Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Epithelial Thickness Profile Change After Corneal Crosslinking: A Retrospective Research
Korneal Çapraz Bağlama Tedavisi Sonrası Epitel Kalınlığın Değişimi: Retrospektif Bir Araştırma
Başak BOSTANCI CERANa, Şennur KALENDERb, Serdar ÖZATEŞa, Akif ÖZDAMARb
aDepartment of Ophthalmology, Okan University Faculty of Medicine, İstanbul, TURKEY
bClinic of Ophthalmology, Dünyagöz Hospital, İstanbul, TURKEY
Turkiye Klinikleri J Ophthalmol. 2021;30(4):211-7
doi: 10.5336/ophthal.2020-80945
Article Language: EN
Full Text
ABSTRACT
 Objective: To assess the corneal epithelial remodeling after corneal crosslinking (CXL) and to investigate the relation between topographic parameters and epithelial thickness change. Material and Methods: Sixty-three eyes of 43 keratoconus patients were included in this retrospective study. Keratometry (K) and elevation data were assessed by Scheimpflug topography and corneal and epithelial thickness profile was obtained by anterior segment spectral-domain optical coherence tomography pre-operatively and at the 1st, 6th and 12th months after CXL. Results: Significant decreases were observed in mean K (p=0.014), maximum K (p=0.049), and mean central corneal thickness (p<0.007) after CXL. Superior corneal epithelial thickness was significantly thinner (p<0.001) and the difference between the minimum and maximum epithelial thickness was less at the post-operative first month and didn't change significantly afterwards. Standard deviation of epithelial thickness across the central 5 mm region statistically decreased in the follow-up period (p=0.008). Conclusion: Significant regularization of the epithelial thickness profile was seen in one year after epithelium-off CXL. Demonstrating the normalization of the corneal epithelium and understanding its impact on the post-operative healing process might contribute to the optimization of treatment protocols.

Keywords: Cross-linking, cornea; keratoconus; epithelium, cornea; tomography, optical coherence
ÖZET
 Amaç: Çalışmanın amacı, korneal çapraz bağlama sonrası epitelyal yeniden düzenlenmenin topografik veriler ışığında incelenmesidir. Gereç ve Yöntemler: Kırk üç keratokonus hastasının 63 gözü, bu retrospektif çalışmaya dâhil edilmiştir. Korneal çapraz bağlama tedavisi öncesi ve tedavi sonrası 1, 6 ve 12. aylarda keratometri (K) değerleri ve korneal topografi, Scheimpflug topografi ile değerlendirilirken, kornea epitel kalınlığı, ön segment optik koherens tomografi ile değerlendirilmiştir. Bulgular: Korneal çapraz bağlama tedavisi sonrası ortalama santral kornea kalınlığında (p<0,007), ortalama K değerinde (p=0,014) ve maksimum K değerinde (p=0,049) istatistiksel anlamlı azalma izlendi. Korneal çapraz bağlama tedavisinden 1 ay sonra superior korneal epitel kalınlığı, istatistiksel anlamlı olarak daha ince (p<0,001); maksimum ve minimum korneal epitel kalınlığı arasındaki fark daha az idi, takip boyunca değişim olmadı. Korneal çapraz bağlama tedavisi sonrasındaki takip süresince santral 5 mm kornea alanındaki epitel kalınlığının standart sapması, istatistiksel anlamlı olarak daha az idi (p=0,008). Sonuç: Korneal çapraz bağlama tedavisinden 1 yıl sonra, korneal epitel kalınlığında anlamlı bir düzgünleşme izlendi. Korneal epitelin iyileşme sürecinin daha iyi değerlendirilmesi ve korneal çapraz bağlama sonrası iyileşme sürecinin anlaşılması, daha verimli tedavi protokollerinin geliştirilmesine yardımcı olacaktır.

Anahtar Kelimeler: Çapraz bağlama, kornea; keratokonus; epitelyum, kornea; tomografi, optik koherens
REFERENCES:
  1. Rico-Del-Viejo L, Garcia-Montero M, Hernández-Verdejo JL, García-Lázaro S, Gómez-Sanz FJ, Lorente-Velázquez A. Nonsurgical procedures for keratoconus management. J Ophthalmol. 2017;2017:9707650. [Crossref]  [PubMed]  [PMC] 
  2. Mohammadpour M, Masoumi A, Mirghorbani M, Shahraki K, Hashemi H. Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes. J Curr Ophthalmol. 2017;29(4):235-47. [Crossref]  [PubMed]  [PMC] 
  3. Spoerl E, Seiler T. Techniques for stiffening the cornea. J Refract Surg. 1999;15(6):711-3. [PubMed] 
  4. Hallahan KM, Rocha K, Roy AS, Randleman JB, Stulting RD, Dupps WJ Jr. Effects of corneal cross-linking on ocular response analyzer waveform-derived variables in keratoconus and postrefractive surgery ectasia. Eye Contact Lens. 2014;40(6):339-44. [Crossref]  [PubMed]  [PMC] 
  5. Randleman JB, Khandelwal SS, Hafezi F. Corneal cross-linking. Surv Ophthalmol. 2015;60(6):509-23. [Crossref]  [PubMed] 
  6. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135(5):620-7. [Crossref]  [PubMed] 
