Blurring Strength & Aberrometric Changes Following Corneal Cross-linking (CxL) and CxL Combined With Photorefractive Keratectomy (PRK) in Keratoconus - Full Text View

Purpose

Primary objective of this study was to assess the impact of the two prevalent therapeutic options, CxL and CxL combined with topography-guided photorefractive keratectomy (t-PRK), on both anterior and posterior corneal High order aberations (HOAs).

Condition	Intervention
Keratoconus	Procedure: Corneal Collagen Cross-Linking (CxL) Procedure: Corneal Collagen Cross-Linking combined with t-PRK

Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Blurring Strength & Aberrometric Changes Following Corneal Cross-linking (CxL) and CXL Combined With Photorefractive Keratectomy (PRK) in Keratoconus.

Further study details as provided by Democritus University of Thrace:

Primary Outcome Measures:

Higher order corneal aberations [ Time Frame: 1 year postoperatively ] [ Designated as safety issue: No ]

Enrollment:	32
Study Start Date:	September 2010
Study Completion Date:	January 2012
Primary Completion Date:	December 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: CxL group Volunteers of this group received CxL treatment.	Procedure: Corneal Collagen Cross-Linking (CxL) The same surgical procedure was applied to all keratoconus patients that included: Instillation of proparacaine hydrochloride 0.5% drops for topical anaesthesia, application of a sponge saturated with 10% alcohol to the central cornea for 30 seconds and subsequent de-epithelialization by means of a hockey knife. Following de-epithelialization, a mixture of 0.1% riboflavin in 20% Dextran solution was instilled to the cornea for 30 minutes (2 drops every 2 minutes) prior to the irradiation, until the stroma was completely penetrated and aqueous was stained yellow. The UVA radiation source was UV-XTM Zurich, . Instillation of riboflavin drops (1 drop every 2 minutes) was continued during irradiation, as well, in order to sustain the necessary concentration of the riboflavin. Moreover, balanced salt solution (BSS) was applied every 6 minutes to moisten the cornea.
Experimental: tCxL group Volunteers of this group received CxL combined with t-PRK treatment	Procedure: Corneal Collagen Cross-Linking combined with t-PRK For tCxL group, the topo-guided PRK preceded the CXL. The epithelium was mechanically removed with a hockey knife and ablation was performed in a 9.0 mm zone with a maximal intended ablation depth of 50μm. No adjuvant Mitomycin-C was applied in any case. For the photorefractive ablation we used the Allegretto Wave 200 Hz (1.0071-1-0.81/1.208 software/ WaveLight AG, Erlangen, Germany) with the T-CAT ablation profile.

Arms

Assigned Interventions

Experimental: CxL group

Volunteers of this group received CxL treatment.

Procedure: Corneal Collagen Cross-Linking (CxL)

The same surgical procedure was applied to all keratoconus patients that included: Instillation of proparacaine hydrochloride 0.5% drops for topical anaesthesia, application of a sponge saturated with 10% alcohol to the central cornea for 30 seconds and subsequent de-epithelialization by means of a hockey knife. Following de-epithelialization, a mixture of 0.1% riboflavin in 20% Dextran solution was instilled to the cornea for 30 minutes (2 drops every 2 minutes) prior to the irradiation, until the stroma was completely penetrated and aqueous was stained yellow. The UVA radiation source was UV-XTM Zurich, . Instillation of riboflavin drops (1 drop every 2 minutes) was continued during irradiation, as well, in order to sustain the necessary concentration of the riboflavin. Moreover, balanced salt solution (BSS) was applied every 6 minutes to moisten the cornea.

Experimental: tCxL group

Volunteers of this group received CxL combined with t-PRK treatment

Procedure: Corneal Collagen Cross-Linking combined with t-PRK

For tCxL group, the topo-guided PRK preceded the CXL. The epithelium was mechanically removed with a hockey knife and ablation was performed in a 9.0 mm zone with a maximal intended ablation depth of 50μm. No adjuvant Mitomycin-C was applied in any case. For the photorefractive ablation we used the Allegretto Wave 200 Hz (1.0071-1-0.81/1.208 software/ WaveLight AG, Erlangen, Germany) with the T-CAT ablation profile.

Detailed Description:

The Pentacam Classic (Oculus Optikgerate GmbH, Heidelberg, Germany, software version 1.14r04) was used for the sake of the study.32 patients with keratoconus were included in the study. Of them, 19 patients underwent CxL treatment (CxL group), while the rest 13 patients underwent CxL combined with t-PRK (tCxL) [tCxL group]. If both eyes were eligible, only one eye was enrolled in the study.Regarding Scheimpflug camera (Pentacam Classic, Oculus Optikgerate GmbH, Heidelberg, Germany, software version 1.14r04 ) measurements, acceptable maps had at least 10.0mm of corneal coverage. Moreover, images with extrapolated data in the central 9.0mm zone were excluded.

For both anterior and posterior corneal surfaces, Pentacam-derived HOAs parameters for both pupil diameters of 4mm and 6mm were calculated, as well as the HOA root mean square (RMS)values. Pentacam-derived HOA measurements were obtained one day prior to treatment and then one year post-op.The impact of the surgical technique (either CXL or tCXL) on spherocylindrical error was evaluated by power vector analysis as described before. Furthermore, manifest refractions comprising of sphere (S), cylinder (C) and axis (φ), were converted into three dioptric powers (M, J0 and J45). Moreover, we calculated the overall blurring strength (B) of the spherocylindrical error by measuring the length of the produced vector.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

progressive keratoconus

Exclusion Criteria:

glaucoma or suspicion for glaucoma,
central corneal thickness (CCT) less than 400μm,
K-readings more than 60D,
history of herpetic keratitis,
pregnancy or nursing,
underlying autoimmune disease

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01527721

Locations

Greece
Eye Institute of Thrace (EIT)
Alexandroupolis, Greece

Sponsors and Collaborators

Democritus University of Thrace

More Information

No publications provided

Responsible Party:	Georgios Labiris, Senior Lecturer of Ophthalmology, Democritus University of Thrace
ClinicalTrials.gov Identifier:	NCT01527721 History of Changes
Other Study ID Numbers:	3/2/2012 37
Study First Received:	February 3, 2012
Last Updated:	February 6, 2012
Health Authority:	Greece: Ethics Committee

Keywords provided by Democritus University of Thrace:

keratoconus
CxL
CxL combined with t-PRK

Additional relevant MeSH terms:

Keratoconus
Corneal Diseases
Eye Diseases

ClinicalTrials.gov processed this record on June 18, 2013