Bulous Kerathopaty The New More Controlled Option For Management

Purpose: The goal of this pilot study is evaluate the effect of teranostic crosslinking on corneal “rehabilitation” after complicated cataract surgery. Although the exact mechanism is not proven, compacting of corneal lamellae by crosslinking facilitates less corneal edema and uniform healthy epithelium.

Clinical research in the real practice.

Methods: 14 eyes of 12 patients with post cataract corneal edema, were evaluated with OCT pachimetry, including epithelial thickness and specular microscopy. Subsequently, all eyes were treated with crosslinking following standard teranostic protocol for bulous kerathopaty. All procedures were done with epithelium off and utilizing universal 0.22% riboflavin. The patients were fitted with therapeutic contact lens for 2 weeks, and examined on day 1, week 1, week 2 and week 8. Patients also filled in a 3 items questionnaire regarding discomfort, difficulties to open the eye and vision.

epithelial thickness was measured at mean of 78±21microns. The best vision was counting fingers.  Non of the specular microscopy evaluations manage to demonstrate endothelial structure. 8 weeks after the procedure the mean thickness reduced respectively for the central cornea at 694±63 microns, and mean epithelial thickness reduced to 62±251microns, but with more uniform distribution. In 8 eyes the vision increased to 0.1. In two eyes to 0.4 and in 4 eyes was unchanged. Subjectively all patients reported Improvement with at least 2 of 3  items.

Conclusion: Teranostic crosslinking might be a good additive solution in management of post-cataract corneal edema. Although, cataract surgery is atraumatic, there are still risky cases with Fuchs’ dystrophy, long standing cataracts or intraoperative complications that require complex management. Better prediction and control offered by the teranistic approach is more reliable and secure in those cases.