Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique

Cosimo Mazzotta,1 Vincenzo Ramovecchi2 1Unità Operativa Complessa di Oculistica, Siena University Hospital, Siena, Italy; 2Unità Operativa Complessa di Oculistica, San Severino Marche Hospital, San Severino Marche, Italy Abstract: Thin corneas with a minimum corneal thickne...

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Autores principales:	Mazzotta C, Ramovecchi V
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/e8813350efb1434098bfd2ace8be7c10
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spelling	oai:doaj.org-article:e8813350efb1434098bfd2ace8be7c102021-12-02T03:14:11ZCustomized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique1177-5483https://doaj.org/article/e8813350efb1434098bfd2ace8be7c102014-07-01T00:00:00Zhttp://www.dovepress.com/customized-epithelial-debridement-for-thin-ectatic-corneas-undergoing--peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483 Cosimo Mazzotta,1 Vincenzo Ramovecchi2 1Unità Operativa Complessa di Oculistica, Siena University Hospital, Siena, Italy; 2Unità Operativa Complessa di Oculistica, San Severino Marche Hospital, San Severino Marche, Italy Abstract: Thin corneas with a minimum corneal thickness less than 400 µm after epithelial removal represent a contraindication to standard epithelium-off cross-linking (CXL) treatment due to a significant endothelial cell density decrease and potentiality of permanent haze development. Preoperative swelling of the cornea with hypoosmolar riboflavin solutions broadens the spectrum of CXL indications to thin corneas. However the iatrogenic swelling effect might not be durable throughout the CXL procedure increasing the risk of postoperative complications. The transepithelial CXL technique proposed for thin corneas demonstrated poor clinical results and mid- to long-term keratoconus instability. The epithelial island CXL technique with customized pachymetry-guided epithelial debridement was evaluated by means of in vivo laser scanning confocal microscopy, corneal topography, and clinical examination in a 1-year follow-up, in order to assess if it may be considered an alternative surgical option for keratoconic patients with thin corneas undergoing corneal collagen CXL. According to our clinical and in-vivo micro-morphological results the technique results safe, and efficacious in stabilizing progressive keratoconus and may be considered a valid option in the treatment of thin ectatic corneas alone or in combination with hypoosmolar or dextran-free riboflavin solutions. Keywords: cross-linking, keratoconus, thin corneas, epithelial island, surgical techniqueMazzotta CRamovecchi VDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 1337-1343 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Mazzotta C Ramovecchi V Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique
description	Cosimo Mazzotta,1 Vincenzo Ramovecchi2 1Unità Operativa Complessa di Oculistica, Siena University Hospital, Siena, Italy; 2Unità Operativa Complessa di Oculistica, San Severino Marche Hospital, San Severino Marche, Italy Abstract: Thin corneas with a minimum corneal thickness less than 400 µm after epithelial removal represent a contraindication to standard epithelium-off cross-linking (CXL) treatment due to a significant endothelial cell density decrease and potentiality of permanent haze development. Preoperative swelling of the cornea with hypoosmolar riboflavin solutions broadens the spectrum of CXL indications to thin corneas. However the iatrogenic swelling effect might not be durable throughout the CXL procedure increasing the risk of postoperative complications. The transepithelial CXL technique proposed for thin corneas demonstrated poor clinical results and mid- to long-term keratoconus instability. The epithelial island CXL technique with customized pachymetry-guided epithelial debridement was evaluated by means of in vivo laser scanning confocal microscopy, corneal topography, and clinical examination in a 1-year follow-up, in order to assess if it may be considered an alternative surgical option for keratoconic patients with thin corneas undergoing corneal collagen CXL. According to our clinical and in-vivo micro-morphological results the technique results safe, and efficacious in stabilizing progressive keratoconus and may be considered a valid option in the treatment of thin ectatic corneas alone or in combination with hypoosmolar or dextran-free riboflavin solutions. Keywords: cross-linking, keratoconus, thin corneas, epithelial island, surgical technique
format	article
author	Mazzotta C Ramovecchi V
author_facet	Mazzotta C Ramovecchi V
author_sort	Mazzotta C
title	Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique
title_short	Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique
title_full	Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique
title_fullStr	Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique
title_full_unstemmed	Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique
title_sort	customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/e8813350efb1434098bfd2ace8be7c10
work_keys_str_mv	AT mazzottac customizedepithelialdebridementforthinectaticcorneasundergoingcornealcrosslinkingepithelialislandcrosslinkingtechnique AT ramovecchiv customizedepithelialdebridementforthinectaticcorneasundergoingcornealcrosslinkingepithelialislandcrosslinkingtechnique
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Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique

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