docSimultaneous surface ablation and CXL for correction of Refractive
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Simultaneous surface ablation and CXL for correction of Refractive
Photo-Refractive- CXL=PiXL A. John Kanellopoulos, M.D.1,2 1New York University School of Medicine, New York, NY, USA 2Laservision.gr Institute, Athens, Greece AJK is a consultant for Alcon, Wavelight and Avedro. Prof. A. John Kanellopoulos, MD Our Athens team’s CXL contributions: Applying topo-guided PRK in CXLed ectatic corneas 2004 Combining CXL with topo-guided reshaping of irregular corneas Athens Protocol: 2005 Higher fluence: 2006 Intrastromal treatments through femto-pockets: 2007 LASIK Xtra: 2008 (ESCRS) LASIK Xtra for hyperopia: 2011 (ASCRS) PiXL CXL corneal differentials: 2013 (AAO) Prof. A. John Kanellopoulos, MD Acknowledgments Theo Seiler-founder of the CXL concept B.J. Dupps-CCF design of treatment patterns on computer models David Muller-Avedro: Design and implementation of a highly customised device The Athens Laservision.gr team Prof. A. John Kanellopoulos, MD Methods We treated 30 consecutive cases of partially sighted eyes with 5 different treatment patterns: • Transepithelial myopic pattern+plus O2 • Myopic pattern following PTK (5mm OZ, 50 um) • Transepithelial toric pattern+O2 • Transepithelial customised topography-guided pattern+O2 • Presby-Hyperopic pattern, after donut-like PTK (50micron 6-9mm oz) Prof. A. John Kanellopoulos, MD Myopic profile central 4mm OZ transepi 4min Paracel+6min VibexXtra Prof. A. John Kanellopoulos, MD Myopic profile central 4mm OZ transepi 4min Paracel+6min VibexXtra Case 1 Prof. A. John Kanellopoulos, MD Myopic profile central 4mm OZ transepi 4min Paracel+6min VibexXtra Case 2 Prof. A. John Kanellopoulos, MD Myopic profile central 4mm OZ transepi 4min Paracel+6min VibexXtra Case 2 Prof. A. John Kanellopoulos, MD Prof. A. John Kanellopoulos, MD Myopic profile central 4mm OZ with 6mm PTK epithelium scrape 6 months post myopic treatment: 4D flattening ! Prof. A. John Kanellopoulos, MD 6 month PTK + myopic treatments Prof. A. John Kanellopoulos, MD “ profile Hyperopic” oz 6-9mm “hyperopic PTK” 6-9oz 30 microns Prof. A. John Kanellopoulos, MD The myopic shift (hyperopia-presby treatment) Prof. A. John Kanellopoulos, MD Hyperopic treatment 1 year Prof. A. John Kanellopoulos, MD Another similar case 13 months Prof. A. John Kanellopoulos, MD Placido topo data Prof. A. John Kanellopoulos, MD 1 year hyperopic (presbyope)! No epithelial changes PiXL Prof. A. John Kanellopoulos, MD Toric profile-transepi: 4min Paracel+6min VibexXtra Prof. A. John Kanellopoulos, MD Transepi toric CXL: 1-8 month validation of transepithelial Toric PiXL! No significant epi changes Prof. A. John Kanellopoulos, MD Case Rep Ophthalmol 2014;5:172–180 DOI: 10.1159/ 000363371 Published online: June 18, 2014 © 2014 S. Karger AG, Basel 1663‒2699/ 14/ 0052‒0172$39.50/ 0 www.karger.com/ cop This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OAlicense), applicable to the online version of the article only. Distribution permitted for noncommercial purposes only. 178 Case Rep Ophthalmol 2014;5:172–180 DOI: 10.1159/ 000363371 © 2014 S. Karger AG, Basel www.karger.com/ cop Kanellopoulos et al.: Topographically Customizable Toric Transepit helial CXL Toric Topographically Customized Transepithelial, Pulsed, Very High-Fluence, Higher Energy and Higher Riboflavin Concentration Collagen Cross-Linking in Keratoconus Anast asios John Kanellopoulosa, b George Asimellisa a William J. Duppsc, d Ibrahim Seven e, f b Laservision.gr Eye Inst it ut e, At hens, Greece; Depart ment of Opht halm ology, NYU M edical School, New York, N.Y., Depart ment s of cOpht halm ology and d Biomedical e f Engineering, Cleveland Clinic, Cole Eye Inst it ut e, Cleveland Clinic, and Depart ment of Chemical and Biomedical Engineering, Cleveland St at e Universit y, Cleveland , Ohio, USA Fig. 1. Customized treatment profile employed in the treatment. Left panel: details of the applied customizable pattern and parameters for UVA exposure; right panel: overlay of the pattern on the sagittal curvature