Transepithelial corneal crosslinking for keratoconus.

PURPOSE: To evaluate outcomes of corneal crosslinking (CXL) using a transepithelial technique for the treatment of keratoconus. SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective case series. METHODS: Transepithelial CXL was performed in keratoconic eyes using riboflavin 0.1% and topical anesthetic containing benzalkonium chloride to facilitate riboflavin diffusion through the epithelium. Eyes were randomized to receive riboflavin administration either every 1 minute or every 2 minutes during ultraviolet-A exposure at 3mW/cm2. The principal outcome was change in maximum keratometry (K) and secondary outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, mean K, and comparison of randomized groups. RESULTS: Eighty-two eyes of 56 patients were treated. At 1 year, maximum K decreased significantly by 0.45 diopters (D) ± 1.94 (SD); it improved by 2.0 D or more in 11 eyes (13%) and worsened by 2.0 D or more in 4 eyes (5%). The mean UDVA significantly improved by 0.7 lines, whereas the CDVA improved by 0.2 lines. Two eyes showed both continued progression with loss of CDVA. Only the 1-minute subgroup showed significant improvements in maximum K (-0.73 D) and UDVA. Transient corneal erosion and epitheliopathy were reported in 21% of eyes. CONCLUSIONS: Transepithelial CXL resulted in significant improvements in maximum K and UDVA over 1 year. There was a suggestion that increased riboflavin dosing might improve procedure outcomes. Further study is required to determine the relative advantages and disadvantages of different transepithelial approaches to the standard CXL protocol with epithelial removal.

Transepithelial corneal collagen crosslinking for keratoconus: six-month results.

PURPOSE: To evaluate the safety and efficacy of corneal collagen crosslinking (CXL) using a transepithelial technique to treat keratoconus. SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective clinical trial. METHODS: Transepithelial CXL was performed in eyes with keratoconus using proparacaine with benzalkonium chloride (BAK) 0.01% to facilitate riboflavin absorption and riboflavin 0.10% without dextran. Eyes were randomized to receive ultraviolet-A treatment (365 nm, 3 mW/cm(2)) with concurrent administration of riboflavin randomized to every 1 minute or every 2 minutes for 30 minutes. The principal outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities and topography-derived maximum keratometry (K) values. Patients were followed for 6 months. RESULTS: Thirty eyes of 25 patients were treated. The mean maximum K value flattened by 0.9 diopter (D) (baseline 58.7 D; 6 months 57.8 D) (P=.01). The maximum K worsened by 2.0 D or more in 1 patient. The mean CDVA improved by 0.83 Snellen lines (P=.03). One patient lost 2 lines of CDVA. There were no differences in the UDVA, CDVA, or keratometry outcomes between the 1-minute instillation subgroup and the 2-minute instillation subgroup. CONCLUSIONS: Transepithelial CXL resulted in a statistically significant improvement in maximum K values and CDVA at the 6-month follow-up. Further follow-up is necessary to ascertain the ability of transepithelial CXL to achieve long-term stabilization of the cornea in eyes with keratoconus.

Twelve-year review of pediatric traumatic open globe injuries in an urban U.S. population.

PURPOSE: To evaluate the epidemiology, anatomical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to compare the observed final visual acuity to the expected visual acuity as predicted by the Ocular Trauma Score (OTS). METHODS: Retrospective chart review of 89 pediatric patients (89 eyes) with open globe injury presenting between 1997 and 2008. RESULTS: Sixty-five patients (73%) were male, average age was 9.7 years, and mean follow-up was 22.6 months. The most common causes of trauma were: accidents (79%), violence (10%), and motor vehicle accidents (9%). Penetrating ocular injury was the most common trauma (54%), followed by blunt rupture (34%). Zone 1 injuries represented 49% of cases, and zones 2 and 3 represented 29% and 21%, respectively. No patient developed endophthalmitis. The average presenting and final visual acuities were logarithm of the minimum angle of resolution 1.927 and 1.401, respectively. Lens trauma was noted in 44 (49%) eyes. Twenty-eight patients (31%) had retinal detachment within 6 months of presentation. Total retinal attachment was achieved in 12 (63%) of 19 eyes undergoing repair. Enucleation was performed in 9 (10%) patients. Final visual acuities were not statistically different from visual acuities predicted by OTS (P > .05). CONCLUSIONS: The visual prognosis in pediatric open globe injury is poor. The zone of injury may correlate with poor final visual acuity, risk of retinal detachment, and subsequent need for an enucleation. The final predicted visual acuity correlated well with the observed final visual acuity in these patients.

Long-term follow-up of spontaneous retinal pigment epithelium tears in age-related macular degeneration treated with anti-VEGF therapy.

PURPOSE: To describe the clinical response following anti-vascular endothelial growth factor (VEGF) therapy in patients with spontaneous retinal pigment epithelium (RPE) tears secondary to age-related macular degeneration (AMD). METHODS: Retrospective chart review of patients with AMD who developed a spontaneous RPE tear and were subsequently treated with anti-VEGF therapy at a single institution. RESULTS: In 5 patients included in the study, the median number (range) of injections received was 14.2 (5-18). The median baseline acuity was 20/200, which remained stable at 12 months and improved to 20/60 at 24 months. These changes were not statistically different. CONCLUSIONS: Anti-VEGF therapy appears safe in eyes with spontaneous RPE tear secondary to AMD and may help to stabilize or even improve acuity in some cases.