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CompletedNCT03355430Updated Nov 28, 2017

Simultaneous Corneal Wavefront-Guided Trans-PRK and Corneal Collagen Crosslinking After ICRS Implantation for Moderate Keratoconus

An observational study in Moderate Keratoconus, sponsored by Yonsei University. Completed at 1 site in Korea, Republic of. Open to participants aged 20 Years to 45 Years. Per ClinicalTrials.gov, last updated 2017-11-28.

Sponsored by Yonsei University · Observational

Study type
Observational
Model
Case-only
Time perspective
Retrospective
Enrollment
23
Ages
20 Years to 45 Years
Sex
All
01

Study summary

The investigators aim to investigate the effects of combined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK) and accelerated corneal collagen cross-linking (CXL) after intracorneal ring segment (ICRS) implantation in patients with moderate keratoconus. Medical records of 23 eyes of 23 patients undergoing combined tPRK and CXL after ICRS implantation were retrospectively analyzed. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal indices based on Scheimpflug tomography, higher-order aberrations (HOAs), and corneal biomechanical properties were evaluated before and after ICRS implantation, and at 1, 3, and 6 months after combined tPRK and CXL. Corneal biomechanical properties were measured using the dynamic Scheimpflug analyzer at approximately the same time of day.

Read the detailed description

The investigators aim to investigate the effects of combined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK) and accelerated corneal collagen cross-linking (CXL) after intracorneal ring segment (ICRS) implantation in patients with moderate keratoconus. Medical records of 23 eyes of 23 patients undergoing combined tPRK and CXL after ICRS implantation were retrospectively analyzed. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal indices based on Scheimpflug tomography, higher-order aberrations (HOAs), and corneal biomechanical properties were evaluated before and after ICRS implantation, and at 1, 3, and 6 months after combined tPRK and CXL. Corneal biomechanical properties were measured using the dynamic Scheimpflug analyzer at approximately the same time of day. The dynamic Scheimpflug analyzer automatically calculated corneal deformation amplitude, radius values, and maximal concave power when the cornea is deformed to its greatest curvature by the air puff. The deformation amplitude is defined as the maximum amplitude when the cornea is deformed to its greatest concave curvature and is influenced by corneal stiffness. The radius values represent the central concave curvature at the highest concavity (depressed to the highest concavity), while maximal concave power is the inverse radius of the curvature at the highest concavity.

02

Conditions studied

  • Moderate Keratoconus

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03

Who can participate

Ages eligible
20 Years to 45 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Patient was intolerant to contact lenses, had moderate keratoconus without apical scarring, and if progression had been noted over the previous 6 months. All included patients underwent combined corneal wavefront-guided tPRK and CXL at least 1 month (average 2.7 ± 1.1 months; range 1 to 4 months) after ICRS implantation. We excluded patients with central or para-central corneal scarring, central pachymetry \< 400 microns, corneal endothelial cell density of less than 2000 cells/mm2, systemic autoimmune disease, a history of herpetic corneal disease, pregnancy, lactation, or severe dry eye syndrome.

Inclusion criteria

  • intolerant to contact lenses
  • moderate keratoconus without apical scarring
  • if progression had been noted over the previous 6 months
  • All included patients underwent combined corneal wavefront-guided tPRK and CXL at least 1 month (average 2.7 ± 1.1 months; range 1 to 4 months) after ICRS implantation.

Exclusion criteria

Exclusion Criteria:

  • central or para-central corneal scarring
  • central pachymetry \< 400 microns
  • corneal endothelial cell density of less than 2000 cells/mm2
  • systemic autoimmune disease
  • a history of herpetic corneal disease
  • pregnancy
  • lactation
  • severe dry eye syndrome
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Study design

Observational model
Case-only
Time perspective
Retrospective
Enrollment
23 participants (actual)
Patient registry
No

Groups and cohorts

  • moderate keratoconus group

    moderate keratoconus group underwent combined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK) and accelerated corneal collagen cross-linking (CXL) after intracorneal ring segment (ICRS) implantation

    Procedure: combined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK) · Procedure: accelerated corneal collagen cross-linking (CXL)

Interventions

  • Procedurecombined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK)

    After at least 1 month (average 2.7 ± 1.1 months; range 1 to 4 months), all patients were scheduled for combined corneal wavefront-guided tPRK and accelerated CXL treatment. tPRK between the corneal ring segments was performed using an excimer laser (Amaris 1050 Excimer Laser platform; Schwind eye-tech-solutions GmbH and Co KG, Kleinostheim, Germany).

