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Angle Closure Glaucoma: Treatment01:28

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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Updated: Dec 12, 2025

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
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Bilateral Keratoconus Progression: Immediate Versus Delayed Sequential Bilateral Corneal Cross-linking.

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    Journal of Refractive Surgery (Thorofare, N.J. : 1995)
    |August 14, 2020
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    Summary

    Immediate sequential bilateral corneal cross-linking (CXL) is more effective and cost-efficient than delayed CXL for progressive keratoconus. Delayed CXL risks further progression in the untreated eye and incurs higher costs.

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    Area of Science:

    • Ophthalmology
    • Corneal Surgery
    • Biomaterials Science

    Background:

    • Keratoconus is a progressive corneal ectasia leading to visual impairment.
    • Corneal cross-linking (CXL) is a standard treatment to halt keratoconus progression.
    • Bilateral keratoconus often requires treatment in both eyes.

    Purpose of the Study:

    • To compare immediate sequential bilateral corneal cross-linking (CXL) with delayed sequential bilateral CXL for treating bilateral progressive keratoconus.
    • To evaluate the efficacy, safety, and economic impact of both treatment protocols.

    Main Methods:

    • Retrospective case note review of patients with bilateral progressive keratoconus treated with sequential or delayed CXL.
    • Assessment of maximum keratometry, minimum central corneal thickness, and corrected distance visual acuity.
    • Cost-effectiveness analysis comparing the two treatment approaches.

    Main Results:

    • No progression was observed in either group after CXL treatment.
    • Five patients (27%) in the delayed CXL group experienced progression in the second eye during the waiting period.
    • Immediate sequential CXL saved an average of four patient visits compared to delayed CXL, indicating greater cost-efficiency.

    Conclusions:

    • Delayed CXL for bilateral keratoconus poses a risk of disease progression in the untreated eye.
    • Immediate sequential bilateral CXL is a safer and more economical treatment option.
    • The findings support same-day bilateral CXL for efficient management of progressive keratoconus.