Deep demarcation line shows efficacy of transepithelial CXL with supplemental oxygen
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Transepithelial corneal cross-linking with supplemental oxygen achieved comparable corneal stromal demarcation line depth to that of conventional epi-off CXL and had a similar safety profile in a study.
“Added advantages were faster recovery and improved patient comfort,” Lim Li, MD, said at the European Society of Cataract and Refractive Surgeons meeting.
Typically, epi-on CXL shows a shallower demarcation line as compared with epi-off CXL, indicating insufficient UV light penetration and efficacy of the procedure. In the literature, a 60% rate of keratoconus progression was reported with the epi-on procedure as compared with a 6% rate with epi-off.
“The new Boost epi-on procedure (Glaukos) addresses the limitations of epi-on by focusing of the three components of CXL: higher riboflavin concentration of 0.25% combined with benzalkonium chloride to improve the penetration, higher power UVA light of 10 J/cm² and goggles infused with 90% oxygen concentration throughout the procedure,” Lim said.
The study, conducted at Singapore National Eye Centre, included 25 eyes of 25 patients with progressive keratoconus who underwent transepithelial CXL with supplemental oxygen.
“The procedure involves a 10-minute application of the transepithelial riboflavin formulation, following which the Boost goggles are worn and supplemental oxygen infusion is set to 90% concentration. The central 9 mm of the cornea is irradiated with 30 mW/cm² of UVA light, pulsed at 1-second intervals for 11 minutes and 6 seconds, giving a total energy of 10 J/cm². Finally, a bandage contact lens is applied,” Lim said.
Twenty of 25 eyes had spectral-domain OCT performed. Twelve eyes (60%) had a grade 3 clearly visible and measurable demarcation line, and eight eyes (40%) had a grade 2 not clearly measurable but visible demarcation line. The mean depth of the demarcation line was 367 µm.
“Endothelial cell count was not significantly different from preop. Mild corneal haze was reported in eight eyes (32%), and one patient (4%) had peripheral stromal infiltrate that resolved with topical broad-spectrum antimicrobial treatment,” Lim said.
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Lim L. Corneal stromal demarcation line and safety of transepithelial corneal cross-linking with supplemental oxygen in keratoconus. Presented at: European Society of Cataract and Refractive Surgeons meeting; Oct. 8-11, 2021; Amsterdam.
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