Long-term radiographic outcomes of expandable versus static cages in transforaminal lumbar interbody fusion

2020 ◽  
pp. 1-10
Author(s):  
Chih-Chang Chang ◽  
Dean Chou ◽  
Brenton Pennicooke ◽  
Joshua Rivera ◽  
Lee A. Tan ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Expandable Cage ◽  
Radiographic Outcomes ◽  
Cage Subsidence ◽  
Cage Group ◽  
The Mean ◽  
Expandable Cages

OBJECTIVEPotential advantages of using expandable versus static cages during transforaminal lumbar interbody fusion (TLIF) are not fully established. The authors aimed to compare the long-term radiographic outcomes of expandable versus static TLIF cages.METHODSA retrospective review of 1- and 2-level TLIFs over a 10-year period with expandable and static cages was performed at the University of California, San Francisco. Patients with posterior column osteotomy (PCO) were subdivided. Fusion assessment, cage subsidence, anterior and posterior disc height, foraminal dimensions, pelvic incidence (PI), segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence–lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA) were assessed.RESULTSA consecutive series of 178 patients (with a total of 210 levels) who underwent TLIF using either static (148 levels) or expandable cages (62 levels) was reviewed. The mean patient age was 60.3 ± 11.5 years and 62.8 ± 14.1 years for the static and expandable cage groups, respectively. The mean follow-up was 42.9 ± 29.4 months for the static cage group and 27.6 ± 14.1 months for the expandable cage group. Within the 1-level TLIF group, the SL and PI-LL improved with statistical significance regardless of whether PCO was performed; however, the static group with PCOs also had statistically significant improvement in LL and SVA. The expandable cage with PCO subgroup had significant improvement in SL only. All of the foraminal parameters improved with statistical significance, regardless of the type of cages used; however, the expandable cage group had greater improvement in disc height restoration. The incidence of cage subsidence was higher in the expandable group (19.7% vs 5.4%, p = 0.0017). Within the expandable group, the unilateral facetectomy-only subgroup had a 5.6 times higher subsidence rate than the PCO subgroup (26.8% vs 4.8%, p = 0.04). Four expandable cages collapsed over time.CONCLUSIONSExpandable TLIF cages may initially restore disc height better than static cages, but they also have higher rates of subsidence. Unilateral facetectomy alone may result in more subsidence with expandable cages than using bilateral PCO, potentially because of insufficient facet release. Although expandable cages may have more power to induce lordosis and restore disc height than static cages, subsidence and endplate violation may negate any significant gains compared to static cages.

scholarly journals Comparative study of expandable cage with integrated plate versus non expandable cage in cervical spine corpectomies

2020 ◽  
Vol 11 (2) ◽  
pp. 86-88
Author(s):  
Nakul Pahwa ◽  
Suniti Kumar Saha ◽  
Kaushik Roy ◽  
Debajyoti Pathak ◽  
Shuvayu Bandyopadhyay
Keyword(s):  
Cervical Spine ◽  
Similar Efficacy ◽  
Plate Versus ◽  
Expandable Cage ◽  
Cage Group ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Expandable Cages

Background: The use of expandable cages in cervical spine has gained popularity over the last decade. They have been used in dorsal spine since long but were rarely used in cervical spine due to their high cost. Now, with more insight into their mechanics, many advantages have been noted over the fixed cages along with similar efficacy and with no added complications. Aims and Objectives: To study the benefits of expandable cage with incorporated anterior cervical plate over non expandable cage in cervical spine corpectomies. Materials and Methods: Ten cases of two level corpectomy were operated in each group and compared for intraoperative time, postoperative fusion rates and complications. Results: Intraoperative time was less in the expandable cage group. Fusion rates were comparable at 6 month follow up. No reported long term complication in both groups. Conclusion: Expandable cages are less frequently used in cervical spine due to their significantly higher cost but there are advantages such as decreased intraoperative manipulation and operative time, less damage to end plates and also useful in cases of poor bone quality.

