ESCRS - PO264 - Transepithelial Ionthophoretic Corneal Collagen Cross Linking (I-Cxl-Te) With Dresda Protocol Uv-Irradiation In Pediatric And Young Adult Patients Affected By Progressive Keratoconus (P-Kc): Results At 72 Months.

Transepithelial Ionthophoretic Corneal Collagen Cross Linking (I-Cxl-Te) With Dresda Protocol Uv-Irradiation In Pediatric And Young Adult Patients Affected By Progressive Keratoconus (P-Kc): Results At 72 Months.

Published 2022 - 40th Congress of the ESCRS

Reference: PO264 | Type: ESCRS 2022 - Posters | DOI: 10.82333/63ah-5a72

Authors: Salvatore Troisi* 1 , Ciro Caruso 2 , Mario Troisi 3 , Ciro Costagliola 4

1Ophthalmology,Salerno University Hospital,Salerno,Italy, 2Eye bank,Pellegrini Hospital ,Napoli,Italy, 3Ophthalmology,Salerno University Hospital,Salerno,Italy;Ophthalmology,University of Naples Federico II,Napoli,Italy, 4Ophthalmology,University of Naples Federico II,Napoli,Italy

Purpose

Undesirable effects have been reported in the literature in about 7% of patients undergoing cross-linking with removal of the epithelium (epi-off CXL). Purpose of the study  is to evaluate refractive and tomographic long-term efficacy and safety of i-CXL-TE associated with 3 mW/cm2 UV-irradiation for 30 minutes (Dresda protocol) in pediatric and young adult patients with progressive keratoconus. We evaluated the role of this technique in patients aged from 12 to 35 years with tomographic progression (increase in Kmax>1.5 diopters or reduction of thinnest point>20 micron) or increase in refractive values >0.75 cylinder diopters in the previous 6 months. The results at 72 months of follow up and the side effects, if present, were reported.

Setting

Ophthalmologic Unit of Salerno  University Hospital, Center of Ocular Surface Pathology (Salerno, Italy).  The study was conducted according to the principles of the Declaration of Helsinki. The study was approved by the Institutional Ethics Committee.

Methods

108 eyes of 79 patients with tomographic or refractive progression of KC in the previous 6 months who underwent iCXL-TE from 01.10.2013 to 31.12.2015, were enrolled in the study. Exclusion criteria: diabetes, immune system diseases, herpetic keratitis, corneal scarring, corneal thinnest point <380microns, endothelial cell density <2000/mm2, pregnancy and breastfeeding.

Epi-on imbibition was performed with a dedicated 0.1% hypotonic riboflavin solution and iontophoretic method for 5 ', followed by Dresda protocol irradiation (3mW/cm2 for 30'). Clinical evaluation and tomographic follow-up by Scheimpflug camera was performed  at 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 60 and 72 months.

Results

Mean increase in Kmax values was +1.91 +/- 0.32D over the 6 months prior to treatment.  Post-treatment mean Kmax values decreased by -0.49 +/-0.83D, -0.88 +/-0.91D, -1.07 +/-1.14D, -1.02 +/-1.11D, -0.96 +/-1.18D , -0.91 +/-1.11, -0,88+/-1.14D at 6, 12, 24, 36, 48, 60, 72 months respectively; 8 eyes needed retreatment. In 77 eyes there was a reduction in Kmax values at 72 months, in 81 eyes there was an improvement in visual acuity (BSCVA -0.18 +/-0.13 LogMar: p<0.05); endothelial counts and tone unchanged during the study. We had two cases of moderate haze, which were resolved in the six months following the treatment; we did not observe other side effects.

Conclusions

The i-CXL-TE treatment seems to halt the worsening of keratoconus at 72 months follow up; there is a statistically significant improvement in mean visual acuity and a reduction in Kmax in 67% of treated patients, comparable with epi-off CXL. No relevant side effects are reported. The results obtained appear significant especially in consideration of the rate of progression of the keratoconus in the six months prior to the treatment. The rapid execution time of the iontophoretic procedure, the safety and the reduced invasiveness allow a better patients compliance. For these reasons the iontophoretic method must be considered with great interest especially in pediatric and young adult patients.