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Binkhorst Lecture: Epi-on cross-linking achieves favorable visual results for keratoconus, ectasia
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NEW ORLEANS — Patients with keratoconus and corneal ectasia who underwent epi-on cross-linking achieved favorable visual results, according to a speaker here.
“We know now [that the epi-on procedure] is effective, produces less pain, provides a much more rapid visual recovery, increases best spectacle corrected visual acuity – which is equivalent to or perhaps better than reported epi-off results – and there’s a much less likelihood of complications with this technique than the classical Dresden technique,” R. Doyle Stulting, MD, PhD, said during the Binkhorst Lecture at the American Society of Cataract and Refractive Surgery meeting.
R. Doyle Stulting
Most complications of cross-linking are a result of epithelial removal, but the epithelium is a barrier to riboflavin absorption, Stulting said.
Stulting said that not only is the procedure safer, but also it can be repeated with minimal risk. Or, an epi-off procedure could be performed later if needed.
Stulting and colleagues of the CXLUSA group conducted a prospective, nonrandomized, multicenter, observational study including 569 eyes in patients older than 8 years of age. Of these eyes, 479 were keratoconic, 74 had ectasia and 16 had pellucid marginal corneal degeneration.
The CXLUSA technique of epi-on was different than the traditional technique, Stulting said. The CXLUSA technique used a novel riboflavin formulation, physician verification and saturation as needed, no riboflavin applied during UVA exposure to prevent blockage in the UVA light and pulsed UVA to allow oxygen to enter the cornea.
In the midst of the study, there were publications outside the U.S. reporting progression of keratoconus in patients who underwent epi-on cross-linking, Stulting said.
“This led us to take a closer look at our protocol and observations,” Stulting said. “The quantification shows a four-fold greater concentration of riboflavin in the CXLUSA formulation [compared to the commercially available formulation].”
Uncorrected visual acuity (UNVA) and best spectacle corrected visual acuity (BSCVA) improved in the 12-month consistent cohort of 137 patients. Mean UNVA at baseline and 12 months was 20/157 and 20/111, respectively. Mean BSCVA at baseline and 12 months was 20/36 and 20/27, respectively.
Mean maximum keratometry decreased 0.2 D from 56.43 D at baseline to 56.20 D at 12 months.
Improvement was also seen in the 24-month consistent cohort of 33 patients who demonstrated mean UNVA at baseline and 24 months was 20/152 and 20/100, respectively. Mean BSCVA at baseline and 24 months was 20/35 and 20/27, respectively.
“I hope in the future that there will be a transition to a safer epi-on procedure that avoids the complications of epithelial removal that we all know so well now,” Stulting said. – by Nhu Te
Reference:
Stulting D. Binkhorst Lecture: Predicting and treating corneal ectasia. Presented at: American Society of Cataract and Refractive Surgery meeting; May 6-10, 2016; New Orleans.
Disclosure: Stulting reports he has financial interests with Abbott Medical Optics, Alcon, Allergan, Calhoun Vision, Cambium Technologies, Carl Zeiss Meditec, EyeYon, Ophtec, Optovue, TearLab and Vision Care Technologies.