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Louis Lhuillier, Mathilde Boiché, Fanny Tréchot, rekia yahia, Naïla HOUMAD, Oualid Guechi, Francois Ameloot, Shanour Premy, adina Agapie, Jean-Marc Perone; Stromal demarcation line after Cross-Linking: Sometimes invisible!. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3001.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate and to compare the visibility and the depth of the stromal demarcation line after corneal collagen cross-linking (CXL) using anterior segment optical coherence tomography (AS-OCT).<br />
All consecutive patients treated with CXL between march 2014 and November 2014 in CHR Metz-Thionville (Mercy Hospital) were included. They all underwent the same procedure: accelerated-CXL protocole (10 minutes UVA irradiation with 9 mW/cm intensity), irradiation device (IROC UV-X™ 2000, Medeuronet). Iso-osmolar riboflavin solution was used for corneas with thinnest pachymetry above 450 µm (before de-epithelization), hypo-osmolar solution was used for thiner corneas (400-450 µm before de-epithelization).<br /> One month after the procedure, AS-OCT examination was performed in all patients (RS-3000, NIDEK). Two independent ophthalmologists scored the visibility of the stromal demarcation line (0: not visible line; 1: visible line, but measurement not clearly defined; 2: clearly visible line). The depth of corneal demarcation line was measured at anytime it was possible.<br />
Twenty-one patients (30 eyes) with progressive keratoconus were included. Mean age was 26.1 ± 8.6 years. Mean duration between the diagnosis of keratoconus and CXL was 17.2 ± 9.5 months. 22 eyes (73%) were stage 1 (thinning of epithelial and stromal layers at the conus) and 8 eyes (27%) were stage 2 (hyperreflective anomalies at the Bowman’s layer level with epithelial thickening) according to Sandali’s AS-OCT keratoconus classification. Pre-operative mean anterior Kmax was 56.8 ± 4.8 D and mean thinnest pachymetry was 451.8 ± 27.3 µm. Nine (30%) demarcation lines were scored 2, 15 (50%) were scored 1 and 6 (20%)were scored 0 (not visible). Mean depth of the corneal stromal demarcation line was 322.5 ± 41.6 μm (range 230-362 μm) according to the first ophthalmologist, and 328.1 ± 39.7 μm (range 232-367 μm) according to the second one.<br />
Mean depth of the corneal stromal demarcation line after CXL was 322.5 µm (first ophthalmologist) and 328.1 (second ophthalmologist). Stromal demarcation line was visible for 80% of the crosslinked corneas. A long term follow-up will be interesting to assess whether or not it is associated with a decreased efficiency of the procedure.<br />
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