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Issue link: https://daily.eyeworld.org/i/124055
10 EW SHOW DAILY Tuesday, April 23, 2013 ASCRS Symposia Corneal collagen crosslinking session gives overview of current state of the technique by Ellen Stodola EyeWorld Staff Writer P anelists Terry Kim, MD, Durham, N.C., John A. Hovanesian, MD, Laguna Hills, Calif., William B. Trattler, MD, Miami, A. John Kanellopoulos, MD, Athens, Greece, Doyle Stulting, MD, Atlanta, Eric D. Donnenfeld, MD, Long Island, N.Y., Peter S. Hersh, MD, Teaneck, N.J., Roy S. Rubinfeld, MD, Washington, D.C., and Barbara S. Fant, PharmD, Cincinnati, discussed corneal collagen crosslinking, some of the issues and specifics that go along with it, complications that can arise, and updates on trials, as it is currently not FDA approved. Dr. Hovanesian said that crosslinking was initially developed to serve as a bridge between keratoconus patients who could be treated with contacts and patients who needed a corneal transplant. "One of the controversies is whether it's necessary to remove or not remove corneal epithelium during these procedures," he said. Dr. Hovanesian noted that currently there is not a lot of published information to compare epi-on and epioff procedures. Dr. Hovanesian said there is no question that crosslinking is an effective tool for ectatic patients, and despite complications that can occur, there is a general trend worldwide toward leaving the epithelium on. Dr. Stulting discussed some of the possible complications that can be associated with corneal collagen crosslinking. "Complications fortunately are rare," he said, noting that they are often not vision threatening. Some of the complications possible with crosslinking are corneal edema, sterile infiltrates, infectious keratitis, stromal scarring, and delayed epithelial healing. However, Dr. Stulting said that he believes the incidence of complications is very small, based on his experience, the experience of others, and the literature available on the topic. "I think this is a technology that will be with us for a long time," Dr. Stulting said. He believes that crosslinking will be effective and will become the preferred treatment for those with ectatic diseases at the time of diagnosis. When discussing some current clinical trials, Dr. Rubinfeld questioned whether the audience had experience with crosslinking, with a good number of people raising their hands to indicate they did; however, the overall majority of these people were not based in the U.S. Ms. Fant brought up the issue of the way that devices and drugs are regulated in different countries. "In the U.S., crosslinking is regulated as a drug, and not as a device," she