USE OF CXL IN KERATOCONUS

Riboflavin/UVA corneal crosslinking (CXL) leads to significant visual improvements in some keratoconus patients, and has saved paediatric patients from needing corneal transplants, the Joint Irish/UKISCRS Refractive Surgery Meeting in Dublin, Ireland heard.

David O’Brart MD gave the Dermot Pierce Memorial lecture on CXL indications, techniques and complications, and discussed the results of his own seven to eight year follow-up studies.

Dr O’Brart said his results have been extremely encouraging, with stabilisation of keratoconus in all treated eyes, excellent stability over seven to eight years of follow-up with continued improvement in corneal shape and reduction of keratoconus in the vast majority of eyes.

Dr O’Brart said CXL in keratoconus continues to show great promise and being able to now offer hope to these patients is “wonderful”.

“The improvement in vision in some patients can be quite phenomenal. What you are seeing at eight years is that visually some of these patients have improved by as many as four lines," he told the meeting.

“If you have a patient with keratoconus, particularly under 40, and you think the condition is progressing, then perform CXL. It is a relatively cheap procedure and a lot cheaper than performing a corneal transplant down the line. It is going to get more sophisticated and we are learning more about optimising the technique,” Dr O’Brart maintained.

Dr O’Brart said while he had gotten very close to achieving comparable riboflavin stromal uptake with an “epithelium-on” iontophoresis technique compared to “epithelium-off CXL”, he stated that “we have not yet discovered how to not damage the epithelium during the procedure”.

Positive potential

Dr O’Brart also described his positive results of performing CXL on children, maintaining that proactive treatment is vital to halt progression of keratoconus and consequent visual loss.

“I now have treated a number of children where in one eye, because of severe disease, I had to undertake corneal transplantation, with the other eye progressing rapidly. After crosslinking of these better eyes, no progression has occurred. It is very likely that these less severely affected eyes would have progressed to such a stage that would require transplantation. CXL has, it appears, saved these eyes thus far from invasive potentially blinding surgery. With the long-term data I have now, I have no qualms about performing CXL on a child,” he told EuroTimes.

Concluding, Dr O’Brart said more prospective and comparative studies are needed, particularly on accelerated CXL, and on different epithelium on and off protocols. “That CXL works is not in doubt but there are still many unknowns in CXL," he said.

David O’Brart: DavidOBrart@aol.com