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      Comment on “Effectiveness and safety of accelerated (9 mW/cm2) corneal collagen cross-linking for progressive keratoconus: a 24-month follow-up”

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      Eye
      Springer Nature

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          Effectiveness and safety of accelerated (9 mW/cm2) corneal collagen cross-linking for progressive keratoconus: a 24-month follow-up

          To examine the effectiveness and safety of accelerated corneal collagen cross-linking (CXL) for keratoconus over a 24-month period and to explore potential prognostic factors for post-treatment visual outcome and progression. A retrospective, non-comparative, interventional case series. All patients who underwent accelerated epithelium-off CXL, using 9 mW/cm 2 ultraviolet-A irradiation for 10 min, for progressive keratoconus in Sunderland Eye Infirmary, UK, between May 2014 and July 2016 were included. All patients completed 24 months’ post-CXL follow-up. Significant post-CXL progression of keratoconus was defined as >1 D increase in Kmax from preoperative to 24-month visit. Fifty-two eyes of 48 patients were included. At 24-month post-CXL, there was a significant improvement in corrected-distance visual acuity (CDVA; −0.05 LogMAR; p  = 0.026), Kmax (−1.68 D; p  < 0.001), K1 (−0.64 D; p  = 0.002) and Kmean (−0.50 D; p  = 0.009). The proportion of eyes with CDVA ≥ 0.3 LogMAR significantly improved from 43 (82.7%) eyes preoperatively to 50 (96.2%) eyes at 24 months ( p  = 0.026). Corneal haze (12, 23.1%) was the only postoperative complication and no adverse event was noted. Final CDVA was associated with lower CDVA ( p  = 0.002) and greater Kmax ( p  = 0.018) at baseline. Post-CXL progression of keratoconus was associated with greater preoperative Kmax ( p  = 0.12) and Kmean ( p  = 0.11), though statistical significances were not achieved. Accelerated CXL (9 mW/cm 2 ) serves as an effective and safe treatment for halting the progression of keratoconus and stabilising the vision over a 24-month period. Our observation suggests that accelerated CXL might be more effective in stabilising keratoconus of milder severity; however further larger studies are required to elucidate this finding.
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            Analysis of photoastigmatic keratectomy with the cross-cylinder ablation

            Aim: The aim was to evaluate the safety and efficacy of the “cross-cylinder” technique in the correction of astigmatism. Setting and Design: A prospective interventional study from a university eye department was conducted. Material and Methods: The photoastigmatic refractive keratectomy (PARK) using the “cross-cylinder” technique was performed in 102 eyes of 84 patients with at least 0.75 D of astigmatism. The study population was divided into two groups: in the first group the preoperative astigmatic power ranged from –0.75 D to –3.00 D (group 1), in the second group it ranged from –3.25 D to –6.00 D (group 2). Group 1 included 82 eyes of 67 patients (29 males and 38 females) with a mean cylinder power of –1.90 ± 0.63 D, group 2 included 20 eyes of 17 patients (13 males and 4 females) with a mean cylinder power of -4.28 ± 0.76 D. All eyes were targeted for emmetropia. The results were evaluated using Calossi's vector analysis method. Six-month postoperative outcomes are presented. Results: Six months after PARK the mean sphere for the entire cohort was +0.28 ± 0.75 D (range +2.5 to –2 D), the mean cylindrical power was +0.33 ± 0.51 D (range +2.5 to –1.25 D) and the mean spherical equivalent refraction was +0.73 ± 0.81 D (range +1.75 to –2 D). Conclusions: The cross-cylinder technique may be safely used with predictable results for the correction of astigmatism.
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              Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus.

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                Author and article information

                Journal
                Eye
                Eye
                Springer Nature
                0950-222X
                1476-5454
                February 15 2019
                Article
                10.1038/s41433-019-0370-x
                6662241
                30770865
                857ea140-4d03-4195-83c3-634a7cbec69e
                © 2019

                http://www.springer.com/tdm

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