Corneal Collagen Cross-linking For The Treatment Of Keratoconus Dr. A. Arafat, M.D., Al-Noor Eye...
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Transcript of Corneal Collagen Cross-linking For The Treatment Of Keratoconus Dr. A. Arafat, M.D., Al-Noor Eye...
Corneal Collagen Cross-linking For The Treatment Of Keratoconus
Dr. A. Arafat, M.D.,
Al-Noor Eye Center,
Specialized Arab Hospital
Nablus, Palestine
An Everyday Storyيوميا مثلها نصادف حالة
• A 17-year old female patient presented for changing her glasses. She last changed them 6 months ago.
Corneal cross linking uncorrected visual acuity
• Right eye : 6/60
• Left eye: 6/24
Corneal cross linking Autorefractor Readings
• Right : -2.50/-0.75 Axis 51
• Left : -2.25/-4.50 Axis 141
Corneal cross linking Best spectacle corrected visual acuity
• Right eye: -2.25/-0.50 Cyl. Axis 65 = 6/6
• Left eye: -1.00/-1.00 Cyl. Axis 95 = 6/6
Corneal cross linking Clinical Examination
• No detectable anterior segment abnormality in either eye
• No fundus abnormality in either eye
Introduction
Methods of Management of Keratoconus
Classical Methods:
• Glasses• Rigid gas-permeable contact lenses• Penetrating keratoplasty
Methods of Management of Keratoconus
New Methods:
• Glasses• Rigid gas-permeable contact lenses• Corneal cross linking• Intracorneal rings• Phakic intraocular lenses• Deep Lamellar keratoplasty• Penetrating keratoplasty
Corneal cross linking
• Useful to stop the progression of the disease
• Minimal improvement in vision
• Minimal decrease in K-readings
• Can be done till age of 38 years
• The earlier the keratoconus the better
• Corneal thickness <400 microns
Corneal cross linking Work-up
• Complete ophthalmologic examination• Uncorrected visual acuity [UCVA],• Best spectacle-corrected visual acuity
[BSCVA]• Keratometry • Corneal topography & tomography
(Pentacam)
Patient Inclusion Criteria
• Pachymetry >400 microns
• K readings <60D
• No central scarring
• No herpes simplex keratitis
Corneal cross linking Study Procedure
• Topical anaesthesia & povodine iodine
• Corneal epithelium is removed
• Riboflavin eye drops are applied Q 3 minutes for 30 minutes
• flare in A.C. is checked
• Pachymetry: if less than 400 microns hypotonic riboflavin is used Q 15 seconds till thickness is 400 or more
Corneal cross linking Study Procedure-continued
• Cornea is exposed to ultraviolet rays for 30 minutes (10 minutes in new machines)
• Riboflavin still applied Q 2 minutes using UV-X machine
• A bandage contact lens is applied
• Antibiotic & steroid eye drops are applied
• Patient is seen next day
Patient Treatment
Corneal cross linkingFollow up
• Contact lenses are removed after 3-4 days
• Eye drops are tapered over one month
• Further management by glasses, RGP contact lenses or intracorneal rings
Corneal cross linkingComplications
• Infection: Rare
• Corneal haze: Temporary
• Corneal oedema: Transient
• Corneal endothelial decompensation: Not seen in our series
Conclusions
• The procedure is effective & safe
• The main effect is stabilising
• Probably best for recent onset, milder, younger, progressive cases
Recommendations Evidence of progression
• Make use of : serial refractions ,medical records and old glasses)
• Any change greater than 0.50 D from the above could point to unstable refraction
• Below 20 years of age: No need for evidence of progression