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Efficacy of topical microemulsion of fatty acids of the ω-3 series on the sub-epithelial corneal nerves regeneration after epithelium-off corneal collagen cross-linking for keratoconus

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Abstract

Purpose

To evaluate efficacy of a microemulsion of fatty acids of the ω-3 series on the regeneration of the sub-epithelial corneal nerve plexus in patients with keratoconus after epi-off cross-linking.

Methods

In this prospective study, we recruited 40 patients, 18 females, mean age 28 years (range 22–37), who were randomly divided in two groups. Group A, 20 patients, after cross-linking were treated with a microemulsion of fatty acids of the ω-3 series. Group B were treated with hyaluronic acid (0.15%)-based tear substitute. Nerve tortuosity, reflectivity and density were examined with in vivo confocal microscopy. Ocular surface disease index (OSDI) questionnaire at the preoperative and at each follow-up visit (1, 3 and 6 months) after treatment was completed.

Results

No significant difference between the two groups was noted at 1 month in terms of nerve density and OSDI. A statistically significant difference between the two groups was detected at 3 months in terms of nerve fibers density (6 ± 0.82 in Group A and 1 ± 0.51 in Group B, P = 0.0001). Reflectivity and tortuosity of the fibers did not show significant differences between the two groups at any time point. At 1 month, OSDI average value in group A and in group B was 31.5 ± 1.94 and 30 ± 1.96, at 3 months 13 ± 1.71 and 28 ± 1.83, and at 6 months 10.5 ± 1.87 and 9.0 ± 1.81, respectively.

Conclusion

The use of a microemulsion of fatty acids appears to ensure a faster regeneration of nerve fibers in patients undergoing epi-off cross-linking.

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Authors and Affiliations

  1. Department of Surgical and Biomedical Sciences, Division of Ophthalmology, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, University of Perugia, 06156, Perugia, Italy

    Carlo Cagini, Marco Messina, Giovanni Torroni, Francesca Riccitelli & Marco Mariniello

  2. Section of Academic Ophthalmology, Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK

    Marco Messina & Harminder S. Dua

Authors
  1. Carlo Cagini
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  2. Marco Messina
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  3. Giovanni Torroni
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  4. Francesca Riccitelli
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  5. Marco Mariniello
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  6. Harminder S. Dua
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Correspondence to Carlo Cagini.

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Cagini, C., Messina, M., Torroni, G. et al. Efficacy of topical microemulsion of fatty acids of the ω-3 series on the sub-epithelial corneal nerves regeneration after epithelium-off corneal collagen cross-linking for keratoconus. Int Ophthalmol 40, 205–212 (2020). https://doi.org/10.1007/s10792-019-01170-0

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  • DOI: https://doi.org/10.1007/s10792-019-01170-0

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