10):1179–83.
Kymionis GD, Grentzelos MA, Plaka AD, Stojanovic N, Tsoulnaras KI, Mikropoulos DG, et al. Evaluation of the corneal collagen cross-linking demarcation line profile using anterior segment optical coherence tomography. Cornea. 2013 Jul;32(7):907–10.
Touboul D, Efron N, Smadja D, Praud D, Malet F, Colin J. Corneal confocal microscopy following conventional, transepithelial, and accelerated corneal collagen cross-linking procedures for keratoconus. J Refract Surg. 2012 Nov;28(11):769–76.
Kymionis GD, Tsoulnaras KI, Grentzelos MA, Liakopoulos DA, Tsakalis NG, Blazaki S V, et al. Evaluation of corneal stromal demarcation line depth following standard and a modified-accelerated collagen cross-linking protocol. Am J Ophthalmol. 2014 Oct;158(4):671-675.e1.
Kymionis GD, Tsoulnaras KI, Liakopoulos DA, Skatharoudi CA, Grentzelos MA, Tsakalis NG. Corneal Stromal Demarcation Line Depth Following Standard and a Modified High-Intensity Corneal Cross-linking Protocol. J Refract Surg. 2016 Apr;32(4):218–22.
Mita M, Waring IV GO, Tomita M. High-irradiance accelerated collagen crosslinking for the treatment of keratoconus: Six-month results. J Cataract Refract Surg. 2014;40(6):1032–40.
Ozgurhan EB, Akcay BIS, Kurt T, Yildirim Y, Demirok A. Accelerated Corneal Collagen Cross-Linking in Thin Keratoconic Corneas. J Refract Surg. 2015 Jun;31(6):386–90.
Moramarco A, Iovieno A, Sartori A, Fontana L. Corneal stromal demarcation line after accelerated crosslinking using continuous and pulsed light. J Cataract Refract Surg. 2015 Nov;41(11):2546–51.
Spadea L, Di Genova L, Tonti E. Corneal stromal demarcation line after 4 protocols of corneal crosslinking in keratoconus determined with anterior segment optical coherence tomography. J Cataract Refract Surg. 2018;44(5):596–602.
Böhm M, Shajari M, Remy M, Kohnen T. Corneal densitometry after accelerated corneal collagen cross-linking in progressive keratoconus. Int Ophthalmol. 2019;39(4):765–75.
Gatzioufas Z, Richoz O, Brugnoli E, Hafezi F. Safety profile of high-fluence corneal collagen cross-linking for progressive keratoconus: preliminary results from a prospective cohort study. J Refract Surg. 2013 Dec;29(12):846–8.
Alnawaiseh M, Rosentreter A, Böhm MRR, Eveslage M, Eter N, Zumhagen L. Accelerated (18 mW/cm2) Corneal Collagen Cross-Linking for Progressive Keratoconus. Cornea. 2015 Nov;34(11):1427–31.
Shetty R, Pahuja NK, Nuijts RMMA, Ajani A, Jayadev C, Sharma C, et al. Current Protocols of Corneal Collagen Cross-Linking: Visual, Refractive, and Tomographic Outcomes. Am J Ophthalmol. 2015 Aug;160(2):243–9.
Turhan SA, Toker E. Changes in Corneal Density after Accelerated Corneal Collagen Cross-linking with Different Irradiation Intensities and Energy Exposures: 1-Year Follow-up. Cornea. 2017;36(11):1331–5.
Pircher N, Pachala M, Prager F, Pieh S, Schmidinger G. Changes in straylight and densitometry values after corneal collagen crosslinking. J Cataract Refract Surg. 2015;41(5):1038–43.
Mathews PM, De Rojas JO, Rapuano PB, Zemsky CJ, Florakis GJ, Trokel SL, et al. Correlation of Scheimpflug densitometry changes with clinical outcomes after corneal crosslinking. J Cataract Refract Surg. 2018;44(8):993–1002.
Hafezi F, Kling S, Gilardoni F, Hafezi N, Hillen M, Abrishamchi R, et al. Individualized Corneal Cross-linking With Riboflavin and UV-A in Ultrathin Corneas: The Sub400 Protocol. Am J Ophthalmol. 2021;224:133–42.
Shetty R, Nagaraja H, Jayadev C, Pahuja NK, Kurian Kummelil M, Nuijts RMMA. Accelerated Corneal Collagen Cross-Linking in Pediatric Patients: Two-Year Follow-Up Results. Biomed Res Int. 2014;2014:1–5.
Yıldırım Y, Olcucu O, Gunaydin ZK, Ağca A, Ozgurhan EB, Alagoz C, et al. Comparison of Accelerated Corneal Collagen Cross-linking Types for Treating Keratoconus. Curr Eye Res. 2017;42(7):971–5.
Suryasa, W., Sudipa, I. N., Puspani, I. A. M., & Netra, I. (2019). Towards a Change of Emotion in Translation of Kṛṣṇa Text. Journal of Advanced Research in Dynamical and Control Systems, 11(2), 1221-1231.
Gandamayu, I. B. M., Antari, N. W. S., & Strisanti, I. A. S. (2022). The level of community compliance in implementing health protocols to prevent the spread of COVID-19. International Journal of Health & Medical Sciences, 5(2), 177-182. https://doi.org/10.21744/ijhms.v5n2.1897
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.








