1.
PACK-CXL in Reducing the Time to Heal in Suppurative Corneal Ulcers: Observations of a Pilot Study From South India.
Basaiawmoit, P, Selvin, SST, Korah, S
Cornea. 2018;(11):1376-1380
Abstract
PURPOSE To assess the usefulness of photoactivated chromophore for infectious keratitis-corneal collagen cross-linking in reducing the time to heal in suppurative corneal ulcers in a South Indian tertiary care center. METHODS This was an observational cohort study with 2 arms. In the prospective arm, 13 patients with suppurative corneal ulcers who presented to the outpatient department were recruited. Their ulcers were exposed to ultraviolet-A with riboflavin (B2) (photoactivated chromophore for infectious keratitis-corneal collagen cross-linking) up to a maximum of 4 sittings at 3-day intervals. Topical antimicrobial therapy was continued as per the standard department protocol. This cohort was compared with a retrospective cohort of 32 consecutive patients who had been admitted and treated at our department for a similar profile of ulcers in the previous 1 year. RESULTS The ulcers in the prospective arm had an average healing time of 21.6 days, whereas the retrospective arm had an average healing time of 48.8 days. This reduction in the time to heal trends not only toward being statistically significant (P = 0.06) but also highly clinically significant. CONCLUSIONS CXL reduced the time to heal in suppurative corneal ulcers less than 6 mm in diameter and can be used as an adjuvant to antimicrobial therapy.
2.
Corneal crosslinking without epithelial removal.
Stulting, RD, Trattler, WB, Woolfson, JM, Rubinfeld, RS
Journal of cataract and refractive surgery. 2018;(11):1363-1370
Abstract
PURPOSE To evaluate the effect of riboflavin-ultraviolet (UV)-A corneal crosslinking (CXL) without epithelial removal on ectatic corneal disease. SETTING Woolfson Eye Institute, Atlanta, Georgia, USA. DESIGN Prospective observational study. METHODS Patients were treated with a new riboflavin formulation without epithelial removal, then exposed to UV light (365 nm) at 4 mW/cm2 with on-off cycling for 30 minutes. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, maximum corneal curvature (maximum keratometry [Kmax]), total higher-order aberrations (HOAs), and coma were measured at 3, 6, 12, and 24 months postoperatively. Progression was defined as an increase of more than 1 diopter (D) in Kmax and loss of more than 1 line of CDVA. RESULTS Five hundred twelve eyes of 308 patients with keratoconus or forme fruste keratoconus and 80 eyes of 55 patients with ectasia after laser in situ keratomileusis (LASIK) were treated with the new riboflavin formulation without epithelial removal; 229 patients received bilateral treatments, 95 of which were simultaneous. The mean UDVA and CDVA improved by 1 to 1.5 Snellen lines at 1 and 2 years postoperatively (P < .0001). Mean Kmax decreased by 0.48 D at 2 years postoperatively (P = .0002). Mean total HOAs and coma decreased by 36% (P < .0001) and 37% (P = .0002), respectively, at 2 years postoperatively. Kmax decreased more than 1 D in three times as many eyes as it increased more than 1 D (P < .0001). No eyes progressed, and there was no loss of effect between 1 and 2 years postoperatively. No vision-threatening events were observed. Pain typically resolved within 24 hours, and visual acuity returned to preoperative levels in 1 to 2 days. CONCLUSION Epithelium-on CXL using this new protocol halted the progression of keratoconus and ectasia after LASIK. It was safer and provided more rapid visual recovery than CXL with epithelial removal, allowing routine bilateral, simultaneous treatment.
3.
Conventional and Iontophoresis Corneal Cross-Linking for Keratoconus: Efficacy and Assessment by Optical Coherence Tomography and Confocal Microscopy.
Jouve, L, Borderie, V, Sandali, O, Temstet, C, Basli, E, Laroche, L, Bouheraoua, N
Cornea. 2017;(2):153-162
Abstract
PURPOSE To compare the efficacy, safety, and microstructural corneal changes during 2 years after conventional corneal collagen cross-linking (C-CXL) and transepithelial corneal CXL by iontophoresis (I-CXL) for keratoconus. METHODS Eighty eyes of 80 patients with progressive keratoconus were treated by C-CXL (n = 40) or I-CXL (n = 40). Patients were investigated before surgery and 1, 3, 6, 12, and 24 months after treatment. We measured central corneal thickness and maximal simulated keratometry values (Kmax) and performed specular microscopy and in vivo confocal microscopy at each time point. The demarcation line was assessed 1 month after treatment. RESULTS Kmax remained stable after I-CXL during the entire study period (P = 0.56), whereas the average keratometry increased by 0.2 diopter (50.9 ± 5.6-51.1 ± 5.2). Kmax significantly decreased 1 (P = 0.02) to 2 years (P < 0.01) after C-CXL, with an average decrease of 1.1 diopters (49.9 ± 4.5-48.8 ± 4.2). The failure rate of I-CXL was 20% and that of C-CXL 7.5%. The demarcation line was superficially visible in 35% of cases after I-CXL compared with 95% of cases after C-CXL. Endothelial cell density and central corneal thickness remained stable during the entire study period. The change in Kmax 2 years after C-CXL and I-CXL and the preoperative Kmax were negatively correlated (r = 0.14, P = 0.013, and r = 0.17, P = 0.007, respectively). CONCLUSIONS I-CXL halted progression of keratoconus less efficiently than did C-CXL after 2 years of follow-up. Longer prospective studies are still needed to ensure I-CXL efficacy.
4.
Comparison of endoscopic treatment modalities for Barrett's neoplasia.
David, WJ, Qumseya, BJ, Qumsiyeh, Y, Heckman, MG, Diehl, NN, Wallace, MB, Raimondo, M, Woodward, TA, Wolfsen, HC
Gastrointestinal endoscopy. 2015;(5):793-803.e3
Abstract
BACKGROUND There are few data comparing endoscopic treatment outcomes for Barrett's esophagus (BE). OBJECTIVE To compare treatment outcomes in BE patients treated with radiofrequency ablation (RFA), RFA after EMR, and porfimer sodium photodynamic therapy (Ps-PDT). DESIGN Retrospective, observational study. SETTING Single tertiary center between 2001 and 2013. PATIENTS A total of 342 BE patients treated with RFA (n = 119), EMR+RFA (n = 98), and Ps-PDT (n = 125). MAIN OUTCOME MEASUREMENTS Rates of complete remission of intestinal metaplasia (CRIM), BE recurrence, and adverse events. RESULTS Baseline BE high-grade dysplasia (HGD) and adenocarcinoma were more common in the Ps-PDT group (89%) compared with the EMR-RFA (70%) and RFA (37%) groups. At a median follow-up of 14.2 months, 173 patients (50.6%) achieved CRIM. CRIM was significantly more common in Ps-PDT patients compared with RFA (P < .001) and EMR-RFA (P < .001) patients on multivariable analysis. In patients who achieved CRIM, the rates of subsequent BE recurrence were relatively similar among the 3 groups. Although the rates of bleeding were similar, strictures were less common in RFA patients (2.4%) compared with EMR-RFA (13.3%, P = .001) and Ps-PDT (10.4%, P =.043) patients. CONCLUSION This study of endoscopic treatment for Barrett's dysplasia and neoplasia found that complete remission was achieved more often and more rapidly after Ps-PDT with similar disease recurrence rates compared with EMR or RFA. Adverse events were more common after EMR and Ps-PDT. Further studies are required to determine which ablation and resection techniques are ideally suited for each BE patient.