Accelerated CXL for the treatment of bullous keratopathy

Accelerated CXL for the
treatment of bullous keratopathy
Zürich November 5th, 2014
Dr Frank Famose – DVM - DESV
Toulouse – France
frankfamose@gmail.com
Outline
What is bullous
keratopathy (BK) ?
What are the
treatments ?
BK and CXL
Definition
Chronic superficial
corneal ulceration
Intense corneal
edema
Ocular pain
Loss of vision
Epithelial edema
Ulceration
Stromal edema
Bullae
Endothelial impairment
The endothelial failure
Endothelial
dystrophy
Degenerative
Post-surgical
Glaucoma
Anterior
Uveitis
Feline « bullous keratopathy »
Corneal hydrops
Treatment
Chronic superficial
corneal ulceration
Intense corneal
edema
Stromal abrasion
Surface
treatments
Topical
Hyperosmotic
drugs
Conjunctival grafts
Thermokeratoplasty
Poor results
BK and CXL : the Human experience
Compaction of the
corneal stroma
Decreased thickness
Improved transparency
Reduced anterior
stromal pressure
More than 30 publications
since 2007
Temporary symptomatic relief
and visual improvement
BK and CXL : the veterinary experience
2 case series
10 dogs, no cats
2 different protocols
Does it work ?
Protocol
Dogs with BK
Accelerated CXL
(30 mW/cm²)
No glaucoma
No hyperosmotic
preparation
Failure of
Previous treaments
6 Months Follow-up
Results
Ulceration
Resolved in 1 week
Discussion : epithelial healing
Early healing
Pain resolution
6 months duration
Same results in the 2 case reports
Discussion : corneal thickness and edema
Early improvement
Return to baseline
Visual improvement ?
Same results in the 2 case reports
Conclusion
CXL useful for BK-induced
corneal ulceration
Short-lasting action
on corneal edema
Protocol
adaptations
More
cases…
Dawson DG, Edelhauser HF. Corneal edema. In: Ocular Disease – Mechanisms and Management (ed. Levin LA, Albert DM). Saunders
Elsevier, Whaltham, 2010; 64-73.
Ghanem RC, Santhiago MR, Berti TB et al. Collagen cross-linking with riboflavin and ultraviolet-A in eyes with pseudophakic bullous
keratopathy. Journal of Cataract and Refractive Surgery 2010; 36: 273-276.
Narayanan R, Gaster RN, Kenney MC. Pseudophakic corneal edema: a review of mechanisms and treatments. Cornea 2006; 25: 993-1004.
Wollensak G. Crosslinking treatment of progressive keratoconus: new hope. Current Opinion in Ophthalmology 2006; 17: 356-360
Wollensak G, Aurich H, Pham TD et al. Hydration behavior of porcine cornea crosslinked with riboflavin and ultraviolet A. Journal of
Cataract and Refractive Surgery 2007; 33: 516-521.
Sharma N, Roy S, Maharana PK et al. Outcomes of corneal collagen crosslinking in pseudophakic bullous keratopathy. Cornea 2014; 33: 243246.
Arora R, Manudhane A, Saran RK et al. Role of corneal collagen cross-linking in pseudophakic bullous keratopathy. Ophthalmology 2013.
Advance online publication. DOI : 10.1016/j.ophtha.2013.07.037.
Bottos KM, Hoffling-Lima AL, Barbosa MC et al. Effects of collagen cross-linking in stromal fibril organization in edematous human corneas.
Cornea 2010; 29: 789-793.
Sondergaard AP, Ivarsen A, Hjortdal J. Reduction of stromal swelling pressure after UVA-riboflavin cross-linking. Investigative
Ophthalmology and Vision Science 2013 ; 54: 1625-1634.
Wollensak G, Aurich H, Wirbelauer C et al. Potential use of riboflavin/UVA cross-linking in bullous keratopathy. Ophthalmic Research 2009;
41: 114-117.
Ehlers N, Hjortdal J, Nielsen K et al. Riboflavin-UVA treatment in the management of edema and nonhealing ulcers of the cornea. Journal of
Refractive Surgery 2009; 25; 803-806.
Hafezi F, Dejica P, Majo F. Modified corneal collagen crosslinking reduces corneal oedema and diurnal visual fluctuations in Fuchs dystrophy.
British Journal of Ophthalmology 2010; 94: 660-661.
Pot SA, Gallhöffer NS, Walser-Reinhardt L et al. Treatment of bullous keratopathy with corneal collagen cross-linking in two dogs. Veterinary
ophthalmology 2013; Advance online publication. DOI: 10.1111/vop.12137.