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Transepithelial ionthophoretic corneal collagen Cross Linking (i-CXL-TE) in pediatric and young adult patients affected by progressive keratoconus (pKC): 60-months follow up.
First Author: S. Troisi ITALY
Co Author(s): C. Plaitano M. Troisi
To report safety, refractive and tomographic efficacy of i-CXL-TE with standard irradiation protocol (Dresda) in patients with progressive keratoconus at 5 years follow up. Purpose of the study is to evaluate the role of this technique in patients aged between 12 and 35 years with tomographic progression (Kmax greater then 1.5 diopters or reduction of thinnest point greater then 20 microns) or increase in refractive values greater than cil-0.75 Diopters in the previous 6 months. Side effects, if present, were noted and reported in the study.
Ophthalmologic Unit of Salerno Hospital University, Center of Ocular Surface Pathology (Salerno, Italy). The study was conducted according to the principles of the Declaration of Helsinki. The study was approved by the Institutional Ethics Committee.
87 eyes of 64 patients with tomographic or refractive progression of KC in the previous 6 months who underwent iCXL-TE from 01.10.2013 to 15.09.2015, were enrolled. Epi-on imbibition was performed with a dedicated 0.1% hypotonic riboflavin solution and iontophoretic method for 5 ', followed by 370nm 3mW / cm2 UV-A irradiation for 30'. Clinical and tomographic follow-up was performed (Scheimpflug camera) at 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 60 months; endothelial count and macular OCT at 3,12,24,36, 48, 60 months.
Mean increase in Kmax values was +1.86 +/- 0.31D over the 6 months prior to treatment. Post-treatment mean Kmax values decreased by -0.46 +/-0.85D, -0.91 +/-0.96D, -1.02 +/-1.18D, -0.99 +/-1.15D, -0.94 +/-1.20D , -0.92 +/-1.12 at 6, 12, 24, 36, 48, 60 months respectively; 6 eyes needed retreatment. In 71 eyes there was a reduction in Kmax values at 60 months, in 75 eyes there was an improvement in visual acuity (BSCVA -0.19 +/-0.15 LogMar: p: less than 0.05); endothelial counts, intraocular pression and OCT unchanged during the study. We did not observe haze or other side effects.
The i-CXL-TE treatment seems to halt pKC at 60 months follow up. There is a statistically significant improvement in visual acuity and no side effects are reported. The reduced execution time and the reduced invasiveness allow a better patients compliance by allowing to carry out the treatment in pediatric and in young adult patients.
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