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Studimi I Disa Parametrave Biokimik Te Kartamos AKTET ISSN 2073-2244 Journal of Institute Alb-Shkenca www.alb-shkenca.org Reviste Shkencore e Institutit Alb-Shkenca Copyright © Institute Alb-Shkenca TREATING KERATOKONUS DISEASE WITH CROSS-LINKING METHOD TRAJTIMI I KERATOKONUSIT ME METODEN E CROSS-LINKING TEUTA рAVE‘I ″iuge oftalologe, “pitali Aeika, Tiae e-ail:[email protected] ABSTRACT Keratokonus is a degenerative disease, starting generally at 14- 25 years old and causing progressive thinning of the cornea. Because of these thinning, corneal shape is reduced into a conical one, causing also distortion of vision. Clinically, keratokonus presents progressive changes of the refraction, principally of astigmatisms, the patient feuetl hage the glasses ut dot feel ofotale ith the. Etee adaeet of the keratokonus can cause corneal perforation, destroying the vision. To avoid this, corneal transplant is required to save the eye. Considering the young age of the patients, high cost of the of the corneal transplantation, and the risk of transplant reject, high priority is given to the early diagnose and halting treatment. Nowadays, cross-linking is the only procedure used to halt the natural progression of keratokonus, Studied and applied for the first time at Dresden University, a great number of clinical studies supported its efficacy in halting the progression of keratokonus. PERMBLEDHJE Keratokonusi është sëmundje degjenerative e kornesë, e cila fillon të evidentohet në moshën 14- jeҫ dhe shkakton hollim progresiv të saj.Për shkak të këtij hollimi, kornea merr formë konike duke shkaktuar deformim dhe dëmtim të shikimit.Klinikisht paraqitet me rritje progressive të korrigjimit optik,kryesisht të astigmatizmit,pacienti ndërron shpesh syzet por nuk ndihet komod me to.Ndërkaq mprehtësia e pamjes ulet progresivisht. Në stadet e deformimit te avancuar dhe të hollimit ekstrem, kur kornea tenton perforimin, transplanti I kornesë është e vetmja metodë që mund të shpëtojë syrin.Duke pasur parasysh faktin se prek kryesisht moshat e reja,koston e lartë të transplantit të kornesë si dhe pasojat invalidizuese për shikimin në rastin e flakjes së këtij të fundit, rëndësi të eҫatë e diagostikii I heshë dhe tajtii e etodë e oss-linking. Cross-linking është për momentin e vetmja metodë e njohur që vitet e fundit po përdoret gjerësisht në frenimin e ecurisë progressive te keratokonusit. E eksperimentuar dhe aplikuar për herë të parë në Universitetin e Dresdenit, studime të shumta kanë mbështetur efikasitetin e saj në trajtimin e keratokonusit. Key words: keatokous,keatoeti,pakieti,oss-likig,koea INTRODUCTION hih od the paallel oes to eah-othe, giig to The oea is a taspaet itefae oeig the fot the oea its atual stegth. This pheoeo is of the ee. It has the futio of potetig the eeall ko as atual oss-likig ad it is esposile fo ad also is a poeful efatig sufae, poidig / the oeas esistae agaist of the ee's fousig poe. The adult oea has a defoatio.″eatoous is a ilateal o- thikess of µ ad is opised of laes: iflaato disease hih auses pogessie oeal epitheliu, Boa's eae, stoa, Deseet's thiig, leadig to potusio, distotio, ad saig eae ad the edotheliu. The stoa is the of the oea It is a atuall ouig oula thikest lae oposed of ollage fiils oieted oditio hih leads to steepeig of the etal paallel to eah-othe. It has also tasesal fiils oea, ieasig opia, iegula astigatis, ad Haveri loss of est spetale-oeted isual auit. Coeal oeal epitheliu lae, folloed iutes of thiig oall ous i the ifeo-tepoal o i ioflai adiistatio, suseuetl, UVA light is the etal oea. Eeptioal ase of supeio applied fo iutes. The oeal epithelial lae is loalizatios hae also ee desied,.″eatokous geeall eoed to iease peetatio of the eoes eidet oall duig puet , although ioflai ito the stoa.[] Duig the UV light the disease has also ee foud to deelop ealie illuiatio, ioflai ats futhe as a shield duig ad latte i life.It potetiall pogesses util the iadiatio to the oea, potetig deepe oula fouth deade of life, he it usuall stailizes. A stutues suh as the edotheliu, les, ad etia stud has deteied that % of o-affeted ees of fo UV-A iadiaes that ae too high Aothe sujets ith uilateal keatoous ill deelop the ipotat ole of ioflai is to peet oeal disease i eas. If left uteated, keatokous dehdatio duig eposue The oiatio of feuetl pogesses to foatio of deseets ioflai ad UV-A light eates –% asoptio teas ko as Vogts sties ad oeal pefoatio, ito the oea duig oss-likig depedig o the seiousl theateig the isio. At this