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Polymers02:34

Polymers

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The word polymer is derived from the Greek words “poly” which means “many” and “mer” which means “parts”. Polymers are long chains of molecules composed of repeating units of smaller molecules, known as monomers. They either occur naturally, such as DNA and proteins, or can be constructed synthetically, like plastics. They have varied structural characteristics, such as linear chains, branched chains, or complex networks, that contribute to the...
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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
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Transepithelial corneal crosslinking for keratoconus.

Peter S Hersh1, Michael J Lai1, John D Gelles1

  • 1From the Cornea and Laser Eye Institute-Hersh Vision Group (Hersh), CLEI Center for Keratoconus (Hersh, Lai, Gelles), Teaneck, and the Department of Ophthalmology, Rutgers-New Jersey Medical School (Hersh, Lesniak), Newark, New Jersey, USA.

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Transepithelial corneal crosslinking (CXL) improved vision and stabilized keratoconus in most patients after one year. Increased riboflavin dosing may enhance outcomes for this keratoconus treatment.

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Vision Science

Background:

  • Keratoconus is a progressive corneal ectasia leading to vision impairment.
  • Corneal crosslinking (CXL) aims to halt keratoconus progression by strengthening corneal tissue.
  • Transepithelial CXL offers a less invasive alternative to standard CXL by avoiding epithelial removal.

Purpose of the Study:

  • To assess the efficacy of transepithelial corneal crosslinking (CXL) in treating keratoconus.
  • To evaluate changes in visual acuity and corneal curvature after transepithelial CXL.
  • To compare outcomes between different riboflavin administration frequencies during transepithelial CXL.

Main Methods:

  • A prospective case series involving 82 eyes of 56 patients with keratoconus.
  • Transepithelial CXL performed using 0.1% riboflavin and ultraviolet-A light (3mW/cm²).
  • Eyes randomized to receive riboflavin every 1 or 2 minutes; outcomes measured at 1 year.

Main Results:

  • Significant improvement in maximum keratometry (K) by -0.45D and uncorrected distance visual acuity (UDVA) by 0.7 lines at 1 year.
  • 13% of eyes showed improvement of 2.0D or more in maximum K; 5% worsened.
  • The 1-minute riboflavin interval subgroup demonstrated significant improvements in maximum K and UDVA.

Conclusions:

  • Transepithelial CXL is effective in improving maximum K and UDVA in keratoconus patients over one year.
  • Higher frequency of riboflavin administration may lead to better outcomes in transepithelial CXL.
  • Further research is needed to compare transepithelial CXL with standard CXL protocols.