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Impression cytologic analysis after corneal cross-linking and insertion of corneal ring segments for keratoconus: two-year results

DOI: 10.1590/S0004-27492012000200006

Keywords: cytological techniques, cornea, riboflavin, keratoconus, corneal surgery, laser, corneal stroma.

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Abstract:

purpose: to report the impression cytologic results after corneal cross-linking and insertion of intrastromal corneal ring segments for keratoconus. methods: thirty-nine eyes were distributed into two groups: 1) cross-linking group (patients underwent corneal cross-linking procedure), and 2) riboflavin eyedrops group (patients received 0.1% riboflavin (w/v) eyedrops in 20% dextran solution for 1 month). after 3 months, all patients underwent insertion of intrastromal corneal ring segments. impression cytologic specimens were obtained from all eyes at baseline, at 1 month and 3 months after cross-linking or riboflavin eyedrops, and again at 6 months, 1 year, and 2 years after intrastromal corneal ring segment insertion. results: patients in the cross-linking group demonstrated improvement in the cell-to-cell contact of epithelial cells and the nucleus-to-cytoplasm ratio on the temporal conjunctiva after treatment (p=0.008 and p=0.047), respectively. on the superior conjunctiva, increases in goblet cell density (p=0.037) and level of organization of nuclear chromatin (p=0.010) after treatment were noted. patients in the riboflavin eyedrops group demonstrated improvement in the cell-to-cell contact of epithelial cells on the superior conjunctiva after treatment (p=0.021). on the temporal conjunctiva, an improvement in the cell-to-cell contact of epithelial cells (p<0.001) and increases in the nucleus-to-cytoplasm ratio (p<0.001), goblet cell density (p=0.001), and less keratinization (p=0.011) were noted. no changes were identified on the cornea for either group. fisher's exact test comparison of the impression cytologic total scores after treatment revealed no difference between groups. conclusion: despite changes in some conjunctival parameters (e.g., cell-to-cell contact of epithelial cells, nucleus-to-cytoplasm ratio, level of organization of nuclear chromatin, goblet cell density, and keratinization), comparison of the total impression cytologic scores revealed no

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