ESCRS - PO0610 - Outcome Of Modified H P M C In Thin Cornea (<400Micron)

Outcome Of Modified H P M C In Thin Cornea (<400Micron)

Published 2023 - 41st Congress of the ESCRS

Reference: PO0610 | Type: Free paper | DOI: 10.82333/zaq5-ce21

Authors: John Sarkar* 1 , SALIL NEPAL 2

1CORNEA ,SUSRUT EYE FOUNDATION AND RESEARCH CENTER ,KOLKATA,India, 2CORNEA,SUSRUT EYE FOUNDATION AND RESEARCH CENTER ,KOLKATA,India

Purpose

To evaluate the changes in thinnest pachymetry , posterior elevation , topographic K value after HPMC CXL with combined Epi On and Epi Off technique in pogressive keratoconus patients wiith pachy <400 micron and associated findings in respect of BCVA , CCT, Specular Microscopy 

Setting

In a teriary eye care center in Eastern part of India with statistical analysis were done in pre CXL and post CXL at a 6 months follow up 

Methods

Prospective , Comparative , Intervensional study included 40 Eyes of 35 Patients of Pogressive Keratoconus , All patients underwent clinical examinations including BCVA, Tomographic indicies of Orbscan , pachymetry both pre and post CXL 6months , patients included Pachy <40 years , documented pogression of keratoconus , pachy <400 micron .

Two modification done - 1. Thinnest pachy <400 micron  and  2.Combined Epi On and Epi OFF procedure , CXL was done under TA with epi ON at visual axis with epi removal at mid periphery and 10 mi  UV-A exposure of 9 Mw/cm 2

 Primary outcome measures :changes in Thinnest pachy , average mean posterior elevationand topo K valuesas compared to pre CXL , additional outco 

me BCVA , SPM 

Results

Mean Age 21.51yrs, M:F  28:7, BCVA though not stastically significant but showing significant improvements , Thinees pachy no difference in Pre CXL and Post CXL (p=0.08)and Topo K also not showing any significant difference pre abd post CXL , POST ELEVATION IN oRBSCAN ALSO COMPARABLE BOTH PRE AND POST CXL WITH stable Specular count pre and post cxl 

Conclusions

Standered CXL Technique can not be done in thin cornea for UVA related Toxicity and HPMC CXL already proven procedure , while several procedure has been proposed , there is no standerised procedure for the treatment of thin cornea , in our study , we used isotonic riboflabin 0.1% with 1.1 % HPMC as a carrier. The WOW factor of this study that its a combined epi on and epi off procedure and epi defect resolved very fast and immediate post op was less symptomatics . SO RECOVERY OF VISION EARLY WITH HALTING PROGRESSION EFFICIENTLY IN COMPARE TO ONLY  HPMC CXL