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Demographic and visual outcomes on keratoconus patients with failed “epi- on”C3R cross-linking procedures

Demographic and visual outcomes on keratoconus patients with failed “epi- on”C3R cross-linking procedures. Yaron S. Rabinowitz M.D. Oana Dumitrascu M.D. The authors have no financial interest in the materials presented in this poster. Background.

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Demographic and visual outcomes on keratoconus patients with failed “epi- on”C3R cross-linking procedures

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  1. Demographic and visual outcomes on keratoconus patients with failed “epi- on”C3R cross-linking procedures Yaron S. Rabinowitz M.D. Oana Dumitrascu M.D. The authors have no financial interest in the materials presented in this poster

  2. Background The standard procedure in collagen cross-linking is to remove the epithelium. Recent reports suggest that it is not necessary to remove the epithelium using the “epi-on” C3R procedure. This study was undertaken to illustrate C3R failures.

  3. Abstract PURPOSE: To present data on unhappy keratoconus patients who presented to our office following C3R “epi-on” cross-linking. METHODS: Retrospective chart review 1 year post procedure RESULTS: 13 eyes were identified. Mean age was 33 yrs (range 23 – 41). Mean uncorrected acuity was 20/200 (range 20/40-20/200). Mean best-corrected acuity was 20/60 (range 20/30-20/200). Mean central pachymetry was 435um (range 380-485). Mean K value was 50.27(range 43-58). Mean I-S value was 4.25(range 1.84-10.86). 4 eyes had repeat cross-linking with the standard epi-off procedure, 4 eyes had corneal transplants and 5 eyes had no further treatment CONCLUSIONS: These data suggest that the “epi-on” C3R procedure may not be optimal for treating keratoconus.

  4. Results - Demographics of failed “epi-on”

  5. Results - DemographicsSummary of findings at presentation • 4/13 (30%) eyes had paracentral scars • 9/13 (70%) eyes had 1 additional surgery • 6/13 (46%) eyes had 2 additional surgeries • 3/13 (23%) eyes had 3 additional surgeries

  6. Results - reasons why patients not happy 8/13(60%) patients noted progression after C3R, we were able to document this in 5 patients one progressed up to 8D 5/13(40%) did not experience an improvement in their vision which was their reason for doing the procedure

  7. Eye 2 - Pre op and 1 year Post op topography C3R - 8 D change

  8. Results - Disposition of Failed C3R patients

  9. Discussion Collagen Cross Linking(CXL) involves the removal of the corneal epithelium, soaking the cornea with riboflavin and applying a homogenous beam of UV light for about 30 minutes to the cornea. Several studies in the published literature suggest that this is a safe and effective method for retarding the progression of keratoconus C3R is a variation of this procedure in which the epithelium is retained and a lamp of unknown origin is used for UV radiation. It is not FDA approved but done on an off label basis This procedure is heavily marketed as being safe and effective, with a < 2% retreatment rate being quoted For C3R,there have been no scientific studies to date demonstrating a high safety profile as has been done for CXL

  10. Discussion In this study we demonstrate that 13 eyes from one practice performing C3R had an unfavorable outcome in a 1 year period This suggests that the “failure rate” for C3R may be higher than the quoted 1.4% “retreatment rate” 5/13 eyes were unhappy because they noticed no visual improvement, 4 had paracentral scars 8/13 eyes noted definite progression within 1 year of receiving the treatment This suggests that patient selection for this particular procedure might have been less than optimal

  11. Conclusion While Collagen Cross linking (CXL) appears to be safe and effective as described by the pioneers of this procedure, it appears that performing this procedure leaving the epithelium on requires further study for safety and efficacy, before being universally adopted. Patients expectations for improved vision should be tempered with the emphasis being placed on retarding the progression, which currently has a quoted 7.6% retreatment rate using the standard “epi-off” CXL procedure

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