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
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)



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


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


fernando aguilera-zarate md

www.institutodeojos.com.mx

[email protected]


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