Retrospective Review of Immediate Restoration of Lordosis in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison of Static and Expandable Interbody Cages

2019 ◽  
Vol 18 (5) ◽  
pp. 518-523 ◽  
Author(s):  
Avani S Vaishnav ◽  
Philip Saville ◽  
Steven McAnany ◽  
Sertac Kirnaz ◽  
Christoph Wipplinger ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
Expandable Cage ◽  
Sagittal Parameters ◽  
Segmental Lordosis ◽  
Expandable Cages

Abstract BACKGROUND Sagittal alignment is an important consideration in spine surgery. The literature is conflicted regarding the effect of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) on sagittal parameters and the role of expandable cage technology. OBJECTIVE To compare lordosis generated by static and expandable cages and to determine what factors affect postoperative sagittal parameters. METHODS Preoperative regional lordosis (RL), segmental lordosis (SL), and posterior disc height (PDH) were compared to postoperative values in single-level MI-TLIF performed using expandable or static cages. Patients were stratified based on preoperative SL: low lordosis (<15 degrees), moderate lordosis (15-25 degrees), and high lordosis (>25 degrees). Regression analyses were conducted to determine factors associated with postoperative SL and PDH. RESULTS Of the 171 patients included, 111 were in the static and 60 in the expandable cohorts. Patients with low preoperative lordosis experienced an increase in SL and maintained RL regardless of cage type. Those with moderate to high preoperative lordosis experienced a decrease in SL and RL with the static cage, but maintained SL and RL with the expandable cage. Although both cohorts showed an increase in PDH, the increase in the expandable cohort was greater. Preoperative SL was predictive of postoperative SL; preoperative SL, preoperative PDH, and cage type were predictive of postoperative PDH. CONCLUSION Expandable cages showed favorable results in restoring disc height and maintaining lordosis in the immediate postoperative period. Preoperative SL was the most significant predictor of postoperative SL. Thus, preoperative radiographic parameters and goals of surgery should be important considerations in surgical planning.

Gingival Health of Porcelain Laminate Veneered Teeth: A Retrospective Assessment

2019 ◽  
Vol 44 (5) ◽  
pp. 452-458 ◽  
Author(s):  
R Arif ◽  
JB Dennison ◽  
D Garcia ◽  
P Yaman
Keyword(s):  
Repeated Measures ◽  
Gingival Crevicular Fluid ◽  
Statistical Significance ◽  
Fluid Collection ◽  
Gingival Recession ◽  
Gingival Health ◽  
Long Term Effect ◽  
The Mean ◽  
Crevicular Fluid

SUMMARY Statement of Problem: The long-term effect of the presence of porcelain laminate veneers (PLVs) on the health of the surrounding gingival issues is not available in the restorative literature. Purpose: To assess the long-term effect of PLVs on the health of the surrounding gingival tissues. A secondary aim was to correlate gingival crevicular fluid (GCF) scores with clinical parameters used for gingival health assessment in teeth treated with PLVs. Methods and Materials: Patients who received PLVs placed at the Graduate Restorative Clinic within a seven- to 14-year period were recalled for clinical evaluations. Periodontal measurements including gingival index (GI), periodontal pocket depth (PPD), gingival recession (GR), and clinical attachment level (CAL) were measured using a standard probe and indices. Gingival Crevicular Fluid (GCF) was measured with a Periotron machine (Periotron 8000, Oraflow Inc), using Periopaper (Periopaper Gingival Fluid Collection Strip, Oraflow Inc.) for fluid collection. Photographs of any observed clinical defect were taken. Data were tabulated using Excel 2010 (Microsoft Corp). Statistical analysis for all descriptive statistics was performed using SPSS 21 (SPSS Software, IBM Corp.) and Stata SE 13 (Stata Software, StataCorp). Repeated-measures analysis of variance (ANOVA) was done to test for statistical significance of the mean pocket depths between the restored and unrestored surfaces of the veneered teeth. The significance level for all tests was p<0.05. Pearson's correlation coefficient was performed for testing statistical significance between GCF and GI and between GCF and PPD. Results: The frequency distribution of the GI included 47 PLVs (43%) with normal gingiva, 16 (15%) with mild inflammation, and 46 (42%) with moderate inflammation and bleeding on probing. The average PPD on the facial surface of the maxillary and mandibular PLVs was 2.17 mm and 2.16 mm, respectively. On the lingual surface, the average PPD was 2.10 mm for maxillary and 2.22 mm for mandibular PLVs. Gingival recession was seen in 27% of the evaluated PLVs. The repeated-measures ANOVA revealed p≥0.136, showing no statistical difference in the mean pocket depths between restored facial and unrestored lingual surfaces of the veneered teeth. A moderate correlation (r=0.407) was found between GCF and GI, which was significant at p<0.001. No correlation (r=0.124) was found between GCF and PPD, which was not significant at p=0.197. Conclusions: Gingival response to the evaluated PLVs was in the satisfactory range, with overall GI scores ranging between normal and moderate inflammation, pocket depths ranging from 1 to 2 mm, and recession present in 27% of the evaluated PLVs. No statistically significant difference was found between the mean pocket depths of the restored and unrestored surfaces of veneered teeth (p≥0.136). A moderate correlation was found between GCF and GI.

