Localized changes in stromal reflectivity after corneal collagen cross-linking observed with different imaging...

Area of Science:

• Ophthalmology
• Corneal Science
• Medical Imaging

Background:

• Keratoconus is a progressive thinning disorder of the cornea.
• Epithelium-off collagen cross-linking (CXL) is a treatment to halt keratoconus progression.
• Understanding stromal changes post-CXL is crucial for monitoring treatment efficacy.

Purpose of the Study:

• To document corneal stromal changes after epithelium-off CXL using confocal microscopy and Scheimpflug imaging.
• To characterize the nature and timing of these stromal alterations in progressive keratoconus patients.

Main Methods:

• Examined 15 eyes from 14 patients before and after CXL.
• Utilized slit-lamp biomicroscopy, Scheimpflug imaging, and confocal microscopy.
• Optical coherence tomography (OCT) was performed on a subset of patients.

Main Results:

• Confocal microscopy revealed a new reflective layer in the mid-to-deep stroma post-CXL, termed intrastromal striate reflections (ISRs).
• This ISR layer appeared by 1 week and persisted up to 12 months, consisting of linear reflective structures.
• Scheimpflug and OCT imaging corroborated these findings, showing increased reflectivity at a similar stromal depth.

Conclusions:

• Modern imaging technologies visualize altered stromal reflectivity after CXL.
• These imaging findings correlate across different devices and with clinical observations.
• This may offer a non-invasive method to monitor CXL treatment effects in individual corneas.