john kanellopoulos, md clinical associate professor nyu medical school, ny
DESCRIPTION
Long term comparison of sequential to combined collagen cross-linking (CXL) and limited topography-guided PRK ( tPRK ) for keratoconus (KCN ) World Cornea Congress Boston 2010. John Kanellopoulos, MD Clinical Associate Professor NYU Medical School, NY - PowerPoint PPT PresentationTRANSCRIPT
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Long term comparison of sequential to combined collagen cross-linking (CXL) and limited topography-
guided PRK (tPRK) for keratoconus (KCN )
World Cornea Congress Boston 2010
Long term comparison of sequential to combined collagen cross-linking (CXL) and limited topography-
guided PRK (tPRK) for keratoconus (KCN )
World Cornea Congress Boston 2010
A. John Kanellopoulos, MDClinical Associate Professor NYU Medical School, NY
Director, Laservision.gr Institute, Athens, Greece
Financial interest: travel expense reimbursement from Wavelight (in the past)
A. John Kanellopoulos, MDClinical Associate Professor NYU Medical School, NY
Director, Laservision.gr Institute, Athens, Greece
Financial interest: travel expense reimbursement from Wavelight (in the past)
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We introduced utilizing a partial topography-guided PRK normalization in progressive keratoconic corneas previously stabilized by CXL.(Kanellopoulos AJ & Binder P: J Cornea July 2007) The topography story line below shows; A; pre-op, B: post CXL, C: difference A-B, D: the topo-guided treatment plan with the Wavelight platform, E: the conrea a year later, F: the difference B-E. G and H show the other untreated eye
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Our combined technique employs the partial PRK first, then riboflavin drops and CXL
immediately after:
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Methods new technique: Methods new technique:
• 1-Topo-customised surface ablation• Epithelial removal: 6.5mm 50nm PTK• Custom topography-guided treatment utilizing
Wavelight topo-guided software (topo or oculink) • (75% cylinder, some or all sphere limited by
cornea thickness up to 50 microns, OZ at least 5mm)
• MMC 0.02% for 30 sec
• 1-Topo-customised surface ablation• Epithelial removal: 6.5mm 50nm PTK• Custom topography-guided treatment utilizing
Wavelight topo-guided software (topo or oculink) • (75% cylinder, some or all sphere limited by
cornea thickness up to 50 microns, OZ at least 5mm)
• MMC 0.02% for 30 sec
•2-Then UVA CCL 3mW/cm2 for 30 minutes with riboflavin 0.1% drops•Follow-up 18-36 months
•2-Then UVA CCL 3mW/cm2 for 30 minutes with riboflavin 0.1% drops•Follow-up 18-36 months
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325 KCN cases were evaluated for UCVA, BSCVA, refraction, keratometry (K), topography, endothelium and clarity. 115 eyes (group A) had tPRK at least 6 months following CCL, 200 eyes (group B) had first tPRK combined with CCL. Mean follow-up was 26 months.
325 KCN cases were evaluated for UCVA, BSCVA, refraction, keratometry (K), topography, endothelium and clarity. 115 eyes (group A) had tPRK at least 6 months following CCL, 200 eyes (group B) had first tPRK combined with CCL. Mean follow-up was 26 months.
Study designStudy design
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ResultsResults
• Group A (had tPRK at least 6 months following CXL): The mean improvement of UCVA was 0.12 to 0.41, BSCVA 0.42 to 0.68.
• Group B (had first tPRK combined with CXL): UCVA 0.11 to 0.5, BSCVA: 0.41 to 0.78.
• Statistically group B did better in all fields evaluated.
• Group A (had tPRK at least 6 months following CXL): The mean improvement of UCVA was 0.12 to 0.41, BSCVA 0.42 to 0.68.
• Group B (had first tPRK combined with CXL): UCVA 0.11 to 0.5, BSCVA: 0.41 to 0.78.
• Statistically group B did better in all fields evaluated.
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Clinical signs of CXL
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A 24 y/oPre: UCVA 20/200 -4.5 -1.50 X 180 20/302 months post: UCVA 20/20 -0.25 -0.75 X34
A 24 y/oPre: UCVA 20/200 -4.5 -1.50 X 180 20/302 months post: UCVA 20/20 -0.25 -0.75 X34
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Conclusions:Conclusions:
• In this study we showed that UVA CXL following a limited topo-guided PRK may be a safe treatment to stabilize KCN and post-LASIK ectasia.
• Visual rehabilitation has been very gratifying• Most treatments delivered more than planned >
need for underscoring nomogram• Our therapeutic goal has not been emmetropia, but
normalization of the cornea and improvement in BSCVA
• In this study we showed that UVA CXL following a limited topo-guided PRK may be a safe treatment to stabilize KCN and post-LASIK ectasia.
• Visual rehabilitation has been very gratifying• Most treatments delivered more than planned >
need for underscoring nomogram• Our therapeutic goal has not been emmetropia, but
normalization of the cornea and improvement in BSCVA
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ConclusionsSequential tPRK and CCL appear to be superior to
the rehabilitation of KCN.The advantages in pre-treating with the topo-
guided PRK are:• 1- just one procedure• 2-less PRK associated scarring• 3-No need to remove cross-linked cornea
• This technique may prevent PK as a necessary option and may have wide application
• Longer follow-up and further studies are necessary
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Thank you
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