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Nacim Bouheraoua, Lea Jouve, Mohamed El Sanharawi, Otman Sandali, Patrick Loriaut, Cyril Temstet, Elena Basli, Vincent Borderie, Laurent Laroche; Corneal confocal microscopy following conventional, transepithelial by iontophoresis, and accelerated corneal collagen cross-linking procedures for keratoconus.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1022.
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To compare early corneal healing following conventional, transepithelial by iontophoresis, and accelerated corneal collagen cross-linking (CXL) protocols.
Forty five patients with progressive keratoconus were divided into three groups to receive conventional, transepithelial by iontophoresis, or accelerated CXL. In vivo corneal confocal microscopy was performed on each patient preoperatively and at 1, 3, and 6 months postoperatively. Density of corneal sub-basal nerves, anterior and posterior keratocytes, and corneal endothelium were assessed.
The subbasal nerve plexus was essentially obliterated immediately following conventional and accelerated CXL. The anterior stroma showed significant changes after CXL: complete obliteration of keratocytes, increased tissue reflectivity, a honey-comb like appearance, and circular lacunae. These changes were more pronounced following conventional and accelerated CXL. There were no apparent changes to the posterior stroma or endothelium.
In vivo corneal confocal microscopy analysis of the postoperative impact of CXL on the cornea revealed clear differences among conventional, accelerated, and transepithelial by iontophoresis CXL protocols. Conventional CXL had a greater impact on the sub-basal nerve plexus and loss of anterior stromal keratocytes in the early postoperative period. The posterior stroma and corneal endothelium were unaffected.
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