El Paso's leader in laser vision surgery.
The first studies published on corneal cross linking (CXL) were by Wollensack in 2003. This innovative treatment uses energy supplied from a UV light source to improve corneal collagen binding and improving the tensile strength of the cornea. This treatment has achieved the European CE mark (counterpart agency to the US FDA) since about 2005 after proving its safety profile. It has been adopted as the standard of care for patients with progressive early to moderate keratoconus by the American Academy of Ophthalmology. It is not however FDA approved in the United States (currently undergoing a lengthy FDA trial).
Early studies have shown a 90 to 95% success rate with CXL in halting progression of the disease. Re-treatment can be performed in patients who have had treatment failure. Studies indicate relatively low change in corneal curvature in the initial six months after treatment, however by 5 to 10 years after treatment, there can be a slow continued flattening in the overall curvature of the cornea, improving vision outcomes over time.
Sun Laser Vision Center is a co-investigator in the POCKET CXL study. This controlled, randomized, multicenter IRB-approved study is comparing whether pulsed or continuous application of the UV energy is more effective. Studies indicate a pulsed application may allow for more oxygen reperfusion of the cornea between pulses and this may be more effective than the standard treatment.
We are currently enrolling patients with keratoconus with evidence of progression. The cornea must be at least 350 microns thick (for hypotonic riboflavin treatment) or 400 microns (for standard riboflavin treatment). The cornea must be free of central scarring. Prior or concurrent Intacs placement is allowed. Patients must be 13 or older to enroll.
The treatment generally takes about an hour in our in-office minor operating room. Under sterile technique the “epi-off” procedure is performed using 30 minute of riboflavin loading of the cornea followed by either a 5 minute continuous application of UV at 18 mW/cm2 or 5 1-minute applications at 18 mW/cm2 with 1 minute rest intervals. A bandage contact lens is placed at the end of the procedure.
Patients generally can return to work in about 3-5 days after the treatment depending upon the rate of his or her healing. Vision stabilizes at about 1-2 months after the procedure, but can be variable (some sooner and some later).
Our results have generally been very good in patients undergoing concurrent placement of Intacs with cross linking and better than our results of Intacs alone. Generally patients with more advanced degrees of keratconus are going to be candidates for both modalities. Patients with lower degrees of keratoconus however often just benefit and are candidates for CXL alone.
Intacs, CXL and a combination of the two treatments have been proven to be effective advances in treating patients with Keratoconus. However, in all cases patients must need to have realistic expectations. The main purpose of these treatments is to stabilize the disease progression and hopefully to have a little gain in vision with glasses or contacts. As with most diseases, the key is early diagnosis. The earlier keratoconus is caught and treated, the greater the likelihood of better, more normal vision outcomes.
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