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Safety and efficacy of high-fluence CXL for progressive keratoconus: short-term results

Poster Details

First Author: Z.Gatzioufas SWITZERLAND

Co Author(s):    O. Richoz   D. Tabibian   F. Hafezi        

Abstract Details


To evaluate the efficacy and safety profile of high-fluence epi-off CXL treatment for progressive keratoconus (KC), with regard to corneal topography and endothelial cell integrity.


Department of Ophthalmology, Geneva University Hospitals HUG, Geneva, Switzerland


Prospective interventional case series of 10 human eyes with progressive KC, which underwent epi-off CXL with high-fluence (18 mW/cm2). CXL was performed according to the Dresden protocol with modifications. Corneal epithelium was removed mechanically over the central 8 mm. Isotonic riboflavin 0.1% drops (PESCHKE; Meditrade GmbH, Huenenberg, Switzerland) were instilled every 2 minutes for 30 minutes. Afterwards, the corneas were exposed to ultraviolet-A light (UV-X System; Peschke Meditrade GmbH, Huenenberg, Switzerland) for 5 minutes with a wavelength of 370 nm and in a dosage of 18 mW/cm2. Administration of additional isotonic riboflavin drops occurred every 2 minutes during the ultraviolet-A exposure. Kmax and corneal thickness at thinnest point were evaluated by Scheimpflug imaging (Pentacam HR, Oculus, Wetzlar, Germany) at 1 month pre-operatively, as well as at 1 month and 3 months postoperatively. Endothelial cell density was measured by scanning-laser confocal microscopy (HRT cornea module, Heidelberg Engineering, Heidelberg, Germany) in the same intervals. Corrected Distance Visual Acuity (CDVA) was also evaluated.


Preoperative endothelial cell density (ECD) was 2942ḟ85 cells/mm2, whereas ECD was 2918ḟ78 cells/mm2 and 2912ḟ82 at 1 and at 3 months postoperatively, respectively. The differences were not statistically significant (all p>0.05, Fisher‘s exact test). Likewise, mean Kmax was decreased from 55,6ḟ3,4 dpt preoperatively to 54,6ḟ4,2 dpt at 1 month postoperatively and 54,1ḟ3,9 at 3 months postoperatively, but the differences were not statistically significant (all p>0.05, Fisher’s exact test). Best-corrected distance visual acuity (BCVA) (logMAR) improved from 0,37ḟ0,22 preoperatively to 0,48ḟ0,34 at 1 month postoperatively and to 0,49ḟ0,42 at 3 months postoperatively. The differences were not statistically significant (all p>0.05, Fisher’s exact test).


High-fluence epi-off CXL treatment for progressive KC did not affect significantly the ECD at 1 month. Mean Kmax decreased and BCVA improved, but the differences were not statistically significant. No other complications occurred during this short-term follow-up period. Further follow-up is required for validating these results.

Financial Disclosure:


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