Accelerated CXL for the treatment of bullous keratopathy

Accelerated CXL for the
treatment of bullous keratopathy
Zürich November 5th, 2014
Dr Frank Famose – DVM - DESV
Toulouse – France
[email protected]
Outline
What is bullous
keratopathy (BK) ?
What are the
treatments ?
BK and CXL
Definition
Chronic superficial
corneal ulceration
Intense corneal
edema
Ocular pain
Loss of vision
Epithelial edema
Ulceration
Stromal edema
Bullae
Endothelial impairment
The endothelial failure
Endothelial
dystrophy
Degenerative
Post-surgical
Glaucoma
Anterior
Uveitis
Feline « bullous keratopathy »
Corneal hydrops
Treatment
Chronic superficial
corneal ulceration
Intense corneal
edema
Stromal abrasion
Surface
treatments
Topical
Hyperosmotic
drugs
Conjunctival grafts
Thermokeratoplasty
Poor results
BK and CXL : the Human experience
Compaction of the
corneal stroma
Decreased thickness
Improved transparency
Reduced anterior
stromal pressure
More than 30 publications
since 2007
Temporary symptomatic relief
and visual improvement
BK and CXL : the veterinary experience
2 case series
10 dogs, no cats
2 different protocols
Does it work ?
Protocol
Dogs with BK
Accelerated CXL
(30 mW/cm²)
No glaucoma
No hyperosmotic
preparation
Failure of
Previous treaments
6 Months Follow-up
Results
Ulceration
Resolved in 1 week
Discussion : epithelial healing
Early healing
Pain resolution
6 months duration
Same results in the 2 case reports
Discussion : corneal thickness and edema
Early improvement
Return to baseline
Visual improvement ?
Same results in the 2 case reports
Conclusion
CXL useful for BK-induced
corneal ulceration
Short-lasting action
on corneal edema
Protocol
adaptations
More
cases…
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