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CXL in 2011

CXL in 2011. Arthur Cummings Wellington Eye Clinic, Dublin, Ireland UPMC Beacon Hospital, Dublin, Ireland. Beta Site Meeting, San Diego, 25 th March 2011. Literature. SimLC. CXL. Keraflex. 4 Eyes treated with Keraflex 28 th October 2010 CXL 4 to 7 days later

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CXL in 2011

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  1. CXL in 2011 Arthur Cummings Wellington Eye Clinic, Dublin, Ireland UPMC Beacon Hospital, Dublin, Ireland Beta Site Meeting, San Diego, 25th March 2011

  2. Literature

  3. SimLC CXL

  4. Keraflex • 4 Eyes treated with Keraflex 28th October 2010 • CXL 4 to 7 days later • 4 Eyes have 12 week data • 2 Eyes considered “good cases” • 2 Eyes “poor cases” as a result of advanced KC

  5. Patient 1 Right Eye, CXL only

  6. Patient 1 Left Eye, Keraflex + CXL

  7. Comparing CXL to Keraflex/CXL

  8. Comparing CXL to Keraflex/CXL 1 Wk. Post-op 1 Mo. Post-op 3 Mo. Post-op Pre-op Pre-Keraflex 1 Wk. Post-op + CXL 1 Mo. Post-op 3 Mo. Post-op

  9. Keraflex + CXL

  10. CXL only

  11. Additional Keraflex Cases 1 Pre-Op 1 Week post-CXL Post-Keraflex 6 Weeks post-CXL 3 Mths post-CXL 2 3 Missed visit

  12. K-Max over time

  13. Average K over time

  14. Patient 1 Pre-operative • CF +4.00 /-15.00 X175 6/10 • 6/20 -2.50 /-1.00 X70 6/12 • 6/15 +0.50/-4.00 X113 6/7.5 6 Weeks post-op 3 Months post-op

  15. UCVA

  16. BCVA

  17. Additional Keraflex Cases

  18. Keraflex • 6 Eyes treated with Keraflex 19th March 2011 • CXL at same sitting • 4 Eyes have 2 minute post-Keraflex data

  19. Keraflex

  20. Intra-Operative Pachymetry Arthur Cummings Eugene Ng ASCRS 2010

  21. No studies looking at intra-procedural pachymetry during CXL. Medio-Cross (Riboflavin 0.1%, Dextran 500 20%) is supposed to be isotonic. We report intra-procedural pachymetry (at 5 minute intervals) using Medio-Cross during CXL

  22. Results 15 consecutive patients who underwent CXL also had intra-procedural pachymetry measurements at 5 minute intervals. All patients had pre-operative pachymetry of >400 microns on both optical and ultrasound pachymetry.

  23. Results A wide variation in the loss of corneal thickness was noted (15-36%). Medio-Cross instillation Pre-op Post epithelium 5 mins 10 mins 15 mins 20 mins Pre UVA Pachy Removal Hypotonic Riboflavin added

  24. Discussion Corneal “desiccation” may have accentuated “thinness” of the cornea as measured by ultrasound pachymetry (speed of sound in denser medium). The safe level of corneal thickness throughout the procedure (as measured by ultrasound pachymetry) needs to be defined if endothelial damage is to be avoided.

  25. Discussion It is possible that the variable effect of Medio-Cross on corneal thickness may be related to the varying effect of CXL efficacy. The effects of hypotonic riboflavin (apart from increasing corneal thickness) may provide a false sense of safety The relative efficacy of CXL where hypotonic riboflavin is used is unknown.

  26. Our current CXL protocol • Pre-op Pachy • Pachy after epithelium removed • Intra-op Pachymetry every 5 minutes • Try and keep corneal thickness = 350 micron • Titrate isotonic vs. hypotonic Riboflavin

  27. Thank You for Your Attention

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