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Intraoperative and Long-Term Corneal Biomechanical Changes in Crosslinked Keratoconic Eyes

Elena Albé MD Paolo Vinciguerra MD, Silvia Trazza, MD. P253. Boston, ASCRS, April, 2010. Intraoperative and Long-Term Corneal Biomechanical Changes in Crosslinked Keratoconic Eyes. Financial discosure: I do not have any financial interest or relationship to disclose. EYE OCULISTICA

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Intraoperative and Long-Term Corneal Biomechanical Changes in Crosslinked Keratoconic Eyes

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  1. Elena Albé MD Paolo Vinciguerra MD, Silvia Trazza, MD P253 Boston, ASCRS, April, 2010 Intraoperative and Long-Term Corneal Biomechanical Changes in Crosslinked Keratoconic Eyes Financial discosure: I do not have any financial interest or relationship to disclose. EYE OCULISTICA Istituto Clinico Humanitas Rozzano, MI, Italy Direttore: Paolo Vinciguerra, MD

  2. AIM of the STUDYTo analyze the biomechanical properties of 24 keratoconic corneas Amsler grade II undergoing CXL and correlate the intraoperative biomechanical and geometrical change t 1 baseline preCXL witht 2 after epithelium removal preCXL sinet 3 after impregnation before UVA preCXL sine2t 4 after CKL procedure postCXL sinet 5 after reepithelialization postCXL with 1,6,12 and 24 months after CXL by means ofCSO TOPOGRAPHER OCULAR RESPONSE ANALYZER PENTACAM CROSS LINKING PROCEDURE • 2% Pilocarpine drops and antipain meds 30 min before CXL. • Oxybuprocaine hydrochloride 0.2% 5 min before CXL. • LASER TEST UVA meter • Laser  370±5 nm • Power 3 mW/cm2 (= 5.4 j/cm2) • RICROLIN riboflavin 0.1% solutioninstillation each minute for 30 min • Riboflavin check absorption in anterior chamber (flare). • UVA Light Corneal irradiationPESCKE X-Linker7.5 mm Ø. • RICROLIN instillation 6 times of 5 min each • Bandage soft CL application and levofloxacin eyedrops

  3. RESULTSCH and CRF p>0.05 p<0.05 p<0.05 p<0.05 preCXL with preCXL sine Before CXL After CXL After RE-EPI

  4. Statistical significance p<0.05 RESULTS CHCorneal Hysteresis 2 years POST XL PRE XL WITH EPI PRE XL Wout EPI POST XL Wout EPI 1 month POST XL 1 year POST XL p>0.05 p<0.05 p<0.05 p>0.05 p>0.05

  5. CRF Corneal ResistanceFactor Statistical significance p<0.05 PRE XL WITH EPI PRE XL Wout EPI POST XL Wout EPI 1 month POST XL 2 years POST XL 1 year POST XL p>0.05 p<0.05 p<0.05 p>0.05 p>0.05

  6. RESULTSPeaks p<0.05 p<0.05 p<0.05 preCXL with preCXL sine After CXL After RE-EPI

  7. Peak 1 and Peak 2 p<0.05 p<0.05 p<0.05 p<0.05 1 year POST XL 6 months POST XL 2 years POST XL

  8. RESULTS CORNEAL THICKNESS p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p<0.05 p<0.05 After CXL After RE-EPI 1m 24m preCXL with preCXL sine Before CXL 6m 12m

  9. Statistical significance p<0.05 RESULTS IOPg 2 years POST XL PRE XL WITH EPI PRE XL Wout EPI POST XL Wout EPI 1 month POST XL 1 year POST XL p>0.05 p>0.05 p<0.05 p>0.05 p>0.05

  10. RESULTS IOPcc Statistical significance p<0.05 PRE XL WITH EPI PRE XL Wout EPI POST XL Wout EPI 1 month POST XL 1 year POST XL 2 years POST XL p>0.05 p<0.05 p<0.05 p>0.05 p>0.05

  11. CONCLUSIONWhat Happens during Cross Linking? Epithelium removal Increases corneal curvature Reduces corneal thickness Reduces light detected during applanation peaks Does not influence corneal biomechanical properties CH and CRF MullerLJ, Pels E, Vrensen GFJM.The specific architecture of the anterior stroma accounts for the maintenance of corneal curvature.BJO.2001;85:437-43 The specific architecture of the most anterior part of the corneal stroma (100-120 microns) has been suggested to be responsible for the stability of the corneal shape. Gatinel D, Chaabouni S, Adam PA, Munck J, Puech M, Hoang-Xuan T. Corneal hysteresis, resistance factor, topography, and pachymetry after corneal lamellar flap. JRS.2007;23:76-84 The creation of a stromal flap can modify the biomechanical properties of the cornea, including a reduction of corneal hysteresis

  12. CONCLUSIONWhat Happens after Cross Linking? • T-dextran and riboflain dehydrate cornea along CXL • Cornea dehydration affects biomechanical properties • increases CH and CRF • reduces light detected during applanation Peaks • Rehydration and corneal oedema affect corneal biomechanical properties • Reduces CH and CRF • Reduces light detected during applanation Peaks • Peak 1 and Peak 2 increase after CXL, suggesting a reduction in KC deformation. • IOPg and IOPcc remain higher till steroid admin. • At 24 months, CXL does not induce any change in IOP. • CXL induces a significant reduction in corneal thickness and total corneal volume, however corneal thickness recovers at 1 year follow-up.

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