Erdal KAYDU, İbrahim ERBAĞCI, Seydi OKUMUŞ, Ümit AKSOY

The Results of Cross-Linking With Riboflavin/UV-A in Patients With Progressive Keratoconus

Objective: To evaluate the results of corneal cross-linking with UV-A/riboflavin in patients with progressive keratoconus.Methods: Forty-seven eyes of 30 patients with progressive keratoconus (16 female, 14 male) were included in the study. Uncorrected and the best corrected distance visual acuities, biomicroscopic findings, intraocular pressure measurements, fundoscopic findings, pachymetric measurements and corneal topography parameters were recorded for each patient.Results: The mean age of the patients was 18.3±5.34 (range: 8-31) years and the mean follow-up duration was 7±2.4 (range: 3-12) months. Following the procedure, the mean decrease in K1, K2, Kav, spherical and cylindrical values were 0.77 D, 0.85 D, 0.80 D, 0.50 D and 0.74 D, respectively (p<0.05). There were no cases with decrease in visual acuity and significant complication during or after the treatment.Conclusion: Cross-linking with riboflavin/UV-A in patients with progressive keratoconus is an effective procedure. In addition, the preservation of visual acuity and not seen a significant complication indicate that a safe metod. However, large prospective randomized controlled studies are needed to evaluate the long-term effects of this treatment.Key words: corneal cross-linking, keratoconus, corneal topography

Anahtar Kelimeler:

korneal çapraz bağlama, keratokonus, korneal topografi

Determining a Safe Time for Oral Intake Following Pediatric Sedation

Objective: While there are suggestions for oral hydration times after general anesthesia, there is no published study with regard to sedation. The aim of this prospective study was to determine a safe time for oral intake after pediatric sedation and its association with nausea and vomiting after discharge.Methods: A total of 180 children (aged 1 month to 13 years) sedated for magnetic resonance imaging were randomly assigned into three groups. All patients fasted for 6 hours and were allowed to take clear fluids until 2 hours before sedation with thiopental (3 mg/kg). After the patients were transported to the recovery room, we allowed the patients to drink as much clear fluids as they wanted prior to discharge in group I, 1 hour after the patients met the discharge criteria for group II, and 2 hours after the patients met the discharge criteria for group III. All patients were assessed for vomiting in the recovery room until 1 hour after their first oral hydration. The parents were then telephoned the next day and questioned regarding nausea/vomiting and any unanticipated hospital admission.Results: There were no statistically significant intergroup differences with respect to age, sex, weight, or the ASA status. There was no nausea and vomiting in either the recovery or post discharge period in any group. In the telephone questionnaire, no hospital admissions were reported.Conclusion: Oral hydration just before discharge is safe, and fasting children after discharge for a period of time is unnecessary for patients sedated with thiopental.Key words: Sedation, oral intake, postoperative nausea and vomiting

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Kennedy RH, Bourne WM, Dyer JA. A 48-year clinical and epidemiologic study of keratoconus. Am J Ophthalmol 1986;101:267-273.
Rabinowitz YS. Keratoconus. Surv Ophthalmol 1998;42:297-319.
Krachmer JH, Feder RS, Belin MW. Keratoconus and related non-inflammatory corneal thinning disorders. Surv Ophthalmol 1984;28:293-322.
Wollensak G. Crosslinking treatment of progressive keratoconus:
new hope. Curr Opin Ophthalmol 2006;17:356-360.
Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-ainduced
collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135:620-627.
Spoerl E, Mrochen M, Sliney D, et al. Safety of UVA riboflavin cross-linking of the cornea. Cornea 2007;26:385-389.
Wollensak G, Wilsch M, Spoerl E, Seiler T. Collagen fiber diameter in the rabbit cornea after collagen crosslinking by riboflavin/UVA. Cornea 2004;23:503-507.
Agrawal VB. Corneal collagen cross-linking with riboflavin and ultraviolet - a light for keratoconus: results in Indian eyes. Indian J Ophthalmol. 2009;57:111-114.
Grewal DS, Brar GS, Jain R, et al. Corneal collagen crosslinking
using riboflavin and ultraviolet-A light for keratoconus: one-year analysis using Scheimpflug imaging. J Cataract Refract Surg 2009;35:425-432.
Caporossi A, Baiocchi S, Mazzotta C, et al. Parasurgical
therapy for keratoconus byriboflavin-ultraviolet type A rays
induced cross-linking of corneal collagen: preliminary refractive
results in an Italian study. J Cataract Refract Surg 2006;32:837-845.
Derakhshan A, Shandiz JH, Ahadi M, et al. Short-term outcomes of collagen crosslinking for early keratoconus. J Ophthalmic Vis Res 2011;6:155-159.
Gümüş K, Mirza E, Erkılıç K. ve ark. İlerleyici tip keratokonus
olgularinda riboflavin/UV-A ile çapraz bağlama tedavisinin erken dönem sonuçlari. TOD Derg 2010;40:18-24.
Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cataract Refract Surg 2008;34:796-801.
Coşkunseven E, Jankov MR, Hafezi F. Contralateral eye study of corneal collagen cross-linking with riboflavin and UVA irradiation in patients with keratoconus. J Refract Surg 2009;25:371-376.
Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Longterm results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena eye cross study. Am J Ophthalmol 2010;149:585-593.
Mazzotta C, Balestrazzi A, Traversi C. et al. Treatment of progressive keratoconus by riboflavin-UVA-induced crosslinking of corneal collagen.Ultrastructural analysis by Heidelberg Retinal Tomography II invivo confocal microscopy in humans. Cornea 2007;26:390-397.
Kymionis GD, Diakonis VF, Kalyvianaki M. et al. Oneyear follow-up of corneal confocal microscopy after corneal cross-linking in patients with post laser in situ keratosmileusis ectasia and keratoconus. Am J Ophthalmol 2009;147:774-778.