cross linking dogs_cats_famose_ecvo
TRANSCRIPT
* EVALUATION OF ACCELERATED-CXL FOR THE TREATMENT OF MELTING KERATITIS IN 8 DOGS AND 10 CATS
* Collagen Cross-Linking
Dr Frank FAMOSE – Toulouse - [email protected] 2013
Melting keratitis
MMP imbalance
Infectious and non-infectious origin
Treatment : antibiotics& anticollagenases
Evolution : perforation
Surgery
Collagen reticulation
Anti-infectious effects
Keratocyte apoptosis
Photochemicalprocess
CXL
Background
StandardProtocol30min 3mW/cm²
Aim of this study
Inclusion criteria
Dogs and cats
Corneal melting
Poor response to medical treatment
Inclusion criteria
Epithelial loss
Cellular infiltration andstromal dissolution
Minimal Corneal thickness> 300 µm
Protocol
Generalanesthesia
Cornealcleaning
Riboflavinesoaking
ExpositionUVA 365 nm
Post-CXLtreatment
OCT
MedetomidineKetamineIsoflurane
Debris removalBact. sampling
PCR (FHV1)
RF 0,1% 20% dextran(VibexTM)
1 drop ev. 2 min30 minutes
30 mW/cm�3 min
5,4J/cm�
TobrexTM BID7 days
Accelerated protocol(KXLTM – Avedro)
Follow-up
Inclusion D4 D8 D15 D31
Pain and clinical score
Fluorescein test
Follow-up
0 : absent1 : light2 : moderate3 : severe
0 : absent1 : present
Results
Pretreatment data
Results
8 Dogs 10 Cats
Corneal infiltration
D1 D8
8/8 dogs – 10/10 cats 0/8 dogs – 0/10 cats
Corneal vascularization
D1 D31
8/8 dogs – 10/10 cats 2/8 dogs – 3/10 cats
Corneal vascularization
D1 D31
8/8 dogs – 10/10 cats 2/8 dogs – 3/10 cats
Corneal scar
D1 D31
8/8 dogs – 10/10 cats
Corneal scar
D1 D31
8/8 dogs – 10/10 cats
Discussion
Reduction of clinicaland pain score
UV light - Free radicals ?
Physical modifications of the cornea
Biological responses of the cornea ?
No Control Group
Standard or accelerated protocol ?
Standard3 mW/cm²30 minutes
« Flash »30 mW/cm²3 minutes
5,4 J/cm²
Total durationabout 1h20
Total durationabout 40 min
Samebiologicaleffects ?
Same energydelivered
Adverse reactions
Infections
Herpesvirus reactivation
Endothelial damage
In humans
No adverse reaction attributableto the treatment
Conclusion
Efficacy
No adverse reaction
Shorteranesthesia
duration
Impending perforation ?
5,4J/cm²
Are antibioticsstill necessary after CXL?
Long term ? Corneal sensitivity ?Drug penetration ?
Normal cat
3 monthsPost CXL
Thank you.