Analysis of the results of modified personalized topographically and tomographically oriented technique of ultraviolet corneal collagen crosslinking

E.G. Solodkova

Volgograd branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0002-7786-5665

B.E. Malyugin

S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”;
A.I. Yevdokimov Moscow State University of Medicine and Dentistry

ORCID: 0000-0001-5666-3493

V.P. Fokin

Volgograd branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0002-2513-9709

S.V. Balalin

Volgograd branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0002-5250-3692

E.V. Lobanov

Volgograd branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0001-9112-3230

I.N. Zakharov

Volgograd State Technical University

ORCID: 0000-0001-7177-7245

V.H. Le

Volgograd State Technical University

ORCID: 0000-0002-1536-3061

Analysis of the results of modified personalized topographically and tomographically oriented technique of ultraviolet corneal collagen crosslinking

Authors:

E.G. Solodkova, B.E. Malyugin, V.P. Fokin, S.V. Balalin, E.V. Lobanov, I.N. Zakharov, V.H. Le

More about the authors

Journal: Russian Annals of Ophthalmology. 2023;139(3): 5‑14

DOI: 10.17116/oftalma20231390315

Downloaded: 52

To cite this article:

Solodkova EG, Malyugin BE, Fokin VP, Balalin SV, Lobanov EV, Zakharov IN, Le VH. Analysis of the results of modified personalized topographically and tomographically oriented technique of ultraviolet corneal collagen crosslinking. Russian Annals of Ophthalmology. 2023;139(3):5‑14. (In Russ., In Engl.)
https://doi.org/10.17116/oftalma20231390315

Доказательная гастроэнтерология: pro et contra

Актуальные вопросы педиатрической практики

Использование инфографики авторами научных работ

Close metadata

PURPOSE

The study aims to develop a modified personalized topographically and tomographically oriented technique of ultraviolet corneal collagen cross-linking (UVCXL) to affect the area of the cornea with weakest biomechanical properties as determined by mathematical modeling.

MATERIAL AND METHODS

Modeling of the biomechanics of keratoconic cornea under conditions of external diagnostic action was done using COMSOL Multiphysics^® software. Finite-element analysis procured 3D images of stress/deformation distribution pattern throughout the cornea. Matching these 3D images with primary topographic and tomographic Pentacam AXL maps and Corvis ST findings allowed determining localization and dimensions of impaired regions of the cornea. The acquired data helped develop the modified corneal collagen cross-linking technique, which was applied in the treatment of 36 persons (36 eyes) with degrees I and II keratoconus.

RESULTS

Uncorrected and best-corrected visual acuity (UCVA and BCVA logMAR) in all patients after modified UVCXL increased after the follow-up period lasting 6—12 months by 0.2±0.19 (23%) and 0.1±0.14 (29%) (p<0.05), respectively, in comparison with preoperative values. Maximum keratometry (K_max) decreased by 1.35±1.63% (3%; p<0.05) in all cases at 6—12 months follow-up. Improvement of corneal biomechanical strength was determined by statistically significant increase in corneal stiffness index (SP-A1) and corneal stress-strain index (SSI) measured with Pentacam AXL and Corvis ST at 6—12 months follow-up by 15.1±5.04 (18%) and 0.21±0.20 (23%) (p<0.05), respectively. Effectiveness of the developed UVCXL technique is also confirmed by the appearance of a characteristic morphological marker — «demarcation line» at the cross-linking site in keratoconus projection at the depth of 240±10.2 µm.

CONCLUSION

The developed personalized topographically and tomographically oriented UVCXL technique provides an evident stabilizing effect on the cornea in the form of an increase in its biomechanical strength, improvement of clinical, functional indicators and safety of keratoconus treatment.

Keywords:

corneal biomechanical properties

keratoconus

ultraviolet corneal collagen cross-linking

Authors:

E.G. Solodkova

Volgograd branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0002-7786-5665

B.E. Malyugin

S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”;
A.I. Yevdokimov Moscow State University of Medicine and Dentistry

ORCID: 0000-0001-5666-3493

V.P. Fokin

Volgograd branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0002-2513-9709

S.V. Balalin

Volgograd branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0002-5250-3692

E.V. Lobanov

Volgograd branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

ORCID: 0000-0001-9112-3230

I.N. Zakharov

Volgograd State Technical University

ORCID: 0000-0001-7177-7245

V.H. Le

Volgograd State Technical University

ORCID: 0000-0002-1536-3061

Received:

29.09.2022

Accepted:

01.02.2023

List of references:

