Progressive high-fluence epithelium-on accelerated corneal crosslinking: a novel corneal photodynamic therapy for early progressive keratoconus

Abstract

PurposeTo assess the preliminary clinical results of a new, progressively higher fluence-pulsed light Epi-On accelerated crosslinking nomogram (PFPL M Epi-On ACXL) in the treatment of progressive keratoconus (KC).SettingSiena Crosslinking Center, Siena, Italy.MethodsA prospective pilot open, non-randomized interventional study, including 32 eyes of 32 young-adult patients over 26 years old with Stages I-III progressive KC undergoing PFPL M Epi-On ACXL, was conducted. Riboflavin loading was performed by using Paracel I 0.25% for 4 min and Paracel II 0.22% for 6 min. The Avedro KXL System (Glaukos-Avedro, Burlington, USA) was used for pulsed-light accelerated crosslinking (ACXL) at air room 21% oxygenation and 13 min of UV-A irradiation. The treatment fluence was set at 7.2 J/cm2, 8.6 J/cm2, and 10.0 J/cm2 in corneas with baseline pachymetry <420 μm (group 1: 8 eyes), ≥ 420 μm <460 μm (group 2, 11 eyes), and ≥ 460 μm (group 3, 13 eyes), respectively. Uncorrected distance visual acuity (UDVA), best-spectacle corrected visual acuity (BSCVA), Scheimpflug corneal tomography, and anterior segment OCT (AS-OCT) data were collected at baseline and postoperatively at 1, 3, and 6 months.ResultsUDVA and BSCVA improved in all groups (P ≤ 0.05). Maximum keratometry values (K max) showed a significant decrease in the 10.0 J/cm2 group (Δ −1.68 D). The coma (HOAs) value improved significantly by the sixth month in all groups. OCT average demarcation lines were 211 ± 19 μm in group 1, 245 ± 23 μm in group 2, and 267 ± 21 μm in group 3.ConclusionsThe preliminary results show that pachymetry-based PFPL M Epi-On ACXL nomogram stabilizes ectasia progression. Higher fluence Epi-On ACXL increases CXL penetration, with better functional outcomes in the absence of complications.

It is time for a Turning Point in Keratoconus

“…4,5 Actually, the preliminary results on new epithelium-on accelerated CXL protocols with progressively higher fluence and pulsed light show that a new pachymetry-based PFPL M Epi-on ACXL nomogram stabilizes ectasia progression. 6 Higher fluence Epi-on ACXL increases CXL penetration, with better functional outcomes in the absence of complications, thus paving the way to a replacement of epithelium-off crosslinking treatments. From a clinical and practical perspective, a safer and faster transepithelial crosslinking treatment with an efficacy profile comparable to Epi-off CXL, with no adverse events and capable of quickly rehabilitating patients with progressive KC to resume their school or work activities, represents a great challenge and a highly interesting goal.…”

“…Moreover, this treatment protocol can be repeated if the progression of ectasia restarts during the follow-up, and the advantages of Epi-on procedures can still be retained in terms of excellent compliance and the absence of infectious and uncontrolled corneal scarring. 6 The Journal of Keratoconus and Ectatic Corneal Diseases has the honor and task of hosting present and future innovations in clinical and surgical research, in keratoconus diagnostics and in everything relating to genetic, hormonal, inflammatory, environmental and biochemical aspects, including new research topic in ocular microbiota. 7,8 All ophthalmologists of good will are invited to contribute with their studies to the success of the IJKECD, owned and managed by Jaypee Brothers Medical Publishers (P) LTD.In recent years we have witnessed and contributed to a revolution in the knowledge of the pathophysiology of keratoconus, of the clinic and of pathophysiological optics, thanks to machines such as Scheimpflug-based and now OCT-based tomography.…”