Abstract 16884: Evaluating the Effectiveness of Atrial Fibrillation Ablation Guided by Spatiotemporal Electrogram Dispersion

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brian Liu ◽  
Arismendy Nunez-Garcia ◽  
Cao Tran ◽  
Michael Wu
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
External Validation ◽  
Posterior Wall ◽  
High Rate ◽  
Single Center Experience ◽  
The Mean

Introduction: Catheter ablation of atrial fibrillation (AF) guided by spatiotemporal dispersion (SD) of electrograms has been proposed as an ablation strategy to treat patients with persistent AF. However, external validation of this technique is lacking. Here we report a single center experience using ablation by SD. Hypothesis: Targeting regions with SD is associated with a high rate of termination and favorable freedom from AF among patients with persistent AF. Methods: Patients with persistent AF who underwent SD from November 2018 to January 2020 were included in this study. All patients underwent pulmonary vein isolation (PVI) in addition to targeting areas of SD. Lesions on areas of electrogram dispersion were anchored to the PVI or to mitral or posterior wall lines where appropriate. EKG, Holter, event monitors or device interrogations were obtained at 3 and 6 months to assess for arrhythmia recurrence. Results: 44 patients met the inclusion criteria and were included in the study. The patients had a mean age of 69±8 years and were 68 % male. The prevalence of comorbidities was as follows: hypertension (89%), diabetes (21%), OSA (37%) and CAD (26%). Average CHADSVASC score was 2.9±1.4, LVEF was 53±11% and left atrium (LA) diameter was 5.2±1 cm. The recurrence rate of AF at 6 months was 14% whereas the recurrence of atrial tachycardia was 20%. Acute AF termination was observed in 73% of the patients. Termination to sinus occurred in 38% of the patients and the remaining terminated to atrial tachycardia which was subsequently ablated to sinus. The mean procedure duration was 240±90 minutes. Univariate analysis showed recurrence was associated with LA diameter (r=.52; p<.001). No recurrences were observed among patients with a LA diameter < 5 cm. Termination rates were higher among patients with LA diameter < 5 cm when compared to LA diameter ≥ 5 cm. However, it did not reach statistical significance (80% vs. 60%; p=.21). Conclusions: The target of electrograms with SD during AF ablation added to PVI was associated with a high termination rate and a good freedom from AF recurrence at 6 months. The ideal candidate for this procedure may be those with LA diameter < 5 cm among persistent AF. The long-term efficacy of this technique merits further studies in larger populations.

scholarly journals Preliminary Results of Expandable Transforaminal Lumbar Interbody Fusion Cages

2021 ◽  
Vol 15 (1) ◽  
pp. 35-40
Author(s):  
Kyriakos Kitsopoulos ◽  
Bernd Wiedenhoefer ◽  
Stefan Hemmer ◽  
Christoph Fleege ◽  
Mohammad Arabmotlagh ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Life Outcomes ◽  
Disc Disease ◽  
Cage Subsidence ◽  
The Mean ◽  
Expandable Titanium Cage ◽  
Segmental Lordosis

Background: Compared with static cages, expandable cages for Transforaminal Lumbar Interbody Fusion (TLIF), are thought to require less posterior bony removal and nerve root retraction. They may allow the creation of a greater lordotic angle and lordosis restoration. Objective: This study investigated whether TLIF using an expandable lordotic interbody cage facilitates an improvement in both segmental lordosis and the restoration of intradiscal height. Methods: A total of 32 patients with 40 operated segments underwent TLIF surgery for lumbar degenerative disc disease and were consecutively included in this prospective observational study. Of those patients, 25 received monosegmental treatment, six were treated bisegmentally, and one was treated trisegmentally. All patients were assessed clinically and radiographically preoperatively, as well as one week, six months, and two years postoperatively. Results: Two patients required revision for screw loosening and pseudarthrosis. In four patients, the endplate was violated intraoperatively due to cage placement. Postoperatively, cage subsidence was observed in four patients. Significant improvement in the mean degree of spondylolisthesis was noted at the two-year mark. Mean segmental lordosis improved postoperatively. A significant increase in mean disc height of the treated segment was also found. Overall, with the exception of pain, no significant clinical or radiographic changes were reported between the first postoperative week and the two-year year follow-up mark. The mean pain, functional, and quality of life outcomes improved significantly from the preoperative to postoperative period, with no deterioration between six months and two years. Conclusion: This study demonstrates that favorable outcomes can be achieved by using an expandable titanium cage in TLIF procedures.

