Treatment of progressive keratoconus by riboflavin-UVA-induced cross-linking of corneal collagen - Ultrastructural analysis by Heidelberg Retinal Tomograph in vivo confocal microscopy in humans

被引:284
作者
Mazzotta, Cosimo
Balestrazzi, Angelo
Traversi, Claudio
Baiocchi, Stefano
Caporossi, Tomaso
Tommasi, Cristina
Caporossi, Aldo
机构
[1] Univ Siena, Dept Ophthalmol & Neurosurg, I-53100 Siena, Italy
[2] Univ Cattolica Sacro Cuore, Inst Ophthalmol, I-00168 Rome, Italy
关键词
collagen cross-linking; in vivo Heidelberg Retinal Tomograph 11 Rostock Corneal Module confocal microscopy; keratoconus; keratocyte repopulation; riboflavin UVA;
D O I
10.1097/ICO.0b013e318030df5a
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Purpose: To assess ultrastructural stromal modifications after riboflavin-UVA-induced cross-linking of corneal collagen in patients with progressive keratoconus. Methods: This was a second-phase prospective nonrandomized open study in 10 patients with progressive keratoconus treated by riboflavin-UVA-induced cross-linking of corneal collagen and assessed by means of Heidelberg Retinal Tomograph II Rostock Corneal Module (HRT II-RCM) in vivo confocal microscopy. The eye in the worst clinical condition was treated for each patient. Treatment under topical anesthesia included corneal deepithelization (9-mm diameter) and instillation of 0.1% riboflavin phosphate-20% dextran T 500 solution at 5 minutes before UVA irradiation and every 5 minutes for a total of 30 minutes. UVA irradiation was 7 mm in diameter. Patients were assessed by HRT II-RCM confocal microscopy in vivo at 1, 3, and 6 months after treatment. Results: Rarefaction of keratocytes in the anterior and intermediate stroma, associated with stromal edema, was observed immediately after treatment. The observation at 3 months after the operation detected keratocyte repopulation in the central treated area, whereas the edema had disappeared. Cell density increased progressively over the postoperative period. At similar to 6 months, keratocyte repopulation was complete, accompanied by increased density of stromal fibers. No endothelial damage was observed at any time. Conclusions: Reduction in anterior and intermediate stromal keratocytes followed by gradual repopulation has been confirmed directly in vivo in humans by HRT II-RCM confocal microscopy after riboflavin-UVA-induced corneal collagen cross-linking.
引用
收藏
页码:390 / 397
页数:8
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