Outcomes of corneal collagen crosslinking in pseudophakic bullous keratopathy. 2014

Namrata Sharma, and Sangeeta Roy, and Prafulla K Maharana, and Sri V Sehra, and Rajesh Sinha, and Radhika Tandon, and Jeewan S Titiyal, and Rasik B Vajpayee
Departments of Ophthalmology, *Cornea and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; †Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia; and ‡Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

OBJECTIVE The aim was to evaluate the outcomes of corneal collagen crosslinking (CXL) in symptomatic pseudophakic bullous keratopathy (PBK). METHODS In a retrospective noncomparative, interventional case series, we reviewed the records of 50 eyes (50 patients) with symptomatic PBK who underwent CXL. Central corneal thickness (CCT), pain score, best corrected visual acuity (BCVA), and corneal transparency were recorded at baseline; at day 7, day 15; and 1, 3, and 6 months after the CXL. RESULTS The mean pain score decreased from 8.1 ± 0.6 at presentation to 2.1 ± 0.7 on day 7 (P = 0.0001). A subsequent regression was seen in pain scores over 6 months (5.3 ± 1.5). The mean CCT decreased from a preoperative value of 724.8 ± 78.4 to 694.9 ± 77.9 μm by the end of the first month (P = 0.0001). The CCT remained stable at subsequent follow-up. The BCVA improved from logarithm of the minimum angle of resolution (log MAR) 2.0 ± 0.5 preoperatively to log MAR 1.8 ± 0.5 by the end of the first month (P = 0.001). The subsequent follow-up showed a progressive deterioration in the BCVA to the preoperative levels at 6 months. Corneal bullae recurred in 44% (22 eyes) at 6 months after an initial disappearance. A significant improvement in the BCVA and a lack of recurrence of bullae were significantly associated with a thinner CCT on presentation. CONCLUSIONS CXL in symptomatic PBK temporarily improves pain without providing long-term improvement in the BCVA. Case selection is important with more effect seen in patients with a thinner CCT at presentation.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D003094 Collagen A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of SKIN; CONNECTIVE TISSUE; and the organic substance of bones (BONE AND BONES) and teeth (TOOTH). Avicon,Avitene,Collagen Felt,Collagen Fleece,Collagenfleece,Collastat,Dermodress,Microfibril Collagen Hemostat,Pangen,Zyderm,alpha-Collagen,Collagen Hemostat, Microfibril,alpha Collagen
D003315 Cornea The transparent anterior portion of the fibrous coat of the eye consisting of five layers: stratified squamous CORNEAL EPITHELIUM; BOWMAN MEMBRANE; CORNEAL STROMA; DESCEMET MEMBRANE; and mesenchymal CORNEAL ENDOTHELIUM. It serves as the first refracting medium of the eye. It is structurally continuous with the SCLERA, avascular, receiving its nourishment by permeation through spaces between the lamellae, and is innervated by the ophthalmic division of the TRIGEMINAL NERVE via the ciliary nerves and those of the surrounding conjunctiva which together form plexuses. (Cline et al., Dictionary of Visual Science, 4th ed) Corneas
D003317 Corneal Dystrophies, Hereditary Bilateral hereditary disorders of the cornea, usually autosomal dominant, which may be present at birth but more frequently develop during adolescence and progress slowly throughout life. Central macular dystrophy is transmitted as an autosomal recessive defect. Corneal Dystrophies,Granular Dystrophy, Corneal,Groenouw's Dystrophies,Macular Dystrophy, Corneal,Stromal Dystrophies, Corneal,Corneal Dystrophy,Corneal Dystrophy, Hereditary,Corneal Granular Dystrophies,Corneal Granular Dystrophy,Corneal Macular Dystrophies,Corneal Macular Dystrophy,Corneal Stromal Dystrophies,Corneal Stromal Dystrophy,Dystrophy, Corneal,Dystrophy, Corneal Granular,Dystrophy, Corneal Macular,Dystrophy, Corneal Stromal,Dystrophy, Hereditary Corneal,Groenouw Dystrophies,Groenouws Dystrophies,Hereditary Corneal Dystrophies,Hereditary Corneal Dystrophy,Stromal Dystrophy, Corneal
D003319 Corneal Stroma The lamellated connective tissue constituting the thickest layer of the cornea between the Bowman and Descemet membranes. Corneal Stromas,Stroma, Corneal,Stromas, Corneal
D003432 Cross-Linking Reagents Reagents with two reactive groups, usually at opposite ends of the molecule, that are capable of reacting with and thereby forming bridges between side chains of amino acids in proteins; the locations of naturally reactive areas within proteins can thereby be identified; may also be used for other macromolecules, like glycoproteins, nucleic acids, or other. Bifunctional Reagent,Bifunctional Reagents,Cross Linking Reagent,Crosslinking Reagent,Cross Linking Reagents,Crosslinking Reagents,Linking Reagent, Cross,Linking Reagents, Cross,Reagent, Bifunctional,Reagent, Cross Linking,Reagent, Crosslinking,Reagents, Bifunctional,Reagents, Cross Linking,Reagents, Cross-Linking,Reagents, Crosslinking
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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