four year results of corneal crosslinling xl in keratoconus n.
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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

slide5
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

corneal aberrometric changes
CornealAberrometricChanges

< Corneal HOA

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

visual quality improvement related with reduced spherical equivalent and reduction corneal hoa
Visual QualityImprovementRelatedwithReducedSphericalEquivalent and ReductionCorneal HOA
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
slide23
fernando aguilera-zarate md

www.institutodeojos.com.mx

drfaguilera@gmail.com