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Accelerated cross-linking protocol may be as effective as standard protocol
ROME — A second-generation cross-linking device offers increased intensity and optimized beam shaping in order to accelerate and enhance the treatment of keratoconus, according to a specialist here.
“The effect of cross-linking depends on the energy doses, so you can theoretically obtain the same effect by increasing the intensity and decreasing the time of irradiation,” Silvia Schumacher, MD, said at the joint Refractive.online and SICCSO meeting.
Silvia Schumacher
Standard cross-linking is performed for 30 minutes with an intensity of 3 mW/cm².
Schumacher and colleagues at the Institute for Refractive and Ophthalmic Surgery in Zurich demonstrated that the same cross-linking effect can be obtained with 10 mW/cm² for 9 minutes. Preliminary data by Spoerl show that it may also work at 45 mW/cm² with an illumination time of 2 minutes.
The accelerated protocol entails removal of the epithelium, riboflavin 0.1% administration every 2 minutes for 30 minutes, and ultraviolet light delivery at 9 mW/cm² for 10 minutes. Total treatment time is decreased from 1 hour to 40 minutes.
Six-month data on 38 eyes showed that equal effects in terms of stress and strain are achieved with the accelerated protocol compared to the standard protocol.
Maintaining the standard protocol for riboflavin application is mandatory to allow the photosensitizing agent to penetrate into the deeper stromal layers, according to Schumacher.
“Shortcuts at this stage, like administering riboflavin for only 5 minutes, are what leads accelerated protocols with other systems to decreased efficacy,” Schumacher said.
- Disclosure: Schumacher has no relevant financial disclosures.