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Customized Corneal Cross-Linking

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Controversies in the Management of Keratoconus

Abstract

Personalized accelerated crosslinking nomograms for the management of corneal ectasia were conceived after comparative analysis of demarcation lines and cell viability observed after customized accelerated epithelium-off crosslinking CXL treatments by spectral domain corneal OCT and scanning laser in vivo confocal microscopy matching all the clinical and instrumental data with mathematical models. Accelerated high-fluence Topography-guided CXL at 30 mW/cm2 UV-Power and Accelerated epithelium-off CXL with 9 and 15 mW/cm2 UV-A power with standardized Fluence of 5.4 J/cm2 were safe and effective demostrating a keratocytes apoptosis and demarcation line depth between 280 and 340 μm. The 30 mW ACXL showed a penetration with continuous and pulsed light between 150 and 200 μm. No endothelial damage was reported in any case. In vivo morphological studies demonstrated that Accelerated CXL allow a pachymetry-guided cutomization of CXL maintainig the standard Fluence of 5.4 J/cm2 and a total treatment time under 20 min. Moreover a pachymetry-guided ACXL nomogram (M nomogram) developed by Mazzotta C and Friedman M matching the physical and mathematical calculations with the miscostructural IVCM and OCT observations of demarcation lines depths allow an efficacous CXL management of primary and iatrogenic ectatic corneas also allowing a safe management of thin ectatic corneas.

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Authors and Affiliations

  1. Post-Graduate Ophthalmology School, University of Siena, Siena, Italy

    Cosimo Mazzotta

  2. Siena Crosslinking Center®, OcuMedical Vision, Siena, Italy

    Cosimo Mazzotta & Marco Ferrise

  3. Eye Center®, Catanzaro, Italy

    Miguel Rechichi & Marco Ferrise

  4. Centro Polispecialistico Mediterraneo, Catanzaro, Italy

    Miguel Rechichi

  5. Studio Oculistico Ferrise, Lamezia Terme, Italy

    Marco Ferrise

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  1. Cosimo Mazzotta
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  2. Miguel Rechichi
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  3. Marco Ferrise
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Editors and Affiliations

  1. Medical Director of IVISION, Refractive Surgery and Keratoconus Treatment Center, Haifa, Israel

    Adel Barbara

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Mazzotta, C., Rechichi, M., Ferrise, M. (2019). Customized Corneal Cross-Linking. In: Barbara, A. (eds) Controversies in the Management of Keratoconus . Springer, Cham. https://doi.org/10.1007/978-3-319-98032-4_10

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