  7. Reinstein DZ, Archer TJ, Gobbe M. Corneal epithelial thickness profile in the diagnosis of keratoconus. J Refract Surg. 2009;25(7):604-10. [Crossref]  [PubMed] 
  8. Reinstein DZ, Gobbe M, Archer TJ, Youssefi G, Sutton HF. Stromal surface topography-guided custom ablation as a repair tool for corneal irregular astigmatism. J Refract Surg. 2015;31(1):54-9. [Crossref]  [PubMed] 
  9. Fernández Pérez J, Valero Marcos A, Martínez Pe-a FJ. Early diagnosis of keratoconus: what difference is it making? Br J Ophthalmol. 2014;98(11):1465-6. [Crossref]  [PubMed]  [PMC] 
  10. Li Y, Chamberlain W, Tan O, Brass R, Weiss JL, Huang D. Subclinical keratoconus detection by pattern analysis of corneal and epithelial thickness maps with optical coherence tomography. J Cataract Refract Surg. 2016;42(2):284-95. [Crossref]  [PubMed]  [PMC] 
  11. Reinstein DZ, Archer T. Combined artemis very high-frequency digital ultrasound-assisted transepithelial phototherapeutic keratectomy and wavefront-guided treatment following multiple corneal refractive procedures. J Cataract Refract Surg. 2006;32(11):1870-6. [Crossref]  [PubMed] 
  12. Lautert J, Doshi D, Price FW Jr, Price MO. Corneal epithelial remodeling after standard epithelium-off corneal cross-linking in keratoconic eyes. J Refract Surg. 2018;34(6):408-12. [Crossref]  [PubMed] 
  13. Rocha KM, Perez-Straziota CE, Stulting RD, Randleman JB. Epithelial and stromal remodeling after corneal collagen cross-linking evaluated by spectral-domain OCT. J Refract Surg. 2014;30(2):122-7. Erratum in: J Refract Surg. 2014;30(3):171. [Crossref]  [PubMed] 
  14. Kanellopoulos AJ, Asimellis G. OCT corneal epithelial topographic asymmetry as a sensitive diagnostic tool for early and advancing keratoconus. Clin Ophthalmol. 2014;8:2277-87. [Crossref]  [PubMed]  [PMC] 
  15. Kanellopoulos AJ, Aslanides IM, Asimellis G. Correlation between epithelial thickness in normal corneas, untreated ectatic corneas, and ectatic corneas previously treated with CXL; is overall epithelial thickness a very early ectasia prognostic factor? Clin Ophthalmol. 2012;6:789-800. [Crossref]  [PubMed]  [PMC] 
  16. Reinstein DZ, Archer TJ, Gobbe M, Silverman RH, Coleman DJ. Epithelial thickness in the normal cornea: three-dimensional display with Artemis very high-frequency digital ultrasound. J Refract Surg. 2008;24(6):571-81. [Crossref]  [PubMed]  [PMC] 
  17. Li Y, Shekhar R, Huang D. Corneal pachymetry mapping with high-speed optical coherence tomography. Ophthalmology. 2006;113(5):792-9.e2. [Crossref]  [PubMed]  [PMC] 
  18. Li Y, Tan O, Brass R, Weiss JL, Huang D. Corneal epithelial thickness mapping by Fourier-domain optical coherence tomography in normal and keratoconic eyes. Ophthalmology. 2012;119(12):2425-33. [Crossref]  [PubMed]  [PMC] 
  19. Temstet C, Sandali O, Bouheraoua N, Hamiche T, Galan A, El Sanharawi M, et al. Corneal epithelial thickness mapping using Fourier-domain optical coherence tomography for detection of form fruste keratoconus. J Cataract Refract Surg. 2015;41(4):812-20. [Crossref]  [PubMed] 
  20. Reinstein DZ, Gobbe M, Archer TJ, Silverman RH, Coleman DJ. Epithelial, stromal, and total corneal thickness in keratoconus: three-dimensional display with artemis very-high frequency digital ultrasound. J Refract Surg. 2010;26(4):259-71. [Crossref]  [PubMed]  [PMC] 
  21. Li Y, Meisler DM, Tang M, Lu AT, Thakrar V, Reiser BJ, et al. Keratoconus diagnosis with optical coherence tomography pachymetry mapping. Ophthalmology. 2008;115(12):2159-66. [Crossref]  [PubMed]  [PMC] 
  22. Zhang X, Sun L, Chen Y, Li M, Tian M, Zhou X. One-year outcomes of pachymetry and epithelium thicknesses after accelerated (45 mW/cm(2)) transepithelial corneal collagen cross-linking for keratoconus patients. Sci Rep. 2016;6:32692. [Crossref]  [PubMed]  [PMC] 
  23. Haberman ID, Lang PZ, Broncano AF, Kim SW, Hafezi F, Randleman JB. Epithelial remodeling after corneal crosslinking using higher fluence and accelerated treatment time. J Cataract Refract Surg. 2018;44(3):306-12. [Crossref]  [PubMed] 
  24. Simon G, Ren Q, Kervick GN, Parel JM. Optics of the corneal epithelium. Refract Corneal Surg. 1993;9(1):42-50. [Crossref]  [PubMed] 
  25. Gatinel D, Racine L, Hoang-Xuan T. Contribution of the corneal epithelium to anterior corneal topography in patients having myopic photorefractive keratectomy. J Cataract Refract Surg. 2007;33(11):1860-5. [Crossref]  [PubMed] 
  26. Lu NJ, Chen D, Cui LL, Wang L, Chen SH, Wang QM. Repeatability of cornea and sublayer thickness measurements using optical coherence tomography in corneas of anomalous refractive status. J Refract Surg. 2019;35(9):600-5. [Crossref]  [PubMed] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com