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Four Year Results Of Corneal Crosslinling (XL) in Keratoconus

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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  1. FourYearResults Of CornealCrosslinling (XL) in Keratoconus • Fernando Aguilera-Zarate MD • Instituto de Ojos de BC • Mexicali, Baja California • Mexico • No FinancialInterest

  2. Objective > CornealRigidity FotopolimerizationcolagenFibers Combination: UV-A + Rivoflabin (vit B2) > fibrilldiameter > interfibrillarjunctions > cornealrigidity < corneal ectasia progression < cornealasimetry CROSSLINKING (XL)

  3. BIOCHEMICAL CORNEAL XL CHANGES

  4. 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

  5. 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 %

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

  7. 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)

  8. 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

  9. 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)

  10. Topographicchanges CornealAsimetry = o´ < Anterior Elevation (eliipsoidal) Reductionor no change Posterior Elevation (ellipsoidal) reductionor no change Reduction of true net power

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

  12. CornealAberrometricChanges < Corneal HOA Coma (z3,-1; z3,1) and trifoil (z3,-3; z3,3)

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

  14. Pachymetric and CornealPower:< opticpachymetry / < total cornealpower

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

  16. Visual QualityImprovementRelatedwithReducedSphericalEquivalent and ReductionCorneal HOA

  17. ReductionCornealIrregularityIndices

  18. 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

  19. 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

  20. Disscusion: UVA-C3 CornealCrosslinking • ImprovesCornealBiomechanics > Rigidity • < CornealAsimetry • < CornealTertiaryHigherOrder Ab (coma / trifoil) • < RefractiveCornealPower (true net power) • > Visual Quality (MTF y PSF) • < Pachimetry (CornealRemodeling)

  21. CONCLUSION 4 YearFollowup of Corneal XL • EffectiveTherapeuticModalitytoPreventor Reduce progresion of EctaticChangesassociatedwithKeratoconus • ImprovesOpticalQualities of Cornea • MinimalSecondaryEffects

  22. fernando aguilera-zarate md www.institutodeojos.com.mx drfaguilera@gmail.com

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