Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy
Abstract Purpose: To report structural changes observable in in vivo confocal microscopy (IVCM) in keratoconic corneas < 400 μm treated with hypotonic riboflavin and collagen crosslinking (CXL). Methods: Ten eyes of ten patients with progressive keratoconus and corneal thickness between 350 and 3...
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Knowledge E
2021-07-01
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| Series: | Journal of Ophthalmic & Vision Research |
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| Online Access: | https://doi.org/10.18502/jovr.v16i3.9429 |
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| author | Aalia Rasool Sufi M. Soundaram Nilam Gohil Jeremy D. Keenan N. Venkatesh Prajna |
| author_facet | Aalia Rasool Sufi M. Soundaram Nilam Gohil Jeremy D. Keenan N. Venkatesh Prajna |
| author_sort | Aalia Rasool Sufi |
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| description | Abstract Purpose: To report structural changes observable in in vivo confocal microscopy (IVCM) in keratoconic corneas < 400 μm treated with hypotonic riboflavin and collagen crosslinking (CXL). Methods: Ten eyes of ten patients with progressive keratoconus and corneal thickness between 350 and 399 μm underwent CXL with hypotonic riboflavin. IVCM was performed preoperatively and at one month, three months, and six months after the procedure. Results: IVCM analysis one month postoperatively showed complete absence of the subepithelial nerve plexus with gradual regeneration over six months in 8 of the 10 eyes, and poor regeneration in the remaining 2 eyes. The anterior stroma showed extracellular lacunae and hyper-reflective cytoplasm in a honeycomb appearance signifying edema at one month which gradually decreased over six months post CXL. Stromal keratocyte apoptosis was evident in the anterior stroma in all cases and extended to the posterior stroma in four eyes with gradual regeneration evident at three and six months. The specular endothelial count decreased by 8% (P = 0.005) post-CXL, but no corneas developed clinical signs of endothelial trauma. Conclusion: IVCM analysis of thin corneas after hypotonic CXL showed posterior corneal structural changes. Posterior stromal changes were accompanied by a decrease in the endothelial cell count. This case series was a preliminary feasibility study that might necessitate conducting a well-designed controlled study. |
| format | Article |
| id | doaj-art-168aab60c4f14c648e579e735579cdbf |
| institution | Kabale University |
| issn | 2008-2010 2008-322X |
| language | English |
| publishDate | 2021-07-01 |
| publisher | Knowledge E |
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| series | Journal of Ophthalmic & Vision Research |
| spelling | doaj-art-168aab60c4f14c648e579e735579cdbf2025-01-13T10:02:33ZengKnowledge EJournal of Ophthalmic & Vision Research2008-20102008-322X2021-07-0116332533710.18502/jovr.v16i3.9429jovr.v16i3.9429Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal MicroscopyAalia Rasool Sufi0M. Soundaram1Nilam Gohil2Jeremy D. Keenan3N. Venkatesh Prajna4 Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India Francis I. Proctor Foundation, University of California, San Francisco Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, IndiaAbstract Purpose: To report structural changes observable in in vivo confocal microscopy (IVCM) in keratoconic corneas < 400 μm treated with hypotonic riboflavin and collagen crosslinking (CXL). Methods: Ten eyes of ten patients with progressive keratoconus and corneal thickness between 350 and 399 μm underwent CXL with hypotonic riboflavin. IVCM was performed preoperatively and at one month, three months, and six months after the procedure. Results: IVCM analysis one month postoperatively showed complete absence of the subepithelial nerve plexus with gradual regeneration over six months in 8 of the 10 eyes, and poor regeneration in the remaining 2 eyes. The anterior stroma showed extracellular lacunae and hyper-reflective cytoplasm in a honeycomb appearance signifying edema at one month which gradually decreased over six months post CXL. Stromal keratocyte apoptosis was evident in the anterior stroma in all cases and extended to the posterior stroma in four eyes with gradual regeneration evident at three and six months. The specular endothelial count decreased by 8% (P = 0.005) post-CXL, but no corneas developed clinical signs of endothelial trauma. Conclusion: IVCM analysis of thin corneas after hypotonic CXL showed posterior corneal structural changes. Posterior stromal changes were accompanied by a decrease in the endothelial cell count. This case series was a preliminary feasibility study that might necessitate conducting a well-designed controlled study.https://doi.org/10.18502/jovr.v16i3.9429collagen crosslinkinghypotonic riboflavinin vivo confocal microscopykeratoconus |
| spellingShingle | Aalia Rasool Sufi M. Soundaram Nilam Gohil Jeremy D. Keenan N. Venkatesh Prajna Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy Journal of Ophthalmic & Vision Research collagen crosslinking hypotonic riboflavin in vivo confocal microscopy keratoconus |
| title | Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy |
| title_full | Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy |
| title_fullStr | Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy |
| title_full_unstemmed | Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy |
| title_short | Structural Changes in Thin Keratoconic Corneas Following Crosslinking with Hypotonic Riboflavin: Findings on In Vivo Confocal Microscopy |
| title_sort | structural changes in thin keratoconic corneas following crosslinking with hypotonic riboflavin findings on in vivo confocal microscopy |
| topic | collagen crosslinking hypotonic riboflavin in vivo confocal microscopy keratoconus |
| url | https://doi.org/10.18502/jovr.v16i3.9429 |
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