One-year data confirm efficacy of high-fluence accelerated epi-off cross-linking
Key takeaways:
- The Dresden protocol for cross-linking has so far shown unmatched results in progressive keratoconus.
- Results show that high-fluence accelerated epi-off CXL has comparable efficacy.
ATHENS, Greece — One-year data of high-fluence accelerated epithelium-off corneal cross-linking for keratoconus showed efficacy comparable to cross-linking with the Dresden protocol, according to a speaker at the ESCRS winter meeting.
“The Dresden protocol was so far the most effective procedure in cross-linking,” Emilio Torres-Netto, MD, PhD, FWCRS, told Healio. Between soaking time and the 30-minute UV irradiation, it takes up to 1 hour, but it is still in use because of its proven effectiveness.
Several accelerated protocols have been proposed to make the procedure faster, improving patient comfort and clinic flow. However, it was not easy to find the right balance between time and efficacy.
“In past years, we have been using the Dresden protocol for cases that were more aggressive and likely to progress, in children for instance, reserving the accelerated protocols for the other cases,” Torres-Netto said.
However, research at the ELZA Institute in Zurich has continued to focus on ways to improve CXL efficiency and achieve higher efficacy in less time. Laboratory data published 2 years ago showed the efficacy of a high-fluence accelerated protocol that has a similar strengthening effect to the Dresden protocol but takes a fraction of the time, close to the accelerated protocols of 9 or 10 minutes. The high-fluence epi-off CXL method delivers 18 mW/cm² of UV energy for 9’15” of continuous irradiation, with a total fluence of 10 J/cm².
“One-year follow-up data of patients who have undergone accelerated high-fluence cross-linking show stability of endothelial cell density, stability of the disease in around 95% of the eyes over 1 year, and very deep demarcation lines,” Torres-Netto said.
No significant changes were found in thinnest corneal and epithelial thickness, manifest refraction spherical equivalent, Q-value, densitometry and endothelial cell density.
Torres-Netto believes that this protocol will replace the Dresden protocol in cases of progressive keratoconus or post-refractive surgery ectasia in which a superior strengthening effect is needed, largely due to the advantages of reducing procedure time and improving patient comfort.
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Torres-Netto E, et al. A high-fluence accelerated epi-off CXL provides a similar clinical biomechanical effect to Dresden protocol CXL: 1-year follow-up data. Presented at: ESCRS winter meeting; Feb. 28-March 2, 2025; Athens, Greece.
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