Four year results of corneal crosslinling xl in keratoconus
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Four Year Results Of Corneal Crosslinling (XL) in Keratoconus. Fernando Aguilera-Zarate MD Instituto de Ojos de BC Mexicali, Baja California Mexico No Financial Interest. Objective > Corneal Rigidity Fotopolimerization colagen Fibers Combination : UV-A + Rivoflabin ( vit B2)

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Four Year Results Of Corneal Crosslinling (XL) in Keratoconus

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Four year results of corneal crosslinling xl in keratoconus

FourYearResults Of CornealCrosslinling (XL) in Keratoconus

  • Fernando Aguilera-Zarate MD

  • Instituto de Ojos de BC

  • Mexicali, Baja California

  • Mexico

  • No FinancialInterest


Crosslinking xl

Objective

> CornealRigidity

FotopolimerizationcolagenFibers

Combination: UV-A + Rivoflabin (vit B2)

> fibrilldiameter

> interfibrillarjunctions

> cornealrigidity

< corneal ectasia progression

< cornealasimetry

CROSSLINKING (XL)


Biochemical corneal xl changes

BIOCHEMICAL CORNEAL XL CHANGES


Definition

Definition

POLIMERIZATION

ChemicalReactionthattransformsmolecules of low molecular mass (monomers) producinghigh molecular weightmolecules (polymers)

Used in Odontologysincetheearly 70’s

Used in Tire and Textil Industriesfor more than 5 decades


Four year results of corneal crosslinling xl in keratoconus

WOOLENSAK,SEILER

AJO,2003;135:625-627

First Report Of Humans Treated by XL

Results:

Regresion KC …………………….72%

< Spherical Equivalent……………1.34 D

< Astigmatism.. ……………………2.01 D

Control Group, progression………..22 %


Crosslinking objective

CROSSLINKING OBJECTIVE

Document 4 yearfollow-up changes in CornealRefractive, Topography and Aberrometry; and toevaluatethe Visual QualityImprovement in Keratoconus corneas Treatedby UV-B Crosslinking


Material and methods

Material and Methods

  • 21 patients

  • 26 eyes (follow-up 4 years)

  • 18-30 years

  • Complete ophthalmicevaluation

    InclusionCriteria: No concurrentophthalmicdiseases

    KC (I-III withconfirmedprogressionbytopography)

    Cornealpaquimetry >400 um at thinnestpoint

    Normal Cristaline Lens Densitometry (pentacam)

    Normal Retinal OCT

    SpecularMicroscopy (Tomey SM 3000)


Surgery corneal crosslinking

Surgery (CornealCrosslinking)

TopicalAnesthesia (proparacaine)

EpithelialremovalwithAmoilsRotatoryBrush

UVA + B2, impregnatión (12 minutes)

Irradiatión 30 min (3.2 J / cm2)

TherapeuticSoftContact Lens (removaluntilepithelization)

Followup 1-5 days, 1-3-6-9-12-18-24-36- >48 months


Results visual quality

Results Visual Quality

  • MTF (modular transfer function)

    Measures visual quality of theeye

    (cornea to retina)

  • PSF (point spread function)

    Measures visual quality of anopticalsystem)

    (Eye-Occipital Cortex)


Topographic changes

Topographicchanges

CornealAsimetry = o´ <

Anterior Elevation (eliipsoidal) Reductionor no change

Posterior Elevation (ellipsoidal)

reductionor no change

Reduction of true net power


Elevation reduction anterior posterior elevation more reduction in ectatic areas

Elevation:Reduction Anterior/Posterior Elevation. More Reduction in EctaticAreas


Corneal aberrometric changes

CornealAberrometricChanges

< Corneal HOA

Coma (z3,-1; z3,1) and trifoil (z3,-3; z3,3)


Refractive irregular ast change in axis 10

Refractive:< Irregular Ast./change in axis<10°


Pachymetric and corneal power optic pachymetry total corneal power

Pachymetric and CornealPower:< opticpachymetry / < total cornealpower


Visual quality mtf improvement at lower frequencies 5 10 c d

Visual Quality:mtfimprovement at lowerfrequencies(5-10 c/d)


Visual quality improvement related with reduced spherical equivalent and reduction corneal hoa

Visual QualityImprovementRelatedwithReducedSphericalEquivalent and ReductionCorneal HOA


Reduction corneal irregularity indices

ReductionCornealIrregularityIndices


Xl early complications 15 d

XL EarlyComplications (15 d)

Corneal Edema……………………..8/26

EpithelialRetardation..…(>6D)……0/26

Loss > 1 Lines VA……….………….0/26

CornealHaze………………………..2/26

CornealMelting……………………..0/26

> IOP……………………………..…..0/26 EndothelialDamage……………..0/26


Late xl complications 3 m

Late XL complications (>3 m)

  • Late Haze (grade I)………….……..1/26

  • Loss > 1 Line Vision………………..0/26

  • EpithelialDefect…………….………0/26

  • CornealMelting……………………..0/26

  • > IOP.………………………………...0/26

  • EndothelialDamage……….……….0/26

  • KC Progression……………………..1/26


Disscusion uva c3 corneal crosslinking

Disscusion: UVA-C3 CornealCrosslinking

  • ImprovesCornealBiomechanics > Rigidity

  • < CornealAsimetry

  • < CornealTertiaryHigherOrder Ab (coma / trifoil)

  • < RefractiveCornealPower (true net power)

  • > Visual Quality (MTF y PSF)

  • < Pachimetry (CornealRemodeling)


Conclusion 4 year followup of corneal xl

CONCLUSION 4 YearFollowup of Corneal XL

  • EffectiveTherapeuticModalitytoPreventor Reduce progresion of EctaticChangesassociatedwithKeratoconus

  • ImprovesOpticalQualities of Cornea

  • MinimalSecondaryEffects


Four year results of corneal crosslinling xl in keratoconus

fernando aguilera-zarate md

www.institutodeojos.com.mx

[email protected]


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