map. Key W ords Topography customizable cross-linking · High-fluence cross- linking · Transepithelial cross-linking · Toric cross-linking · Keratoconus · Photorefractive int rastromal cross- linking · KXL II Abst ract Purpose: To report a novel application of toric topographically customized transepithelial collagen cross-linking (CXL) aiming to achieve refractive astigmatic changes in a keratoconic cornea. Methods: Specially formulated riboflavin transepithelial administration and delivery of high-fluence UVA in a topographically customized pattern was applied in an eye with progressive keratoconus. Visual acuity, cornea clarity, keratometry, topography, and pachymetry with a multitude of modalities, as well as endothelial cell counts were evaluated for > 6 months. Results: Uncorrected distance visual acuity changed from preoperative 20/ 40 to 20/ 25 at 6 months. A mean ast igmatic reduction of 0.8 D, and significant cornea surface normalization was achieved 6 months postoperatively. There was some mild change in the epithelial distribution, with the treated area having a slight normalization in t he average epithelial thickness. Conclusions: We introduce herein the novel application of a topograph- Fig. 2. Placido disk topography data showing sagittal curvature maps depicting significant refractive Downloaded by: 87.203.71.0 - 6/20/2014 11:17:32 AM changes along the axis of the customized cross-linking pattern. Panel 1: 1 day preoperatively. Panel 2: 6 months postoperatively. Panel to the right: difference 2–1. A. Jo hn Kan ello p o ul os, M D Laservisio n.g r Eye Inst it ut e 17 Tso ch a St reet , GR–115 21 At hens (Greece) E- M ail ajk@b rilliant vision.com Prof. A. John Kanellopoulos, MD Customized astigmatism correction Prof. A. John Kanellopoulos, MD Custom CXL profile used in a KCN cornea: Inner ring: 12Joules, middle: 10J, outer 8J Prof. A. John Kanellopoulos, MD After topo-guided PiXL Prof. A. John Kanellopoulos, MD Topo-guided like changes achieved! Prof. A. John Kanellopoulos, MD KCN s/pAthens Protocol in 2006 residual cone and cylinder 3 months afetr PiXL Prof. A. John Kanellopoulos, MD PiXL for KCN case 2 Prof. A. John Kanellopoulos, MD Topo-custom cylinder correction Prof. A. John Kanellopoulos, MD PiXL in a previously CXLed cornea -2.50 -2 65=20/30 to -450 -1 90 = 20/20! Prof. A. John Kanellopoulos, MD 2 X 60 degrees at 6mm OZ plus flash CXL: 45mW/cm2 for 3 min Prof. A. John Kanellopoulos, MD Femto-assisted AK Xtra Prof. A. John Kanellopoulos, MD 2 X 60 degrees at 6mm OZ plus flash CXL: 45mW/cm2 for 3 min Prof. A. John Kanellopoulos, MD Epi-off PiXL for KCN!!! Prof. A. John Kanellopoulos, MD Epi-on PiXL Prof. A. John Kanellopoulos, MD Epi-off PiXl myopic correction 4D!!! Prof. A. John Kanellopoulos, MD hyperopic LASIK CXL with customised PIXL, pre-op +2.75 -3.75 @ 167 9/10 +3.50 -4.25 @ 178 =9/10 Prof. A. John Kanellopoulos, MD UDVA=20/20! Prof. A. John Kanellopoulos, MD Home TV & Video U.S. World Politics Justice Entertainment Tech Health Living Travel Opinion iReport Money SIGN UP 1 of 2 52 0 11 VIEWS COMMENTS SHARES About this iReport Not verified by CNN Posted October 3, 2014 by Institute14 Follow Location Athens, Greece | Sports LOG IN 13 year old boy and family from Utah, USA, travel to Athens Greece in order to receive Advanced eye treatment for keratoconus By Institute14 | Posted October 3, 2014 | Athens, Greece 11 Keratoconus is an eye disorder affecting mainly teenagers and with probable genetic link. It manifests by thinning and distorting progressively the shape of the cornea-the clear structure that acts as a powerful lens in front of our Prof. A. John Kanellopoulos, MD colored iris of our eyes-(this is called ectasia in medical terminology) As a result young patients with keratoconus may loose significant part of their Pediatric PiXl Conclusions CXL differentials can provide corneal refractive changes (as they always had with classic CXL in a “crude” way!) Photorefractive intrastromal CXL treatments with the KXL II: Clinical experience of over 14 months showed no scarring or haze. Presentation Title Goes Here Prof. A. John Kanellopoulos, MD
