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First Author: R.Rubinfeld USA
Co Author(s): W. Trattler M. Mrochen R. Correa R. Epstein G. Berdy R. Malahotra
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Transepithelium corneal cross linking has been reported to be ineffective, which appears to be related to insufficient loading of riboflavin in the cornea. The purpose of this analysis is to determine the efficacy of Transepithelial CXL in patients with a pre-Op diagnosis of keratoconus who were evaluated at the slit lamp to ensure adequate riboflavin loading before proceeding to UV light application.
Washington Eye Physicians and Surgeons, Chevy Chase, Maryland; Center for Excellence in Eye Care, Miami, Fl; IROC Science to Innovation AG, Zurich, Switzerland
Patients with a diagnosis of keratoconus who underwent transepithelial CXL with slit lamp confirmation of adequate corneal riboflavin loading and who had a minimum follow-up of 4 months were included in the analysis. Patients with cataracts, INTACS, RK, and a diagnosis other than keratoconus were not included in the analysis. UCVA, BSCVA, and K Max measurements were taken and evaluated against pre-Op measurements at both 6 months follow up and 1-year follow up post-CXL.
The total number of eyes was 390. 70% were male. The age range was 11 to 72 with an average age of 32. Minimum follow up time was 4 months and maximum follow-up time was 15 months. 229 eyes had a follow-up visit at 6 months (average follow-up time =6.8 months.) 49.7% and 46.6% of eyes resulted in an improvement of 1 or more lines in UCVA & BSCVA, respectively. 39.5% & 38.2% of eyes experienced no change in UCVA & BSCVA at 6 months, respectively. Average change in kmax was -0.94D at 6- month follow-up. 99 eyes had a follow-up visit at 1 year (average follow-up time = 12.2 months). 57.6% % 49.4% of eyes resulted in an improvement of 1 or more lines in UCVA & BSCVA, respectively. 30.4% and 28.2% of eyes experienced no change in UCVA & BSCVA at 1 year visit, respectively. Excluding one eye with possible progression, the average change in kmax was -0.80D at 1 year follow-up.
Reports that Transepithelial Corneal Collagen crosslinking is ineffective appear to be related to inadequate loading of the cornea with riboflavin. In this study of transepithelial CXL, patients were examined in the slit lamp to ensure adequate loading of the riboflavin prior to proceeding with UV light application. In this study, trans-epithelial CXL appears to be both safe and effective for the treatment of eyes with a pre-Op diagnosis of keratoconus. In particular, approximately 50% of eyes achieved improvement in UCVA and BSCVA, and flattening of KMax was observed. The presented results demonstrate that trans- epithelium cross linking with confirmation of adequate corneal riboflavin loading can provide an efficacy that is comparable to the epi-off Dresden protocol with reduced risk.
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