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R. Cuiña Sardiña, M. Iradier, D. Diaz-Valle, R. Mendez, P. Arriola, J. M. Benitez-del-Castillo; Cross-Linking in Keratoconus: Early Changes by Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5465.
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Confocal microscopy permits an in vivo ultrastructural analysis of the cornea. The purpose of this study was to evaluate keratoconic corneas after cross-linking by confocal microscopy in the early postoperative period.
We examine five keratoconic corneas using the Heidelberg HRT II with the Rostock module. After the application of a topical anesthesia, mechanical scraping of the epithelium was performed. Preirradiation the cornea was soaked in rivoflavin solution 0.1% (Ricrolin, Italy) every 2.5 minutes for 30 minutes. The corneas were exposed for 30 minutes to UVA radiation (3mW/cm2). Corneas were examined before and one, two, four, twelve and twenty-four weeks after cross-linking.
An increase in epithelial stratification was observed and all the epithelial cells appeared nucleated one week after treatment. Anterior stroma keratocytes were activated. A clear delimitation line between the middle stroma and the posterior stroma was observed. The endothelium was normal. Epithelial cells started to normalized after two weeks, nevertheless intra and subepithelial nerves were not present until three months after surgery when stromal fibrosis appeared.
Confocal microscopy is a useful technique for evaluating ultrastructural changes after corneal cross-linking.
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