RESUMEN
PURPOSE: To report predictive factors of outcome of conventional epithelium-off corneal crosslinking (CXL) in the treatment of progressive keratoconus. METHODS: This is a monocentric observational retrospective study conducted at Eye and Ear International Hospital, Lebanon. All patients with progressive keratoconus who underwent CXL between January 2008 and January 2016, with minimal 3-years follow-up were included. Primary treatment outcomes were maximum keratometry (K max), best-corrected distance visual acuity (CDVA), and failure. Failure was defined as an increase of 1.00 diopters (D) or more in K max and/or an increase of 0.1 logMAR or more in CDVA and conversion to corneal transplantation. Statistical analysis was done to identify predictors of treatment success. Univariate and multivariate analyses were performed to determine the correlations between baseline parameters and outcomes, and an equation for predicting K max and CDVA was created. RESULTS: 156 eyes of 102 patients were enrolled. The mean age was 23.85 ± 6.52 years. Failure occurred in 31 eyes (19.87%). Gender and thinnest pachymetry did not have any impact on postoperative outcomes. Concerning the CDVA outcome, multivariate analysis showed that a better preoperative CDVA was associated with higher improvement in CDVA, and higher baseline K max and higher posterior mean K were associated with a worse outcome CDVA. Regarding postoperative K max, a higher baseline K max, a worse baseline CDVA, and a younger age were associated with less flattening postoperatively. CONCLUSION: CXL is a safe and effective method in treating progressive keratoconus. However, the clinical benefits can differ among patients, and in our series, a nonnegligible number of cases show a continued progression of their ectasia. Further studies to identify predictors of postoperative progression prior to the procedure could help sort out good responders to treatment.
RESUMEN
The chromatographic purification of biological macromolecules requires a novel approach to overcome some of the pore size limitations of commercially available resins. Membrane adsorbers offer the potential for better resolution as well as productivity. Sharp peaks are gained by the rapid exchange rate with the adsorbing membranes associated with the convective flow path, in contrast to the pore diffusion requirement for resin exchange. The resolution advantage is preserved even when the very short bed heights of membranes are exploited for the purpose of exceptionally high flow rates and productivity. Breakthrough experiments were used to assess the membrane dynamic loading capacities of flexible macromolecules using supercoiled (SC) DNA as a model system. In contrast to reports for smaller biomolecules such as proteins and antibodies, the dynamic capacity for DNA was found to be highly dependent on flow rates and concentrations. Increasing flow rates induced DNA elongation, which increased the surface coverage and, in turn, lowered the capacity. Increasing concentrations beyond C*, the overlap concentration, led to exclusion-volume interactions, which reduced the size of DNA and increased the membrane adsorber capacity. In the chromatographic mode, membranes with a strongly positive charge were able to resolve various isoforms of DNA, surpassing the capabilities of analogous chromatographic resins. In this study, we found that the convective-flow-induced-structural behavior of DNA is responsible for the resolution in separation.