poit,oeal oetatio ad the oeal thikess Gie tasplatatio is euied to estoe useful isio ad the sipliit ad iial osts of the teatet, saig the ee. Coeal Collage Coss-likig is a oss-likig teatet is also ell-suited fo teatet fo keatoous ad othe oeal etasia deelopig outies Late ad latest stud, as hih as deeloped fist at the Uiesit of Desde the “iea Ee “tud, iestigates log-te effets of i . I this poedue ultaiolet UV light ad stadad oss-likig. Thee huded ad sit-thee ioflai itai B dops ae used to stegthe the ees ee teated ad oitoed oe eas, oea's stutue, to slo o halt the pogessio of poduig eliale log-te esults poig the keatoous, peetig deteioatio of isio ad the effia of the poedue i tes of log-te stailit eed fo oeal tasplatatio. нistl epeieted of the oea haltig the pogessio of i poie ad aits oeas, the esults shoed that keatokous, ad poig the safet of the ioflai soaked ad UVA iadiated oeas ee poedue stiffe ad oe esistat to ezati digestio. Iestigatios also poed that the teated oeas I ou hospital, oss-likig tehiue is applied fo otaied high oleula eight poles of ollage . The patiet peseted ith oplais suh as: due to fiil oss-likig.Othes, i ito pogessie hageets i efatio, hagig iestigatios, o hua ad poie oeas feuetl the glasses ad ot feelig ofotale ith eaied the est teatet paaetes fo stadad the, high astigatis ad opia, ae suspeted fo oss-likig, suh as ioflai oetatio, itesit, keatokous. These patiets ae adised to udego aelegth of UV-A light, ad duatio of teatet. topogaphi eaiatio ith Petaa istuet Also it has ee poed that UVA iadiatio is ot hih is ased o the “heipflug okig piiple, haful fo the edotheliu, if the oeal thikess is takig – iages of the oea at diffeet agles aoe µ Afte the laoato, liial esults usig a otatig aea. Ateio ad posteio oeal ee also eouagig. The pilot stud iluded eleatios ae the easued usig topogaphi patiets ith pogessie keatokous that ee aalsis, poidig useful ifoatio i keatokous teated ith oss-likig. All of the shoed stopped diagosti ad gadig the seeit of keatokous pogessig afte teatet.% had flatteig of the IV-th gade of keatokous ith pahet loe tha steepest keatoet, deease i aeage ad µ, Vogts stiae o oeal hdops ae aiu keatoeti alues ad % had isual iediatel adised to udego oeal tasplat auit ipoeet. No opliatio epoted poedue. The patiets, diagosed i stage - of keatokous, ith o oeal hageets ae Afte that, oss-likig eae a oldide used folloed fo oth to hek the eidee of tehiue. Geeall is applied usig Desde keatokous pogessio ad i this ase, ae adised potool euiig the eoal of etal of to udego oss-likig poedue. Othes, alead 2 AKTET Vol. VIII, Nr 1, 2015 Haveri pesetig lea eidee of pogessio i opaiso Table 2 Values of steepest keratometry of ealie topogaphi eaiatio ae iediatel Time Value Testi Wilcoxon p adised to the oss-likig poedue. The esults of Before cross- linking 50.6 follo-up ae olleted ad disussed i ‘esults ad 1 Month after 51.1 Z=2.6 P = 0.0117 Disussio shoig eidee of flatteig the oea treatment ad stoppig the pogess of keatokous. 3 Months 50.5 Z= 0.04 P = 0.969 6 Months 49.9 Z= 2.399 P = 0.0164 PATIENTS AND METHODS 12 Months 49.2 Z= 3.85 P < 0.001 ees ith pogessie keatoous ee iluded i the stud. Aeage age as . eas the ougest Table 3 Values of average keratometry eas old ad the oldest eas old. A otatig Time Value Test Wilcoxon “heipflug aea Petaa р‘, Oulus is used to Before cross-linking diagose ad follo-up the keatokous efoe ad 48.3 post oss-likig teatet. Coeal eleatio, 1 Month after treatment 50.0 Z=3.8 P = pahet ad keatoet ee the paaetes 0.0001 easued. The ilusio iteias ee: pogessio of 3 Month after treatment 48.3 Z= 0.54 P = keatoous eseted as a iesig i aiu 0.585 keatoet steepest keatoet at least , D i oths, peopeatie oeal thikess aoe µ, 6 Month after treatment 47.6 Z= 2.83 P = o oeal sa, o peisious oeal 0.004 sugeies.Patiets udeet oss-likig poedue 12 Month after treatment 47.1 Z= 2.8 P < aodig to Desde potool.Afte oss-likig 0.001 poedue the patiets ee folloed ith thee diesioal oeal topogaph Petaa р‘ Table 4 Values of UCVA (uncorrected visual acuity) Oulus ad the paaetes folloed ee: Time Value Test Wilcoxon keatoet steepest, flattest, aeage,oeal Before cross-linking pakiet aeage ad thiest, uoeted ad 0.68 est-oeted isual auit. The follo-up tie as 1 Month after treatment 0.21 Z=1.15 P = oths. 0.24 3 Month after treatment 0.29 Z= 0.63 P = RESULTS AND DISCUSSION 0.524 The values for each parameters are recorded after 1 6 Month after treatment 0.31 Z= 1.88 P = month, 3 month, 6 months and 12 months after cross- 0.05 linking.
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