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Beitragstitel One-year clinical experience with PACE (Second generation customized corneal cross-linking) to reduce corneal topographical asymmetry and improve vision in patients with keratoconus and ectasia after LASIK
Beitragscode P20
Autor:innen
  1. Farhad Hafezi ELZA Institute & Universität Genf Präsentierende:r
  2. Emilio A. Torres-Netto ELZA Institute AG
  3. Shady Awwad American University of Beirut Medical Center
  4. Enes Aydemir ELZA Institute AG
  5. Mark Hillen ELZA Institute AG
  6. Léonard Kollros ELZA Institute AG
  7. Nikki L. Hafezi ELZA Institute AG
  8. Francesco Versaci CSO Italia
Präsentationsform ePoster
Themengebiete
  • External Disease / Cornea
Abstract-Text Purpose
PTK-assisted customized epi-on (PACE) corneal cross-linking (CXL) is a new method developed by ELZA which involves a PTK (phototherapeutic keratotomy) over the cone while avoiding any stromal tissue removal. Several gradients are created to achieve the customized effect: First, the PTK area is an epi-off CXL area as opposed to the rest of the cornea, which is treated in an epi-on fashion. Second, once riboflavin is applied, it generates a riboflavin gradient with highest concentrations in the epithelium-denuded region. A differential UV gradient is also applied, where the highest fluences are delivered over the cone. PACE achieves substantial corneal flattening, several diopters greater than first-generation customized CXL.


Setting
ELZA Institute, Dietikon, Zurich, Switzerland.

Methods
This prospective study involved PACE being performed on 122 eyes with ectasia (keratoconus, n=118; post-laser refractive surgery ectasia, n=4).
We report on the 1-year topographic, tomographic and visual outcomes of eyes with either stable or progressive corneal ectasia that underwent PACE cross-linking.
The procedure was performed by one of two surgeons (FH, ETN) at a single site (ELZA Institute, Zurich). All patients underwent a comprehensive assessment of corneal topography and tomography using (Pentacam, Oculus; MS-39, CSO Italia), corneal biomechanics (Corvis ST, Oculus) and conventional visual acuity assessments before PACE, and at regular intervals post-surgery, as well as at the one-year follow-up visit.

Results
We will show how PACE successfully reduces corneal topographical asymmetry by up to 12 D and will detail the changes in topographic and biomechanical parameters reflecting corneal flattening and asymmetry reduction. Subgroup analyses will reveal demographic and pre-procedural corneal characteristics linked to significant flattening and regularization effects, alongside visual outcomes. assess if these effects are consistent across progressive and non-progressive ectasias.

Conclusions
By exploiting both riboflavin and UV light gradients, PACE cross-linking can deliver greater corneal regularization effects than earlier customized cross-linking approaches, without removing any stromal tissue. PACE improves the quality of vision by not only flattening the steep areas of the keratoconus, but also by a coupling effect that regularizes the astigmatism in the upper cornea.