Corneal Epithelium Treatment Procedures
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Corneal Epithelium Treatment Procedures

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Questions and Answers

What condition is characterized by irregular astigmatism affecting younger individuals?

  • Corneal scarring
  • Keratoconus (correct)
  • Postrefractive surgery ectasia
  • Pellucid marginal degeneration

    • Corneal crosslinking (CXL) has universally positive outcomes for all pediatric cases of keratoconus.

    False

    What is the gold standard treatment when refractive correction is no longer possible due to severe irregular astigmatism?

    Penetrating keratoplasty

    What is the primary purpose of applying riboflavin solution to the de-epithelized cornea?

    <p>To enhance riboflavin penetration and stimulate corneal cross-linking</p> Signup and view all the answers

    Transepithelial cross-linking (CXL) is an older technique compared to conventional CXL.

    <p>False</p> Signup and view all the answers

    The incidence of keratoconus (KC) is estimated to be 1 in _______.

    <p>2000</p> Signup and view all the answers

    What is the recommended power of UVA light exposure during the riboflavin treatment?

    <p>3 mW/cm2</p> Signup and view all the answers

    Which treatment has been proposed to address thin corneas that are not candidates for CXL?

    <p>Prophylactic CXL</p> Signup and view all the answers

    Match the following treatments or conditions with their descriptions:

    <p>Keratoconus = Irregular astigmatism in younger individuals Pellucid marginal degeneration = Affects the peripheral cornea Prophylactic CXL = Proposed for thin corneas Penetrating keratoplasty = Gold standard for severe cases</p> Signup and view all the answers

    The corneal epithelium is typically removed mechanically with a __________.

    <p>blunt hockey knife</p> Signup and view all the answers

    What can be used to correct vision in the initial stages of keratoconus?

    <p>Rigid gas permeable lenses or scleral contact lenses</p> Signup and view all the answers

    What complication can arise after de-epithelizing the cornea?

    <p>Corneal haze</p> Signup and view all the answers

    Match the treatment with its associated effect:

    <p>Transepithelial CXL = Faster healing and less discomfort Conventional CXL = Longer treatment duration Antibiotic drops = Postoperative care Bandage contact lens = Pain relief</p> Signup and view all the answers

    Photosynthetic pigments have been shown to increase corneal stiffness when excited with near-infrared illumination.

    <p>True</p> Signup and view all the answers

    The study conducted by Stulting et al. involved 512 eyes of patients with ________.

    <p>keratoconus</p> Signup and view all the answers

    What is the minimum corneal thickness that should be obtained before considering treatment?

    <p>400 µm</p> Signup and view all the answers

    What is a risk factor for progression following corneal collagen crosslinking (CXL)?

    <p>Steeper Kmax preoperatively</p> Signup and view all the answers

    Dry eye symptoms can worsen after CXL treatment due to abnormal nerve migration.

    <p>True</p> Signup and view all the answers

    What does CXL stand for in the context of ophthalmology?

    <p>Corneal collagen crosslinking</p> Signup and view all the answers

    Corneal subepithelial nerve fibers are affected following _____ treatment.

    <p>CXL</p> Signup and view all the answers

    Match the studies with their findings related to corneal collagen crosslinking:

    <p>Sorkin N = Systematic review on corneal collagen crosslinking Spoerl E et al. = Increased resistance against enzymatic digestion Mastropasqua L = Review on technique and new perspectives Akhtar S et al. = Regeneration of corneal architecture after CXL</p> Signup and view all the answers

    After how long did one study observe complete regeneration of corneal subepithelial nerve fibers following CXL treatment?

    <p>6 months</p> Signup and view all the answers

    Progression in abnormal nerve migration can be observed for up to 5 years after CXL treatment.

    <p>True</p> Signup and view all the answers

    How long after CXL treatment did early regeneration of corneal subepithelial nerve fibers occur according to a study?

    <p>1 month</p> Signup and view all the answers

    What is the focus of the study by Ng et al. in 2021?

    <p>Transepithelial versus epithelium-off corneal crosslinking for progressive keratoconus</p> Signup and view all the answers

    Corneal collagen crosslinking is effective for treating infectious keratitis.

    <p>True</p> Signup and view all the answers

    What technique is used in the study by Cherfan et al. to increase corneal stiffness?

    <p>Collagen cross-linking using rose Bengal and green light</p> Signup and view all the answers

    The study conducted by Martinez et al. in 2020 focused on cross-linking-assisted infection reduction in _____ keratitis.

    <p>fungal</p> Signup and view all the answers

    Which of the following studies evaluates the cellular and molecular effects of rose Bengal photodynamic antimicrobial therapy?

    <p>Naranjo et al.</p> Signup and view all the answers

    Match the authors with their respective studies:

    <p>Ng et al. = Transepithelial versus epithelium-off crosslinking Martinez et al. = Fungal keratitis Cherfan et al. = Corneal stiffness enhancement Papaioannou et al. = Infectious keratitis systematic review</p> Signup and view all the answers

    Which study discusses the use of the bacteriochlorophyll derivative WST11?

