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First Author: R.Rubinfeld USA
Co Author(s): W. Trattler M. Mrochen R. Correa G. Perez G. Berdy R. Malahotra
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Transepithelial 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 or post-LASIK ectasia who were evaluated at the slit lamp to ensure adequate stromal riboflavin loading before proceeding to UV light application.
Center for Excellence in Eye Care, Miami, Fl; Washington Eye Physicians and Surgeons, Chevy Chase, Maryland; IROC Science to Innovation AG, Zurich, Switzerland
Patients with a diagnosis of keratoconus or post-LASIK ectasia who underwent transepithelial CXL with slit lamp confirmation of adequate corneal riboflavin loading with a minimum follow-up of 4 months were included in the analysis. Patients with cataracts, INTACS, RK, and a diagnosis other than keratoconus and post LASIK ectasia were not included. UCVA, BSCVA, and K Max measurements were compared with pre-Op measurements at both 6 months follow up and 1-year follow up post-CXL.
The total number of eyes diagnosed with keratoconus and post LASIK ectasia was 390 and 71. 70% of keratoconic eyes and 60.5% of post LASIK ectasia eyes were male. 229 keratoconic eyes had a follow-up visit at 6 months. 49.7% and 46.6% of eyes resulted in an improvement of 1 or more lines in UCVA & BSCVA, respectively. 43 eyes (Post Lasik Ectasia) had a follow-up visit at 6 months. 41.8% and 37.2% of eyes improved 1 or more lines in UCVA and BSCVA, respectively. Average change in kmax of -0.94D and -0.12D was observed in eyes with keratoconus and post LASIK ectasia at 6- month visit, respectively. 99 keratoconic eyes had a follow-up visit at 1 year. 57.6% & 49.4% of eyes resulted in an improvement of 1 or more lines in UCVA & BSCVA, respectively. 19 post LASIK ectatic eyes had a follow-up visit at 1 year. 55.5% and 36.8% of eyes improved 1 or more lines in UCVA and BSCVA, respectively. Excluding one eye of one keratoconus patient with possible progression, the average change in kmax was 0.80D and 0.60D in keratoconus and post LASIK ectasia at 1 year follow-up.
Reports that have suggested Transepithelial Corneal Collagen crosslinking is ineffective appear to be related to inadequate loading of the corneal stroma with riboflavin. In this study of transepithelial CXL, patients were examined in the slit lamp to ensure adequate loading of the riboflavin prior to 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 or post-LASIK ectasia. In particular, approximately 50% of eyes achieved improvement in UCVA and BSCVA, and flattening of KMax was observed. These results demonstrate that trans-epithelial cross linking with confirmation of adequate corneal riboflavin loading can provide efficacy that is comparable to the epi-off Dresden protocol with reduced risk.
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