scholarly journals Effect of Tobacco Cessation on Weight in a Veteran Population

2020 ◽  
Vol 11 ◽  
pp. 215013272096365
Author(s):  
Crystal Zhou ◽  
Nicole G. Tran ◽  
Timothy C. Chen
Keyword(s):  
Weight Gain ◽  
Tobacco Cessation ◽  
Statistical Significance ◽  
Limited Information ◽  
Inclusion Criteria ◽  
Descriptive Data ◽  
Weight Outcomes ◽  
The Mean ◽  
Statistical Change

Introduction/Objectives: Weight gain concerns remain a barrier to tobacco cessation. Literature suggests that weight gain can occur after stopping tobacco, but continuing tobacco can have far worse outcomes. Limited information is available regarding weight gain in military personnel. The objective of this study was to evaluate weight change in veterans that stopped tobacco for a minimum of 12 months enrolled in a pharmacist managed telephone tobacco cessation clinic (PMTTCC). Methods: A retrospective analysis of veterans who had been tobacco-free for 12 months enrolled in a PMTTCC were included in this analysis. Primary outcomes were change in weight (kg) and body mass index (BMI) from baseline. Descriptive data were utilized where appropriate and paired t-tests were utilized for the primary outcomes. Results: Seventy-seven patients were screened and 10 were excluded. Sixty-seven veterans met inclusion criteria and were mostly male (91%, n = 61) and Caucasian (74.6%, n = 50). At 12 months post cessation, the mean weight gain was (1.81 kg ± 6.83, P = .03) and BMI (0.51 ± 2.23 kg/m2, P = .06). Conclusions: Veterans appeared to have minimal weight gain despite statistical significance and no statistical change with BMI after 12 months of being tobacco-free. Results suggest that the long-term weight gain is minimal, and a comprehensive tobacco cessation program can be helpful to improve weight outcomes.

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

2020 ◽  
pp. 107110072096967
Author(s):  
Carlo Biz ◽  
Alberto Crimì ◽  
Ilaria Fantoni ◽  
Jacopo Tagliapietra ◽  
Pietro Ruggieri
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Radiographic Outcomes ◽  
Case Series Study ◽  
Significant Correction ◽  
The Mean ◽  
Series Study ◽  
Severe Hallux Valgus

Background: This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. Methods: This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. Results: The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients’ satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex ( P = .047), severity ( P = .050), associated procedures ( P = .000), and preoperative angle ( P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. Conclusions: The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. Level of Evidence: Level IV, case series study.

scholarly journals Retrospective Data Analysis of Anterior Cervical Discectomies and Fusion Without Plate and Screws

2019 ◽  
Vol 73 (5) ◽  
pp. 433-439
Author(s):  
Artis Gulbis ◽  
Edgars Ginevičs ◽  
Agnese Ozoliņa ◽  
Kaspars Ruks ◽  
Indulis Vanags ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Life Quality ◽  
Biochemical Properties ◽  
Retrospective Data ◽  
3D Print ◽  
Patient Gender ◽  
Retrospective Data Analysis ◽  
Cage Subsidence ◽  
Cervical Disease ◽  
The Mean

