Four year results of corneal crosslinling xl in keratoconus
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Four Year Results Of Corneal Crosslinling (XL) in Keratoconus PowerPoint PPT Presentation


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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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FourYearResults Of CornealCrosslinling (XL) in Keratoconus

  • Fernando Aguilera-Zarate MD

  • Instituto de Ojos de BC

  • Mexicali, Baja California

  • Mexico

  • No FinancialInterest


Objective

> CornealRigidity

FotopolimerizationcolagenFibers

Combination: UV-A + Rivoflabin (vit B2)

> fibrilldiameter

> interfibrillarjunctions

> cornealrigidity

< corneal ectasia progression

< cornealasimetry

CROSSLINKING (XL)


BIOCHEMICAL CORNEAL XL CHANGES


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

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


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 (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

  • MTF (modular transfer function)

    Measures visual quality of theeye

    (cornea to retina)

  • PSF (point spread function)

    Measures visual quality of anopticalsystem)

    (Eye-Occipital Cortex)


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 EctaticAreas


CornealAberrometricChanges

< Corneal HOA

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


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


Pachymetric and CornealPower:< opticpachymetry / < total cornealpower


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


Visual QualityImprovementRelatedwithReducedSphericalEquivalent and ReductionCorneal HOA


ReductionCornealIrregularityIndices


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 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 CornealCrosslinking

  • ImprovesCornealBiomechanics > Rigidity

  • < CornealAsimetry

  • < CornealTertiaryHigherOrder Ab (coma / trifoil)

  • < RefractiveCornealPower (true net power)

  • > Visual Quality (MTF y PSF)

  • < Pachimetry (CornealRemodeling)


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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