Preliminary outcomes show advantages of high-oxygen epi-on customized CXL
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Preliminary results of an ongoing study on topography-guided customized corneal cross-linking indicate that the high-oxygen epi-on protocol leads to less pain and faster improvement as compared with the epi-off procedure in room air.
“We have shown previously that customized remodeled vision (CuRV) CXL has refractive advantages over conventional CXL in keratoconus. In an ongoing study, we are now comparing the results of one eye treated with epi-on CuRV in high oxygen and one eye with epi-off CuRV in room air in 45 patients,” Anders Behndig, MD, PhD, said at the virtual European Society of Cataract and Refractive Surgeons winter meeting.
The treatment protocol consists of HPMC-riboflavin imbibition for 10 minutes followed by individualized treatment patterns with a maximum effect of 7.2 J/cm2 to 16 J/cm2, depending on maximum keratometry. The treatment localization is based on the posterior corneal surface with maximum effect at the steepest point of the corneal posterior surface and a tapering of 2 J/2 D of less effect toward the periphery. The 6-mm vertex-centered zone is treated with 5.4 J/cm2. For epi-on, humidified oxygen at 2.5 L per minute is flushed over the eye via Boost goggles (Glaukos) during the entire procedure. The average treatment time is 16.4 minutes per eye.
“Significantly less pain was reported in the 8 hours after treatment with epi-on,” Behndig said. “Both CDVA and UDVA improved at 6 and 12 months with both protocols, and no differences were found between the groups. However, low-contrast acuity improved faster with the epi-on protocol.”
Improvement for low-contrast acuity at 10% was seen at 1 month with epi-on and at 6 months with epi-off and was then stable over the follow-up. No differences were found at 6 months and 12 months. The same was found for low-contrast acuity at 2.5%, with improvement at 3 months with epi-on and 12 months with epi-off. No adverse events and no change in endothelial cell count were reported.
“These preliminary results indicate that the high-oxygen epi-on treatment protocol is promising as an alternative to epi-off CuRV. The final results of our study are approaching,” Behndig said.
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Behndig A. Individualized topography-guided crosslinking for keratoconus – comparison of epi-on in high oxygen to epi-off in room air protocols. Presented at: European Society of Cataract and Refractive Surgeons winter meeting; Feb. 18-20, 2022 (virtual meeting).
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