Eyeworld Daily News

EW SHOW DAILY 12 ASCRS News Monday, April 16, 2018 by Liz Hillman EyeWorld Staff Writer There were 25 eyes in the femto CXL group and 21 eyes in the con- ventional CXL group; follow-up was 1 year. Uncorrected visual acuity improved by two lines in the exper- imental group compared to one line in the control with similar results in best corrected visual acuity. The femto CXL group showed better retention of corneal thickness, sug- gesting that a deeper stiffening effect reduces keratolysis. Both procedures resulted in corneal flattening. Dr. Ponniah concluded that the crosslinking of the posterior corne- al stroma deeper than 250 µm, as shown by the demarcation lines, is possible with the femto CXL group. At 2 years out, the corneas in the femto CXL group have remained sta- ble, he added. EW Editors' note: The physicians have no financial interests related to their comments. A paper session Saturday af- ternoon focused on a va- riety of topics pertaining to keratoconus research, including evaluations of different crosslinking techniques, cellular research, and more. James Loden, MD, Nashville, Tennessee, an ophthalmologist himself, described his personal experience with crosslinking. He was diagnosed with keratoconus at 23 years old and became concerned about the potential for progression, even at his age (52 years old), after hearing Theo Seiler, MD, speak about progression in patients older than 50. Upon evaluation, he showed a 0.5 D change in refraction and subtle Vogt's striae but no change in topog- raphy; however, he acknowledged that he had only taken a 48-hour break from wearing his gas perme- able lenses before measurements. Dr. Loden, along with other colleagues, developed a modified crosslinking technique that included a 10 µm PTK with the VISX laser (Johnson & Johnson Vision, Santa Ana, California), a 30-minute ribo- flavin soak followed by UV irradia- tion at 9 mw for 5 minutes, another 5-minute riboflavin soak, followed by irradiance at 3 mw for 5 minutes, 5 more minutes of soak, and another 5 minutes of irradiance at 3 mw, followed by use of a bandage contact lens. Dr. Loden explained that he was concerned about the risk of haze and the healing period accompanied by the traditional crosslinking proce- dure; he wanted to get back into the OR as soon as possible. Dr. Loden said he experienced no sensation during the PTK, ribo- flavin soak, or UV light procedures. When he did experience sensation, he said it was on the inner surface of the lids. He suggested physicians apply more topical drops if the patient appears to be experiencing discomfort. He did, however, begin to experience extreme photophobia 4 hours after surgery, which lasted for 4 days, despite use of medications for attempted relief. He was back in the clinic the day after surgery but was very uncomfortable at this time, wearing sunglasses indoors. He was back in the OR by postop day 7. The best paper of session was awarded to Lional Raj Daniel Raj Ponniah, MD, Tirunelveli, India, whose study compared femto laser- assisted crosslinking (CXL) outcomes to those of epi-off crosslinking. The femto laser technique involved the creation of a corneal stromal bed of 8.5–9 mm in diameter, 140–160 µm deep with two incisions 180 degrees apart into which riboflavin solution was loaded. Riboflavin was soaked on top of the cornea as well. Keratoconus papers feature research on various aspects of the disease and crosslinking therapies

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