[Treatment of Keratoconus with Corneal Cross-linking--Results and Complications in 2 Years Follow-up]. / Corneal cross-linking v liecbe keratokónusu--výsledky a komplikácie v dvojrocnom sledovaní.

OBJECTIVE: The objective of the study was to assessment of changes of monitored parameters after CXL. Incidence of complications were assessed in the whole group and in groups of patients divided according to the selected criteria. Evaluated parameters were also relations between them and in time. METHODS: The 86 eyes of patients with progressive keratoconus who underwent CXL according to the Dresden protocol in the years 2007-2009 at the Ophthalmic clinic FN Brno Bohunice were included in this study. RESULTS: There was observed significant increase of BCVA (letters--before CXL 42,30±10,35, 1st year after CXL (1Y) 44,68±10,04, p<0,01, 2nd year after CXL (2Y) 44,44±10,57, p<0,01) and SE (-5,95±3,98D, -5,27±3,84D, p<0,01, -4,94±3,68D, p<0,01), and decrease of maximum curvature of the cornea (MAX--before CXL 50,39±4,17D, 1Y 49,46±4,13D, p<0,01, 2Y 49,42±4,14D, p<0,01). Change of ultrasound CCT, polymegatisms, pleomorfisms and corneal endothelial cell density was not significant. The value of MAX is the most important parameter in estimating the effect of CXL. The highest incidence of corneal opacity after CXL was observed in the eyes of patients with III. stage of keratoconus over 40 years old, carrying hard contact lenses and with biomikroskopic symptom of keratoconus on the cornea. We found that corneal thickness measurement with Orbscan II and the mesurement of IOP with noncontact method is incorrect by patients after CXL. CONCLUSION: Corneal cross-linking of the cornea is safe and effective procedure of stopping the progression of keratoconus in 97% of eyes in the period up to 2 years after CXL.

[The effectiveness of corneal cross-linking in stopping the progression of keratoconus]. / Efektivita corneal cross-linkingu v zastavení progresie keratokónusu.

OBJECTIVE: Objective of the study was to prove the efficiency of corneal cross-linking (CXL) in stopping the progression of keratoconus. METHODS: In this study were included 58 eyes of patients with progressive keratoconus who underwent CXL according to the Dresden protocol in the years 2007-2009 at the Ophthalmic clinic FN Brno Bohunice. The eyes of patients were divided into four groups according to the change of maximum curvature of the cornea two years after CXL. RESULTS: Stabilization of maximum curvature of the cornea have been reported in 40 % of eyes, regression in 57 % of eyes by an average of 1,92D and disease progression in 3 % of eyes 2 years after CXL. The eyes with regression over 2D had significantly higher best-corrected visual acuity before and after the procedure compared to the group with stabilization. Spherical equivalent increased significantly in all groups, on average, in the group with stabilization of 0,54D, in the group with mild regression of 0,71D and in the group with a large regression of 2,09D. In the group with a large regression 100 % of eyes had stabilization or increase in SE. Our observations showed that, when a decrease in the patient keratometric values of cornea is present after CXL, it is comprehensive and applies to all parameters. CONCLUSION: We have confirmed that corneal cross-linking stops the progression of the disease in 97 % of eyes two years after the procedure.

[Corneal cross-linking--modern method of keratoconus treatment]. / Corneal cross-linking--moderná metóda liecby keratokónusu.

PURPOSE: The aim of research study was to evaluate the effect of corneal cross-linking (CXL) in the frame of patients with progressive keratoconus 1 year after treatment. METHODS: There were 40 eyes of 35 patients with mean age 28, 45 +/- 9.3 (SD) (15 to 48 years) included in the study. Patients were treated with standard protocol of CXL with abrasion of corneal epithelium. Complete ophthalmological examination included best corrected spectacles visual acuity (BCSVA), slit-lamp microscopic finding, corneal topography and corneal thickness measured with ultrasound method was performed before, on the 5-th day, 1. 6., 12. month after CXL. We divided patients according to the stage of keratoconus into 2 groups (stage I. and stage II.) and according to the age into 3 groups (until 20, from 21 to 39, over 40 years). RESULTS: In all treated eyes, the CXL was without relevant complications. The only complication was stromal haze of cornea. In the evaluation based on stage of keratoconus, in the first group any patient became a haze of cornea in 1 year after CXL. In the second group 35.7% of patients had a haze of cornea. The average BCSVA 1 year after treatment was improved in the 1. group about 5.38 letter and in the 2. group about 1.25 letter. Topographic analysis showed decrease of simulated keratometry and refraction (1. group--0.1 D, 2. group--0.17 D), maximal keratometry and refraction (1. group--0.67 D, 2. group--0.76 D). Minimal keratometry and refraction in the 1. group decreased (1.17 D) and increased in the 2. group (1.09 D). In the evaluation based on the age was haze monitored in the first group one year after CXL in 12.5% of researched eyes. In the second group was haze of cornea in 20% of eyes and in the third group consisting of patients over 40 years old, in 50% of eyes. The average BCSVA was improved in the 1. group (2.85 letter), and in the 2. group (3.68 letter).The average BCSVA was decreased in the oldest patients in about 1.43 letter. In the 1. and 2. group the topographic analysis showed decrease of simulated keratometry and refraction (1. group--0.12D, 2. group--0.21D), maximal keratometry and refraction (1. group--1.13 D, 2. group--0,68D), minimal keratometry and refraction (1. group--1.17D, 2. group--0,69 D). In the 3. group the topography analysis showed increase of simulated keratometry and refraction (0,8D), maximal keratometry and refraction (0,98D), minimal keratometry and refraction (0,28D). Corneal pachymetry remained stable in all researched groups of patients. CONCLUSIONS: CXL is considered as safe procedure to stop progression of keratoconus also for patients until 19 years old. The best effect and minimal complications were by patients until 40 years old and by patients with the I. grade.