{"id":124,"date":"2013-11-07T14:53:12","date_gmt":"2013-11-07T14:53:12","guid":{"rendered":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/?page_id=124"},"modified":"2021-12-21T13:47:53","modified_gmt":"2021-12-21T13:47:53","slug":"modified-protocol-for-the-treatment-of-thin-corneas","status":"publish","type":"page","link":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/modified-protocol-for-the-treatment-of-thin-corneas\/","title":{"rendered":"CROSSLINKING THIN CORNEAS"},"content":{"rendered":"<p>In order to overcome the contra-indication of crosslinking corneas with a thickness bordering on 400\u03bcm,\u00a0a number of treatment modifications have been proposed for the treatment of very thin corneas. These include the use of hypo-osmolar riboflavin solutions to swell the cornea to reach the optimum tissue thickness for cross-linking <strong>[1]<\/strong>; the use of transepithelial riboflavin solutions <strong>[2]<\/strong> and\/or iontophoresis-assisted riboflavin delivery <strong>[3]<\/strong> to avoid the requirement for removal of the epithelium and maximise the thickness of the tissue; the use of higher riboflavin concentrations to protect the corneal endothelium by reducing the amount of UVA radiation reaching the deeper layers of the tissue <strong>[4]<\/strong>; the use of pachymetry-guided epithelial debridement (\u2018epithelial island technique\u2019) to selectively remove the epithelium from regions of the cornea with a thickness &gt;400\u2009\u00b5m<strong> [5]<\/strong>; the use of a shielding riboflavin-soaked contact lens (\u2018contact lens-assisted cross-linking\u2019) <strong>[6]<\/strong>; and the use of additional corneal tissue (refractive lenticules) spread over the cornea to thicken the thinnest parts of the tissue prior to cross-linking (\u2018lenticule assisted cross-linking\u2019) <strong>[7]<\/strong>.<\/p>\n<p><strong>[1]<\/strong> Hafezi, F. et al. Collagen crosslinking with ultraviolet A and hypoosmolar riboflavin solution in thin corneas. Journal of Cataract and Refractive Surgery. 2009;35:621-4.<\/p>\n<p><strong>[2]<\/strong> Spadea, L, et al. Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas. Clin Ophthalmol 2012; 6: 1785-1792<\/p>\n<p><strong>[3]<\/strong> Bikbova, G. et al. Standard corneal collagen crosslinking versus transepithelial iontophoresis-assisted corneal crosslinking, 24 months follow-up: randomized control trial. \u00a0Acta Ophthalmol 2016; 94: e600-e606<\/p>\n<p><strong>[4]<\/strong> O\u2019Brart, NAL.\u00a0et al\u00a0An investigation of the effects of riboflavin concentration on the efficacy of corneal cross-linking using an enzymatic resistance model in porcine corneas. Invest Ophthalmol Vis Sci\u00a02018; 59:\u00a01058\u20131065<\/p>\n<p><strong>[5]<\/strong> Kymionis, G. et al. Customized pachymetric guided epithelial debridement for corneal collagen cross linking. BMC Ophthalmology. 2009;9:10.<\/p>\n<p><strong>[6]<\/strong> Knyazer, B. et al\u00a0Corneal cross-linking in thin corneas: 1-year results of accelerated contact lens-assisted treatment of keratoconus. J Refract Surg\u00a02019; 35:\u00a0642\u2013648.<\/p>\n<p><strong>[7]<\/strong> Sachdev, MS. et al\u00a0Tailored stromal expansion with a refractive lenticule for crosslinking the ultrathin cornea. J Cataract Refract Surg\u00a02015; 41:\u00a0918\u2013923.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>Last updated: December 2021<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In order to overcome the contra-indication of crosslinking corneas with a thickness bordering on 400\u03bcm,\u00a0a number of treatment modifications have been proposed for the treatment of very thin corneas. These include the use of hypo-osmolar riboflavin solutions to swell the cornea to reach the optimum tissue thickness for cross-linking [1]; the use of transepithelial riboflavin [&hellip;]<\/p>\n","protected":false},"author":826,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-124","page","type-page","status-publish","hentry"],"jetpack_shortlink":"https:\/\/wp.me\/P3RmFt-20","jetpack_sharing_enabled":true,"meta_box":[],"_links":{"self":[{"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/pages\/124","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/users\/826"}],"replies":[{"embeddable":true,"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/comments?post=124"}],"version-history":[{"count":10,"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/pages\/124\/revisions"}],"predecessor-version":[{"id":1696,"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/pages\/124\/revisions\/1696"}],"wp:attachment":[{"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/media?parent=124"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}