Personalized cross-linking
Dermot McGrath
Published: Sunday, September 23, 2018
François Malecaze MD, PhD.
CUSTOMISED or topography-guided corneal cross-linking CXL (TG-CXL) may offer keratoconus patients a new option in personalised CXL with the potential for improvements in visual outcomes, according to François Malecaze MD, PhD.
“The goal is to selectively cross-link weaker zones on the cornea by administering customised UV patterns and this approach holds the promise of further optimisation in the future,” Dr Malecaze told the audience at the joint ESCRS/EuCornea symposium on Corneal Cross-Linking: Current Status and Future Perspectives”.
There are two main theoretical advantages of TG-CXL, noted Dr Malecaze.
“Recent research using Brillouin microscopy into corneal biomechanics suggests that pathology is centred on the cone. A customised treatment, therefore, should induce a local stiffening, flatten the cone and consequently improve visual function,” he said.
Dr Malecaze noted that TG-CXL induces a greater flattening effect than conventional CXL, as well as producing a gradient in the biological response to treatment from the area of the cone to the surrounding area.
While clinical results of TG-CXL to date have confirmed a greater flattening of K-max readings and improved corneal regularisation, the goal in the future will be to deliver a personalised treatment using epi-on CXL for better patient comfort and oxygen pulses for more enhanced flattening effect, he said.
“It holds a lot of promise. TG-CXL is safe and efficient to treat progressive keratoconus and is currently the most adapted solution to customise treatment to each patient. Promising improvement is expected with the introduction of trans-epithelial riboflavin solution and oxygen saturation,” he said.