September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Optical Coherence Tomography and Confocal Microscopy Evaluation after Standard and Transepithelial Corneal Collagen-Crosslinking by Iontophoresis for Progressive Keratoconus in Pediatric Patients
Author Affiliations & Notes
  • Lucia Lapenna
    Ophtalmology, Di Venere Hospital, Bari, BA, Italy
  • Elena Albe
    Istituto Clinico Humanitas , Rozzano, MI, Italy
  • Footnotes
    Commercial Relationships   Lucia Lapenna, None; Elena Albe, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 5733. doi:
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      Lucia Lapenna, Elena Albe; Optical Coherence Tomography and Confocal Microscopy Evaluation after Standard and Transepithelial Corneal Collagen-Crosslinking by Iontophoresis for Progressive Keratoconus in Pediatric Patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5733.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To compare the efficacy and early morphological changes in the cornea following conventional (C-CXL) and transepithelial by iontophoresis (I-CXL) collagen cross-linking in progressive keratoconus.

Methods : Twenty-four eyes, of 18 pediatric patients affected by progressive keratoconus ( grade 1 to 3 according to the Amsler –Krumeich classification) were enrolled in this prospective study.
The mean age was 16.7 ± 2.4 (SD) years with range in between 14–18 years. All of the 24 treated eyes showed progression, as defined by an increase of maximal keratometry (Kmax) readings of the anterior corneal surface, of at least 1.00 diopter (D) in corneal topographies over a maximum of 12 months,maximal keratometry range was in between 45.50 to 65.70 D, corneal pachimetry higher than 400 µm and clear cornea without visible scar. This case series was underwent corneal collagen-crosslinking and was divided into two groups:
C-CXL ( 12 eyes) and I-CXL (12 eyes).
UCVA, BSCVA, refraction , maximal keratometry values (Kmax) , confoscan microscopy (density of corneal sub-basal nerves, anterior and posterior keratocytes), AS-OCT and endothelial cell count were evaluated at baseline and at 1, 3, 6 and 12 months.
The Kruskal-Wallis test, the Mann-Whitney U test and paired Student t-test were used.

Results : Compared to preoperative values, the mean corneal sub-basal nerve and anterior stromal keratocyte densities were significantly lower at 6 months in the C-CXL groups (P < 0.001), whereas they returned to preoperative values in the I-CXL group (P = 0.081 and P = 0.902, respectively). The corneal demarcation line visible in AS-OCT after C-CXL was measured in 94% at a mean depth of 335.8µm (SD, 69.6;) and for the I-CXL, the corneal demarcation line was seen only in 43.6% at a mean depth of 240 µm (SD, 35.6) (P=0.005). The corneal demarcation line also was significantly deeper after C-CXL than after I-CXL (P < 0.001).

Conclusions : Iontophoresis was associated with weaker damage of corneal sub-basal nerves and anterior keratocytes compared to conventional procedures, but the demarcation line was present in less than 50% of cases and was more superficial than with the traditional procedure.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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