Cross-linking w terapii stożka rogówki – nowe możliwości terapeutyczne
Cross-linking in Keratoconus – New Therapeutic Opportunities
Piotr Szymanek1, Monika Udziela1,2, Katarzyna Szymanek2
1 ACL-VISION Specjalistyczne Ambulatorium Okulistyczne, Niepubliczny Zakład Opieki Zdrowotnej
Dyrektor: dr Piotr Szymanek
2 Samodzielny Publiczny Kliniczny Szpital Okulistyczny w Warszawie
Katedra i Klinika Okulistyki II Wydziału Lekarskiego Warszawskiego Uniwersytetu Medycznego
Kierownik: prof. dr hab. n. med. Jerzy Szaflik
Summary: Nowadays the majority of keratoconus (KC) cases are diagnosed at the early stage.
Corneal Cross-Linking is indicated for progressive KC defined as stage I–III by the Amsler-Krumeich classification. The CXL procedure consists of saturation of the corneal stroma with riboflavin and UV-A irradiation leading to photopolymerization of collagen fibers in corneal stroma.
The aim of this study was to evaluate the effectiveness of CXL in arresting KC progression using two methods: standard corneal collagen cross-linking and transepithelial CXL (TE CXL) without corneal de-epithelialization. The second procedure might be used even in KC treatment in cases of corneal thickness less than 400 μm.
25 eyes from 19 patients after standard CXL with eye drop riboflavin solution Ricrolin (0.1% Ryboflavin, Sooft Italia) as group I; and 29 eyes from 20 patients after TE CXL with Ricrolin TE (0.1% Ryboflavin + enhancer, Sooft Italia) as group II were enrolled to the study. The source of UVA light was a UV light single-LED emitter UV-A Vega (CSO, Florence). Mean age in group I was 26.7 yrs and in group II – 32.1 yrs. Assessment of visual acuity, optical pachymetry, corneal topography (R0, Ecc) and slit-lamp examination were performed before treatment then in proper periods after procedure. Follow-up was up to 14 months.
In most cases stabilization and in several cases regression of KC were observed.
No decrease in visual acuity has occurred in any individuals from both groups.
Average VA improvement was more significant in group II.
Mean pachymetry in group I minimally decreased after procedure, while in group II mean value increase was observed.
Slit-lamp examination of the corneas after standard CXL revealed discrete haze. The corneas after TE CXL remained transparent over the entire follow-up.
Słowa kluczowe: stożek rogówki, zabieg cross-linking, ryboflawina.
Keywords: keratoconus, corneal cross-linking, ryboflavine.