Abstract Surgical intervention in cervical disease can relieve neurological symptoms and improve life quality. This study aimed to analyse retrospective data of microscope-assisted anterior cervical discectomy and fusion (ACDF) surgeries. The retrospective study was carried out at the ORTO clinic, Rīga, Latvia, from 2013 to 2017. Data from 198 patients were extracted retrospectively. Data on patient gender, age, diagnosis, extent of operation, type of cage and the overall height of the implants were used. Comparative analysis was carried out with the SPSS 22 software. P < 0.05 represented statistical significance. During the study period, 198 elective ACDF were carried out with increasing number of surgeries: 25 cases in 2013, 43 in 2014, 38 in 2015, 44 in 2016, and 48 in 2017. ACDF were significantly more often performed for females (n = 117, 59%) compared to males (n = 81, 41%; p < 0.003). Women were older with an average age of 50 ± 1 years than men (age 46 ± 1; p = 0.007). The mean surgery time was 1.5 ± 1 hours and the mean hospitalisation time was 3 ± 1 days. Four types of cages were used in similar number of operation: Cervios Peek Chronos C (24%), Syncage C (21%), EIT 3D print (29%), Cervios C Peek (26%); p = 0.2, regardless of patient age or gender. Most often, in 98 cases, the overall height of implants was 6–10 mm. The maximal height was 22 mm, where two patients underwent three-level, and one had a four-level discectomy. The most prevalent disc lesion levels were C5/6 and C6/7, followed by C4/5 and C3/4. One- and two-level discectomies were performed in similar numbers: 95 and 81 cases. However, only 20 patients underwent three level and two patients had four level discectomies in 2016 and 2017. Two level discectomy at C5/6, C6/7 was carried out significantly more often for women (55 vs. 26; p = 0.01), and for men 1-level lesion was more common in C6/7; p = 0.04. The overall incidence of cage subsidence was 5.5%, and the highest incidence was 24% when a Syncage C was used. The ACDF appears to be performed increasingly more often, particularly, in females. The most frequent operation was in one or two cervical levels; including level C6/7 in both genders. In the last years, three- and four-level cervical discectomies have become one of the surgical opportunities. Choice of cage was not influenced by patient gender and age, while cage biophysical and biochemical properties may influence the choice.

scholarly journals Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis

2017 ◽  
Vol 11 (2) ◽  
pp. 204-212 ◽  
Author(s):  
Hamid Rahmatullah Bin Abd Razak ◽  
Priyesh Dhoke ◽  
Kae-Sian Tay ◽  
William Yeo ◽  
Wai-Mun Yue
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
Sf 36 ◽  
Cage Subsidence ◽  
The Mean

<sec><title>Study Design</title><p>Retrospective review of prospective registry data.</p></sec><sec><title>Purpose</title><p>To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis.</p></sec><sec><title>Overview of Literature</title><p>MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion.</p></sec><sec><title>Methods</title><p>The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates.</p></sec><sec><title>Results</title><p>Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m<sup>2</sup>. The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (<italic>p</italic>&lt;0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported.</p></sec><sec><title>Conclusions</title><p>Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.</p></sec>

Long-term visual, anterior and posterior corneal changes after crosslinking for progressive keratoconus

2021 ◽  
pp. 112067212110528
Author(s):  
Abdelrahman Salman ◽  
Ali Ali ◽  
Shaaban Rafea ◽  
Rana Omran ◽  
Buraa Kubaisi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Statistical Significance ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Long Term Outcomes ◽  
Corrected Distance Visual Acuity ◽  
Hyperopic Shift ◽  
The Mean

Aim To evaluate the long-term outcomes of corneal cross-linking (CXL) in patients with progressive keratoconus. Method In this retrospective non-comparative study, forty-five eyes of 31 patients with progressive keratoconus were treated with 30 min “epi-off” corneal cross-linking. The visual, refractive, topographic and tomographic outcomes were evaluated preoperatively and at least 10 years after cross-linking. Results Ten years post-corneal cross-linking, the mean anterior maximum keratometry decreased (−2.10 ± 3.25 D, P = 0.0001). Conversely, the posterior maximum keratometry increased (6.38 ± 9.79 D, P = 0.065). Both uncorrected and corrected distance visual acuity improved (LogMAR −0.08 ± 0.30) and (LogMAR −0.05 ± 0.21), respectively (P > 0.05, both). A statistically significant hyperopic shift was observed postoperatively (0.70 ± 1.31 D, P = 0.0009). The anterior topographic cylinder values revealed no change (−0.17 ± 1.31 D, P = 0.3), whereas the mean posterior cylinder values decreased (absolute value increased) significantly compared to baseline from −1.31 ± 0.97 D to −1.82 ± 1.78 D, (P < 0.05). The minimum corneal thickness values decreased significantly (−35.11 ± 48.63 µm, P = 0.0001). Four eyes (8.8%) showed more than 1 D increase in the anterior maximum keratometry. Conclusion This protocol and duration of Epi-off corneal cross-linking was found to be effective in halting keratoconus progression over the follow up period (10 years). Anterior corneal flattening and a hyperopic shift were observed. A statistically significant increase in the posterior corneal cylinder was observed. Although, not reaching statistical significance, the logMAR uncorrected and corrected visual acuity were improved.

Sign in / Sign up

Export Citation Format

Share Document