ESCRS - PO0163 - Preliminary Endothelial Safety Of A New 10 J/Cm2 High-Fluence Corneal Cross-Linking (Cxl) Protocol For Progressive Keratoconus

Preliminary Endothelial Safety Of A New 10 J/Cm2 High-Fluence Corneal Cross-Linking (Cxl) Protocol For Progressive Keratoconus

Published 2023 - 41st Congress of the ESCRS

Reference: PO0163 | Type: Case report | DOI: 10.82333/aczd-dd66

Authors: M. Enes Aydemir* 1 , Nikki L. Hafezi 1 , Emilio A. Torres-Netto 1 , Nanji Lu 1 , Mark Hillen 1 , Farhad Hafezi 2

1Ophthalmology,ELZA Institute AG,Dietikon,Switzerland, 2Ophthalmology,ELZA Institute AG,Dietikon,Switzerland;Ocular Cell Biology Laboratory,University of Zurich,Zurich,Switzerland

Today, the clinical CXL protocol with the highest increase in biomechanical stiffness remains the epithelium-off Dresden protocol (30 min @ 3 mW/cm2). We recently published the laboratory data of a new 10 J/cm2 high-fluence accelerated epi-off CXL protocol that decreases irradiation time from 30 minutes to 9 min 15 sec duration, while providing a biomechanical stiffness similar to the Dresden protocol. Here, we present the initial clinical data on endothelial cell safety of this new regimen.

Laboratory study. ELZA Institute, Dietikon, Switzerland and Laboratory for Ocular Cell Biology, CABMM, University of Zurich.

Methods: Between February 2021 and January 2023, we prospectively measured 14 eyes from 14 patients with progressive keratoconus. All patients were treated with an epi-off CXL protocol using high-fluence settings (10 J/cm2; 9 min 15 sec @ 18 mW/cm2). Endothelial cell density (ECD), speed of postoperative epithelial healing, keratometric readings (Kmax and Kmean, respectively) of the anterior corneal surface, and corrected distance visual acuity (CDVA) were evaluated preoperatively and at 12 months after CXL.

 

Results: High-fluence epi-off CXL with a fluence of 10J/cm2 had no significant effect on endothelial cell density (From 2727 ± 245 to 2756 ± 296 cells/mm2, P = 0.446) nor on the speed Kmean decreased (From 47.26 ± 3.68 to 46.91 ± 4.26, P = 0.187) but Kmax decreased significantly (from 54.56 ± 7.44 to 53.46 ± 7.88, P < 0.05). No complications were observed postoperatively.

In this preliminary study we showed that high fluence epi-off CXL using 10 J/cm2 does not seem to affect neither endothelial cell density nor the speed of epithelial healing.