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Beitragstitel | One-year clinical experience with an optimized epi-on CXL procedure that does not require additional oxygen nor iontophoresis and that provides clinical results similar to accelerated epi-off CXL |
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Beitragscode | P19 |
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Präsentationsform | ePoster |
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Abstract-Text |
Purpose Epithelium-on (epi-on) CXL offers several benefits such as low infection risk and quick recovery. Also, epi-on CXL is ideal for an office-based setting, reducing overall costs and facilitating access to treatment in areas with less evolved infrastructure. In the past, epi-on CXL methods either produced a suboptimal corneal stiffening effect compared with epi-off CXL, and more recently, have required extra technologies like iontophoresis and supplemental oxygen to achieve a similar stiffening effect. We report the results of a novel, pulsed, high fluence epi-on CXL that requires neither iontophoresis nor additional oxygen to achieve a stiffening effect comparable to the widely utilized 10 minutes at 9 mW/cm² accelerated epi-off CXL protocol. Setting The study was conducted at the ELZA Institute, Zurich, Switzerland. Methods A total of 60 eyes with progressive ectasia (keratoconus or post-laser refractive surgery ectasia) received 20 minutes of 0.1% riboflavin-with-penetration enhancer application, followed by an accelerated epi-on 10 J/cm² fluence CXL protocol (10 mW/cm² for 9 min 15 sec). All patients received comprehensive corneal topography, tomography and biomechanical assessments (Pentacam and CorVis ST, Oculus; MS-39, CSO Italia) plus slit lamp and visual acuity assessments at baseline, after the procedure and at all follow-up visits, including the 1-year follow-up assessment. Results We will present one year follow-up data detailing the effectiveness of this protocol in terms of halting ectasia progression, changes in topography, tomography, and Corvis ST biomechanical assessment parameters. The mean depth of the demarcation line observed was at 230 µm, similar to published data on accelerated 10 minutes epi-off CXL using 9 mW/cm2. Conclusions We previously characterized and published (TVST 2021) in pre-clinical, ex vivo studies that the use of second-generation penetration enhancers to enable transepithelial riboflavin saturation of the stroma, combined with higher UV fluences can compensate for the UV absorption and oxygen consumption and barrier effect that the presence of the epithelium causes, and generates a stiffening effect similar the most common form of epi-off accelerated CXL (10 minutes at 9 mW/cm²) – without requiring iontophoresis or supplemental oxygen. This study will show whether these effects are also present when performed in the clinical setting. |