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Customized pattern Myopic, astigmatic, and hyperopic refractive correction with transepithelial, very high-fluence collagen cross-linking: early clinical results of a novel application

Poster Details

First Author: V.Moustou GREECE

Co Author(s):    A. Kanellopoulos   G. Asimellis           

Abstract Details


To report safety and efficacy of a customizable application of high-fluence collagen crosslinking (CXL) through the intact epithelium (transepithelial) with a novel device, aiming to achieve predictive and stable refractive myopic, astigmatic, and hyperopic changes in virgin corneas.

Setting: Clinical and Research Eye Institute, Athens, Greece


20 cases treated with a novel device employing very high-fluence CXL, applied in a customized pattern aiming to achieve myopic (10 cases), hyperopic (5 cases), and astigmatic (5 cases) predictable refractive changes. Riboflavin penetration through the intact epithelium was applied with specially-formulated solutions in a two-step process. The CXL device (KXL II, Avedro, Waltham MA) was employed to deliver a total of 12 joules/cm2, in pre-determined pattern. One year postoperatively we evaluated cornea clarity, cornea keratometry, cornea topography, both with Placido disc and Scheimpflug imaging, as well as cornea anterior segment Optical Coherence Tomography (OCT) and endothelial cell counts (ECC).


Of the 10 myopic cases an average of 2.3D achieved at the first week. Slight regression to 1.44D at one month, stayed stable until the sixth month. Mean keratometry change was from 44.90D to 43.46D. No significant change in endothelial cell counts or cornea clarity. Mild change in the epithelial thickness distribution. Of the 5 astigmatic cases treated, a mean astigmatic reduction of 0.8 D, and significant cornea surface normalization was achieved, along with modest normalization in epithelial thickness distribution. Of the 5 hyperopic cases treated, a mean hyperopic refractive increase of +0.8 D was achieved one year postoperatively.


We introduce herein the novel application of very high-fluence CXL with a predictable well-defined myopic refractive (flattening), astigmatic, and hyperopic (steepening) corneal effect. This novel technique carries the advantage of essentially no post-operative morbidity, immediate visual rehabilitation and a potential for it to be tapered until the desired result is reached. FINANCIAL DISCLOUSRE: One or more of the authors travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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