    <p>Marcovich et al.</p> Signup and view all the answers

    Data sharing was applicable in all studies mentioned.

    <p>False</p> Signup and view all the answers

    What is the purpose of corneal collagen cross-linking (CCL)?

    <p>To strengthen the cornea</p> Signup and view all the answers

    Collagen cross-linking is only used in adult patients.

    <p>False</p> Signup and view all the answers

    What technique can be used alongside collagen cross-linking for keratoconus?

    <p>Topography-guided PRK</p> Signup and view all the answers

    Collagen cross-linking is effective in treating ____________ degeneration.

    <p>pellucid marginal</p> Signup and view all the answers

    Match the following outcomes with their corresponding study:

    <p>Murchison et al. = Infectious keratitis after CCL Greenstein et al. = Natural history of corneal haze Toprak et al. = Pediatric corneal CCL outcomes Caporossi et al. = Efficacy of adult CCL</p> Signup and view all the answers

    Which of the following is a review article about patient selection for corneal collagen cross-linking?

    <p>Patient selection for corneal collagen cross-linking: An updated review</p> Signup and view all the answers

    All studies agree on the same measurement techniques for evaluating outcomes after CCL.

    <p>False</p> Signup and view all the answers

    What procedure was performed alongside collagen cross-linking in the Athens protocol?

    <p>Transepithelial PRK</p> Signup and view all the answers

    Study Notes

    Corneal Cross-Linking (CXL) Procedure

    • The central corneal epithelium, measuring 9 mm, can be mechanically removed through various methods, including debridement with specialized tools.
    • Riboflavin solution (0.1% riboflavin in 20% dextran) is applied to the de-epithelialized cornea for 30 minutes before exposure to UVA light (370 nm).
    • UVA exposure is conducted at a power of 3 mW/cm2 for a duration of 30 minutes, with riboflavin solution applied every 2-5 minutes during the process.
    • Potential complications from de-epithelialization include corneal haze and pain; a bandage contact lens is often used postoperatively for pain management.

    Importance of Riboflavin and Corneal Thickness

    • Riboflavin serves as a crucial agent for enhancing corneal stiffness and is subject to penetration limitations due to the epithelium acting as a barrier.
    • Ultrasound pachymetry can assess corneal thickness and determine suitability for CXL; a minimum corneal thickness of 400 µm is preferred.
    • For corneas thinner than 400 µm, hypotonic riboflavin ophthalmic solution can be used to ensure adequate riboflavin absorption.

    Transepithelial CXL (Epi-On)

    • Transepithelial CXL is a less invasive alternative that promotes faster healing, improved comfort, and a reduced risk of corneal haze.
    • Clinical studies have shown significant improvements in visual acuity and decreased keratometric values after CXL treatment.

    Keratoconus (KC) Details

    • Keratoconus is a common form of spontaneous corneal ectasia occurring predominantly in younger individuals, with an estimated incidence of 1 in 2000.
    • Initial treatment often involves rigid gas permeable or scleral lenses; penetrating keratoplasty is considered the gold standard in cases of severe irregular astigmatism.

    Pediatric Population Considerations

    • The efficacy of CXL in children (ages 9-18) for keratoconus remains debated; some studies show improvement while others report worsening of corneal thickness.
    • The Siena Pediatrics CXL study, a significant study with 152 KC patients aged 10-18, gives insights into long-term outcomes post-treatment.

    Risks and Complications

    • Risks associated with CXL treatment include corneal haze, changes in corneal shape, and potential for disease progression or flattening.
    • Steeper Kmax preoperatively may indicate a higher risk of progression after CXL.

    Dry Eye and Nerve Damage

    • CXL affects corneal subepithelial nerve fibers, with early regeneration observed within the first month, though symptoms of dry eye may persist.
    • Long-term neuropathic symptoms can develop, impacting patient comfort.

    Innovative Treatment Strategies

    • Prophylactic and simultaneous treatments are being explored to improve corneal stiffness without the drawbacks associated with traditional CXL, especially in thin corneas.
    • Recent advancements include the use of photosynthetic pigments and novel formulations to enhance treatment outcomes.

    Summary of Findings

    • Visual acuity improved by 1–1.5 Snellen lines after 1–2 years post-CXL, with a decrease in mean Kmax measurements.
    • The approach must balance effectiveness with patient comfort and potential complications, requiring careful patient selection and monitoring.

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    Related Documents

    ccl.pdf

    Description

    This quiz covers the methods of mechanically removing the central corneal epithelium and the subsequent application of riboflavin solution. It highlights various techniques such as using a blunt hockey knife and transpethelial phototherapeutic approaches. Test your knowledge on the procedures involved in corneal treatment.

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