  • Procedureaccelerated corneal collagen cross-linking (CXL)

    After at least 1 month (average 2.7 ± 1.1 months; range 1 to 4 months), all patients were scheduled for combined corneal wavefront-guided tPRK and accelerated CXL treatment. tPRK between the corneal ring segments was performed using an excimer laser (Amaris 1050 Excimer Laser platform; Schwind eye-tech-solutions GmbH and Co KG, Kleinostheim, Germany).

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What researchers measure

Primary outcomes

  1. visual acuity

    visual acuity in eyes undergoing combined corneal wavefront-guided transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking after intracorneal ring segment implantation in patients with moderate keratoconus

    Time frame: Pre-operation (baseline)

  2. visual acuity

    visual acuity in eyes undergoing combined corneal wavefront-guided transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking after intracorneal ring segment implantation in patients with moderate keratoconus

    Time frame: 1 minute before tPRK-CXL(transepithelial photorefractive keratectomy-accelerated corneal collagen cross-linking)

  3. visual acuity

    visual acuity in eyes undergoing combined corneal wavefront-guided transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking after intracorneal ring segment implantation in patients with moderate keratoconus

    Time frame: 1 month after tPRK-CXL

  4. visual acuity

    visual acuity in eyes undergoing combined corneal wavefront-guided transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking after intracorneal ring segment implantation in patients with moderate keratoconus

    Time frame: 3-month after tPRK-CXL

  5. visual acuity

    visual acuity in eyes undergoing combined corneal wavefront-guided transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking after intracorneal ring segment implantation in patients with moderate keratoconus

    Time frame: 6-month after tPRK-CXL

Secondary outcomes

  1. Corneal indices

    Multiple corneal indices were measured at the 8-mm zone using the Scheimpflug tomography system (Pentacam HR; OCULUS).

    Time frame: Pre-operation (baseline)

  2. Corneal indices

    Multiple corneal indices were measured at the 8-mm zone using the Scheimpflug tomography system (Pentacam HR; OCULUS).

    Time frame: 1 minute before tPRK-CXL

  3. Corneal indices

    Multiple corneal indices were measured at the 8-mm zone using the Scheimpflug tomography system (Pentacam HR; OCULUS).

    Time frame: 1 month after tPRK-CXL

  4. Corneal indices

    Multiple corneal indices were measured at the 8-mm zone using the Scheimpflug tomography system (Pentacam HR; OCULUS).

    Time frame: 3-month after tPRK-CXL

  5. Corneal indices

    Multiple corneal indices were measured at the 8-mm zone using the Scheimpflug tomography system (Pentacam HR; OCULUS).

    Time frame: 6-month after tPRK-CXL

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Study locations

1 site
  • Department of Ophthalmology, Yonsei University College of Medicine
    Seoul, 03722, Korea, Republic of
07

References and documents

Publications

  • Lee H, Kang DSY, Ha BJ, Choi JY, Kim EK, Seo KY, Kim TI. Visual rehabilitation in moderate keratoconus: combined corneal wavefront-guided transepithelial photorefractive keratectomy and high-fluence accelerated corneal collagen cross-linking after intracorneal ring segment implantation. BMC Ophthalmol. 2017 Dec 29;17(1):270. doi: 10.1186/s12886-017-0666-1. PubMed 29284455 ↗

Individual participant data

Plan to share: No

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Registry details

Key details

Study ID
NCT03355430
Lead sponsor
Yonsei University
Responsible party
Sponsor
First posted
Nov 28, 2017
Start date
Jul 7, 2016
Primary completion
Jan 2, 2017
Completion
Jan 2, 2017
Last update
Nov 28, 2017

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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