Roberts CJ, Dupps WJ Jr. Biomechanics of corneal ectasia and biomechanical treatments. J Cataract Refract Surg. 2014;40:991998. https://doi.org/10.1016/j.jcrs.2014.04.013
Sinha Roy A, Dupps WJ Jr. Patient-specific computational modeling of keratoconus progression and differential responses to collagen cross-linking. Invest Ophthalmol Vis Sci. 2011;52:9174-9187. https://doi.org/10.1167/iovs.11-7395
Seiler TG, Fischinger I, Koller T, Zapp D, Frueh BE, Seiler T. Customized corneal cross-linking: one-year results. Am J Ophthalmol. 2016;166:14-21. https://doi.org/10.1016/j.ajo.2016.02.029
Shetty R, Pahuja N, Roshan T, Deshmukh R, Francis M, Ghosh A, PhD, Roy S. Customized Corneal Cross-linking Using Different UVA Beam Profiles. J Refract Surg. 2017;33(10):676-682. https://doi.org/10.3928/1081597X-20170621-07
Cassagne M, Pierné K, Galiacy SD, Asfaux-Marfaing MP, Fournié P, Malecaze F. Customized Topography-Guided Corneal Collagen Cross-linking for Keratoconus. J Refract Surg. 2017;33 (5):290-297. https://doi.org/10.3928/1081597X-20170201-02
Ambrosio R Jr, Lopes BT, Faria-Correira F, Salomão MQ, Jens Bühren J, Roberts CJ, Elsheikh A, Vinciguerra R, Vinciguerra P. Integration of Scheimpflug-Based Corneal Tomography and Biomechanical Assessments for Enhancing Ectasia Detection. J Refract Surg. 2017;33(7):434-444. https://doi.org/10.3928/1081597X-20170426-02
Joda AA, Shervin MM, Kook D, Elsheikh A. Development and validation of a correction equation for Corvis tonometry. Comput Methods Biomech Biomed Engin. 2016;19:943-953. https://doi.org/10.1080/10255842.2015.1077515
Luce DA. Determining in vivo biomechanical properties of the cornea with an ocular response analyzer. J Cataract Refract Surg. 2005;31(1):156-162. https://doi.org/10.1016/j.jcrs.2004.10.044
Roberts CJ, Mahmoud AM, Bons JP, Hossain A, Elsheikh A, Vinciguerra R, Vinciguerra P, Ambrósio RJr. Introduction of Two Novel Stiffness Parameters at Interpretation of Air Puff-Induced Biomechanical Deformation Response Parameters with a Dinamic Scheimpflug Analyser. J Refract Surg. 2017;33(4):266-273. https://doi.org/10.3928/1081597X-20161221-03
Izquierdo L, Gilani F, Henriquez M, Izquierdo L, Ambrósio A. Independent Population Validation of the Belin/Ambrysio Enhanced Ectasia display: Implications for Keratoconus studies and screening. Int J Keratoconus Ectatic Corn Dis. 2014;3(1):1-8. https://doi.org/10.5005/jp-journals-10025-1069
Vinciguerra R, Elsheikh A, Roberts CJ, Ambrósio R Jr, Kang DCY, Lopes BT, Morenghi E, Azzolini C, Vinciguerra P. Influence of Pachymetry and Intraocular Pressure on Dynamic Corneal Response Parameters in Healthy Patients. J Refract Surg. 2016;32:550-561. https://doi.org/10.3928/1081597X-20160524-01
Esporcatte LPG, Salomão MQ, Lopes BT, Vinciguerra P, Vinciguerra R, Roberts C, Elsheikh A, Dawson DG, Ambrósio R Jr. Biomechanical diagnostics of the cornea. Eye Vis. 2020;7:9. https://doi.org/10.1186/s40662-020-0174-x
Ambrosio R Jr, Noguerira LP, Caldas DL, et al. Evaluation of corneal shape and biomechanics before LASIK. Int Ophthalmol Clin. 2011;51:11-38. https://doi.org/10.1097/IIO.0b013e31820f1d2d
Pandolfi A. Cornea modelling. Eye Vis. 2020;7:2. https://doi.org/10.1186/s40662-019-0166-x
Iomdina EN, Petrov SYu, Antonov AA, Novikov IA, Pahomova IA, Archakov AYu. The corneoscleral shell of the eye: potentials of assessing biomechanical parameters in normal and pathological conditions. Ophthalmology in Russia = Oftal’mologiya. 2016;13(2):62-68 (In Russ.). https://doi.org/10.18008/1816-5095-2016-2-62-68
Solodkova EG, Malyugin BE, Zakharov IN, Bagmutov VP, Fokin VP, Balalin SV, Lobanov EV, Le V.H. Development of a set of mathematical models of corneal biomechanical parameters with diagnosed keratoconus before and after treatment with corneal collagen cross-linking. Russian Journal of Biomechanics = Rossiyskiy zhurnal biomekhaniki. 2022;(3):10-28 (In Russ.). https://doi.org/10.15593/RZhBiomeh/2022.3.01
Yeoh OH. Some Forms of the Strain Energy Function for Rubber. Rubber Chem Technol. 1993;66(5):754-771. https://doi.org/10.5254/1.3538343
Mazzotta C, Balestrazzi A, Baiocchi S, Traversi C, Caporossi A Stromal haze after combined riboflavin-UVA corneal collagen cross-linking in keratokonus: in vivo confocal microscopic evaluation. Clin Experiment Ophthalmol. 2007;35(6):580-582. https://doi.org/10.1111/j.1442-9071.2007.01536.x

Close metadata