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Four Year Results Of Corneal Crosslinling (XL) in Keratoconus

Four Year Results Of Corneal Crosslinling (XL) in Keratoconus. Fernando Aguilera-Zarate MD Instituto de Ojos de BC Mexicali, Mexico drfaguilera@gmail.com No Financial Interest.

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Four Year Results Of Corneal Crosslinling (XL) in Keratoconus

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  1. FourYearResults Of CornealCrosslinling (XL) in Keratoconus Fernando Aguilera-Zarate MD Instituto de Ojos de BC Mexicali, Mexico drfaguilera@gmail.com • No FinancialInterest

  2. TheObjective of CrosslinkingistoIncreaseCornealRigidityand HalttheProgression and EvenAchieveRegression of KC byPhotopolimerization of CornealCollagenFibersUsingRivoflabin (B2 Vit) + UltraVioletRadiation of 370 nm(Wolensaklab. Studies)

  3. WOOLENSAK,SEILER AJO,2003;135:625-627 First Report Of Humans Treated by XL Their Results at 12 months: Regresion KC ………………………72% < Spherical Equivalent…………….1.34 D < Astigmatism.. …………………….2.01 D Control Group, progression……...22 %

  4. STUDY OBJECTIVE Document 4 yearfollow-up Changes in CornealRefractive, Topography and Aberrometry; And toEvaluatethe Visual QualityChanges in Keratoconic Corneas Treatedby UV-B Crosslinking

  5. Material and Methods • 21 patientsDx KC (Usher I-II) • 26 eyes(follow-up 4 years) • 18-30 years - 12 men / 9 female • Complete ophthalmicevaluation • InclusionCriteriaforEpithelium Off CrosslinkingTreatment: Siena University XL Protocol (12 minute B2 impregnation / 30 minute UV-A 370 nmRadiationwithlimbalareaprotection) No concurrentophthalmicdiseases • SteepestKM < 58.5D • KC withconfirmedprogressionbytopography (>0.5 D of astigmaticpower, axis, asimetryorpachymetrychange in 1 year (2 yearpreop. followup) • Cornealpaquimetry>400 umat thinnestpoint ..(Scheimpflug) • Normal Cristaline Lens Densitometry…………... (Scheimpflug) • Normal Retinal OCT ………………………………...(Fourier Domain) • CornealSpecularMicroscopy……………….........(Cellcount, Shape, etc)

  6. Results: Visual QualityMTF (Modular Transfer Function)PSF (Point Spread Function)Bothwereimprovedafter XL and havecontinuedtoimproveover time in 98% of patients

  7. TopographicChanges 4 years • CornealAsimetry and KC IndiceswereReduced (93%) orUnchanged (5%) • Anterior Elevation(eliipsoidal) Reduction (85%) or No change (13%) • Posterior Elevation(ellipsoidal) Reduction (78%) or No change (19%) • True Net Power (RayTracing) Reduction (98%) or No Change (2%)

  8. ELEVATION:Reduction Anterior/Posterior Elevation. More Reduction in EctaticAreas(ARROWS)REFRACTIVE: Reduction Irregular Ast / ChangeAst. Axis < 5 Mean AstigmatismCornealChange: 2.37 KM D

  9. PACHYMETRIC AND CORNEAL POWER:< Opticpachymetry / < Total CornealPower (RayTracing)ABERROMETRIC CHANGES:Reduction in COMA…………….. (z3,-1 / z3,1) Reduction of TRIFOIL……………(z3,-3 / z3,3) PACHYMETRIC DIFFERENCE CORNEAL HOA

  10. Visual Quality: MTF Improvement at lowerfrequencies(5-10 c/d) SVA Improvement (ReductionCorneal LOA and HOA)

  11. XL EarlyComplications (15 d) Reticular Haze Transient CornealEdema………………………8/26 EpithelialRetardation..…(>5D)…….0/26 Loss > 1 Lines VA……….…………...0/26 CornealHaze……………………….…2/26 CornealMelting……………………....0/26 IOP >…………………………..………..0/26 EndothelialDamage………………..0/26 NO LATE COMPLICATIONS No Haze, No Scars, No Infiltrates 1 KC Progression……….….1/26 OCT DEMARCATION LINE LESS 300 um DEPTH

  12. Disscusion: UVA-C3 CornealCrosslinking • ImprovesCornealBiomechanics> Rigidity • < CornealAsimetry • < CornealTertiaryHigherOrder Ab (coma / trifoil) and LOA (astigmaticreduction) • < RefractiveCornealPower (True Net Power - RayTracing) • > Visual Quality (MTF y PSF) • < Pachimetry (CornealRemodeling) thatStartstoIncreaseafter 18 Months (KeratociteCollagenProduction?) • CONCLUSIONS 4 YEAR PO XL: • Effective Long TermTherapeuticModalitytoPreventor Reduce progresion of EctaticChangesassociatedwithKeratoconus (97%) • No Changes in CristallineDensitometrynor in Retinal OCT • ImprovesOpticalQualty of Cornea (Reducing HOA and LOA) • SafeProcedurewithMinimalSecondaryEffects (TransientEarly Reticular Haze 8%, less 3 monthduration)

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