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C. Pacheco Del Valle, R. Velasco, A. Babayan, O. Baca; Confocal Microscopy After Cross-Linking. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5471.
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To evaluate morphological changes and cell density by confocal microscopy after cross-linking.
This is a case report study; we included patients after cross-linking treatment (riboflavin/UVA light). Inclusion criteria: Eighteen years of age and older and non complications associated with previous treatment. We analyzed corneal cell populations such as epithelium, keratocytes, endothelium and stromal characteristics (morphological changes) by confocal microscopy using ConfoScan3® (Nidek technologies, Italy), in days 7, 30 and 90 after treatment with riboflavin and UVA. These characteristics were evaluated and a mean of 250 images were taken in each visit. In order to measure corneal thickness and observe qualitative characteristics of the treatment area we used OCT visante ® (Carl Zeiss Meditec Inc. Mod. 1000; 1300 nm, Dublin Ca. USA) and at least 36 images per case were taken.
Three cases were included. All patients were female and the diagnosis in all was keratoconus. Re-epithelialization was complete after day 7 in two cases. Only one case presented it after 2 weeks. This patient also had grade III haze. No activated keratocytes were observed across the study. Fibrosis-like images were observed by day 30 and during follow up period. Full thickness stromal edema was present in all cases. There was marked stromal edema (mean 100 microns per case); It was best circumscribed clinically and by OCT within the anterior third in the first 2 weeks of treatment. nevertheless confocal microscopy still reveals it 30 days after cross-linking application in all cases. These two findings made difficult to observe any endothelium characteristics.
Temporal activation of keratocytes and repopulation was not seen during the follow up period. All cases had subepithelial fibrosis. No nerves were seen. Images Cross line-like were seen.
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