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First Author: C.Mazzotta ITALY
Co Author(s): A. Paradiso S. Baiocchi A. Caporossi
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To assess morphological corneal changes induced by Accelerated CXL (ACXL) in patients with progressive keratoconus by in vivo confocal analysis and AC OCT
Departement of Ophthalmology Siena University
18 patients affected from progressive keratoconus, age between 13 and 27 years (mean 20 years) were enrolled. 5 patients undergoing trans-epithelial treatment with Paracel plus Vibex Xtra solution (Avedro, Waltham, MA) at 45 mW/cm2 UVA power for 2.40 minutes. 13 patients undergoing epithelium-off procedure: 4 eyes with Vibex solution at 30 mW/cm2 for 4 minutes, 5 eyes with Vibex solution at 12 mW/cm2 for 10 minutes and 4 eyes with Vibex rapid solution at 30 mW/cm2 for 4 minutes. Energy dose (7.2 J/cm.2) was delivered by KXL I UV A source (Avedro Inc, Waltham, MA) soaking time was 4 minutes for Paracel plus 6 minutes for Vibe Xtra, 20 minutes for Vibex standard solution and 10 minutes for Vibex rapid. Morphological studies were conducted by in vivo HRT II scanning laser confocal microscopy (Heidelberg, Germany) Visante and Cirrus AC-OCT (Zeiss, Jena, Germany)
Penetration of treatments were detected at different depths depending on UV A power and exposure time, ranging from 100 for trans-epithelial accelerated CXL to 200 micron in Epithelium-off accelerated CXL.
The volume of cross-linked tissue increased when energy dose goes down to 30 mW in epithelium off ACXL. The volume of cross-linked stroma seems to be inversely proportional to exposure time and UV-A power. The removal of epithelium is essential to increase UV A diffusion into the stroma also in ACXL.