New Tel-Aviv protocol combines cross-linking with tissue-sparing laser ablation procedure

ATHENS, Greece — A new protocol for customized laser ablation combined with corneal collagen cross-linking provides good visual acuity improvement while halting keratoconus progression, according to a poster presented at the European Society of Cataract and Refractive Surgeons Winter Meeting.

CXL is the gold standard for treating progressive keratoconus. However, the conventional CXL procedure has a limited effect on vision. Existing protocols that address this issue by combining CXL and refractive techniques, such as the Athens and Cretan protocols, have the disadvantage of leading to significant corneal thinning.

“The idea of the Tel-Aviv protocol is to halt progression and improve UCVA and BCVA while leading to as little corneal thinning as possible,” Michael Mimouni, MD, said.

Results from a study of 131 patients showed that the Tel-Aviv protocol resulted in better improvement of visual acuity and more flattening of the cornea as compared with standard CXL, with only 15 µm more thinning.

“The excimer laser is set in the PRK mode, epithelium on, and we enter into the treatment parameters 50% of the cylindrical power on axis with the manifest refraction axis,” Mimouni said. “Then we take whatever we have left, up to 60 µm of ablation, and enter that into the spherical treatment parameter of the machine. After performing the excimer laser ablation, we perform a 10-minute accelerated CXL. As mentioned earlier, our results showed significant improvement in all the examined parameters, with only 15 µm more thinning than regular standard CXL,” Mimouni said.

He suggested that the Tel-Aviv protocol, developed by Igor Kaiserman, should be considered for patients with progressive keratoconus and corneas above 430 µm. – by Michela Cimberle

Reference:

Mimouni M, et al. Customized laser epithelial removal and corneal collagen cross-linking for keratoconus: the Tel-Aviv protocol. Presented at: ESCRS Winter Meeting; Feb. 15-17, 2019; Athens, Greece.

Disclosure: Mimouni reports no relevant financial disclosures.

Editor's note: This article has been updated to name Igor Kaiserman, MD, as the originator of the Tel-Aviv protocol.