Crosslinking for progressive keratoconus: is there room for improvement?

IF 0.9 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology Pub Date : 2023-03-04 DOI:10.1080/17469899.2023.2207010

C. Mazzotta, Manuela Pulvirenti, Marco Zagari, S. Jihad, Ashraf Armia Balamoun

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引用次数: 0

Abstract

ABSTRACT Introduction the review reports the results of photodynamic accelerated crosslinking (ACXL) protocols focusing on the novelties of high fluence pulsed light transepithelial (Epi-On) ACXL treatments. Areas covered Review covers the outcomes of accelerated crosslinking (ACXL) for all thickness ectatic corneas, including the new epithelium-on (Epi-On) strategies with progressively enhanced fluence, higher riboflavin concentrations and pulsed light irradiation that are considered a promising way forward of photodynamic CXL therapy of Keratoconus (KC), addressing the role of CXL in combination with excimer laser corneal remodeling and lamellar keratoplasty. Literature research is focused on advancements in transepithelial procedures and high fluence accelerated crosslinking treatments looking at CXL plus combined procedures. Expert opinion Today CXL can be considered to all intents a customized corneal photodynamic therapy (CPDT) of ectasia with different application modalities. ACXL protocols optimized the clinical workflow and patient compliance reducing the time of treatment to 20–25 minutes, adapting fluence, improving oxygen kinetic and riboflavin loading. Standardized protocols for thin corneas improved the issue of thin corneas. High irradiance pulsed light Epi-ON ACXL performed with and without iontophoresis, at air-room oxygenation or adding intraoperative supplemental oxygen, reduced the gap of efficacy with Epi-Off techniques, creating the conditions for transition to the Epi-On.

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交联治疗进展性圆锥角膜:还有改进的余地吗?

摘要引言综述报道了光动力加速交联（ACXL）方案的结果，重点是高通量脉冲光跨上皮（Epi-on）ACXL治疗的新颖性。综述涵盖的领域涵盖了加速交联（ACXL）治疗所有厚度扩张性角膜的结果，包括具有逐渐增强的注量、更高的核黄素浓度和脉冲光照射的新上皮开启（Epi-on）策略，这些策略被认为是光动力学CXL治疗角角膜（KC）的一种有前途的方法，探讨CXL在准分子激光角膜重塑和板层角膜移植术中的作用。文献研究的重点是跨上皮手术和高通量加速交联治疗的进展，着眼于CXL加联合手术。今天的专家意见CXL可以被认为是一种定制的角膜光动力疗法（CPDT），具有不同的应用模式。ACXL方案优化了临床工作流程和患者依从性，将治疗时间缩短至20-25 分钟，适应通量，改善氧动力学和核黄素负荷。薄角膜的标准化方案改善了薄角膜的问题。在空气室充氧或添加术中补充氧气的情况下，使用和不使用离子电渗法进行的高辐照度脉冲光Epi ON ACXL，减少了Epi-Off技术的疗效差距，为过渡到Epi-ON创造了条件。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Ophthalmology Health Professions-Optometry

CiteScore

1.40

自引率

0.00%

发文量

期刊介绍： The worldwide problem of visual impairment is set to increase, as we are seeing increased longevity in developed countries. This will produce a crisis in vision care unless concerted action is taken. The substantial value that ophthalmic interventions confer to patients with eye diseases has led to intense research efforts in this area in recent years, with corresponding improvements in treatment, ophthalmic instrumentation and surgical techniques. As a result, the future for ophthalmology holds great promise as further exciting and innovative developments unfold.