sex female 30,53% or 210 eyes male 69,47%or 450 eyes
pre SR equiv: mean -3,79 D ± 4,216 D (from -28,58 to 5,52) pre SR sph: mean -2,44 D ± 4,02 D (from -25,67 to 6,02) pre SR cyl: mean -2,70 D ± 1,91 D (from -9,95 to 0,00)
eyes 1 y: 400 (follow up rate 47,63%) eyes 2 y: 307 (follow up rate 23,35%) eyes 3 y: 90(follow up rate 6,87%) eyes 4 y: 26 (follow up rate 1,98% eyes 5 y: 26 (follow up rate 1,98%)
0,9
0,8
0,7
0,6
0,5
0,4
0,3
0,2
0,46
0,45
0,54
0,55
0,60
0,67
0,73 0,73
D
0,60
pre op 1 m 3 m 6 m 1 y 2 y 3 y 4 y 5 y
Change in BCVA %
«SAFETY» Visual acuity Visual acuity
Spherical changed over time Astigmatism changed over time
D
D D
Sim k1 Sim k2 SRI: baseline vs follow up
SRC: baseline vs follow up SAI: baseline vs follow up Total aberration baseline vs follow up
1st A length: is the cord length of the first applanation 2nd A length: is the cord length of the second applanation V in : is the corneal speed during the first applanation moment
V out : is the corneal speed during the second applanation moment W‐Dist: is the distance of the two "knee's" at the highest concavity point Curvature Rad HC: is the (central concave) curvature at the highest concavity point
Def Amp : is the maximum amplitude, so how far was the cornea shifted from the start point to the highest concavity point.
CORVIS PARAMETERS
6,00
5,00
4,00
3,00
2,00
1,00
Time CORVIS PARAMETERS second
25
20
15
10
5 0
INTRAOP RESULTS CH and CRF
0,00 1 st A lenght
2nd A lenght
V in V out W-Dist Curv Rad
HC
Def Amp 1st A-time 2st A-time HC-time
pre CXL 5,67 22,19 17,32 pre CXL 1,76 1,63 0,13 0,45 5,39 4,68 1,28 post CXL 1,73 1,50 0,11 0,39 3,17 1,00 1,35
post CXL 5,62 21,27 17,31
1st A‐time : is the time from starting until the first applanation (This delivers also the IOP‐NCT value)
p>0.05
p<0.05 p<0.05 p<0.05
2nd A‐time : is the time from starting until the second applanation
preCXL with
preCXL sine
After staining
After UVA ir
After RE-EPI
POSTOP RESULTS CH and CRF INTRAOP RESULTS Peaks POSTOP RESULTS Peak 1 and 2 AK ↑ AK ↑ AK ↓ CCT↓ CCT↓ CCT↑
p<0.05
p<0.05
PRE XL
PRE XL POST XL 1 month 6 months 12 months 24 months
p<0.05
p<0.05
p<0.05
WITH EPI Wout EPI Wout EPI POST XL POST XL POST XL POST XL preCXL preCXL After After p>0.05 p<0.05 p<0.05 p>0.05 p>0.05 p>0.05 with sine CXL RE-EPI
By age….
Loss>1
Change in BSCVA Safety %
unchanged
BSCVA:line change over time
by curvature group
By curvature group….
Spherical equivalent change over time by curvature group
Spherical change over time by curvature group
Astigmatism change over time by curvature group
ΔD ΔD ΔD
Course IC 29 – Cross-Linking – Vinciguerra - 7
Post CXL
BSCVA:line change over time by pachymetry group
Spherical change over time by thinnest point value group
ΔD
By thinnest point value group….
Astigmatism change over time by thinnest point value group
Spherical equivalent change over time by thinnest point value
group
Packing of lamellae in normals, keratoconus and after CXL
ΔD ΔD
NORMAL Kc
CXL
NORMALE Kc
CXL
Effects of riboflavin/UVA corneal cross-linking on keratocytes and collagen fibres in human cornea. Mencucci R, Marini M, Paladini I, Sarchielli E, Sgambati E, Menchini U, Vannelli GB.
Clin Experiment Ophthalmol. 2010 Jan;38(1):49-56. Lectin binding in normal, keratoconus and cross-linked human corneas.
Mencucci R, Marini M, Gheri G, Vichi D, Sarchielli E, Bonaccini L, Ambrosini S, Zappoli Thyrion GD, Paladini I, Vannelli GB, Sgambati E. Acta Histochem. 2010 Jan 4 According to Rita Mencucci, 2006
Collagen diameter increase after CXL (nm)
Transition line of keratoconus post cxl over time
in different pts
Post cxl + lac
12,2 %
4,6 %
340μ in cornea
1 yrs post cxl
292μ in cornea
2 yrs post cxl
404μ in cornea
328μ in cornea
(Wollensak,Spoerl,Seiler: Cornea 2004)
3 yrs post cxl
3,5 yrs post cxl
Deep opacity after CXL Haze post PRK
100µ Striae after cxl
296µ
Apparent corneal thinning
“Thinning” is only temporary because: Riboflavine solution contain dextrane
that together with the exposure to air of the denuded cornea dehydrates the stroma Collagen fibers and lamellae are packed
by CXL
Corneal thickness normalization Epithelium takes weeks to return to normal thickness
Stroma rehydrates
Increase of fiber diameter due to CXL
Corneal thickness can even increase with time (1‐2 years)
Pachymetry map shows a more physiological distribution with time
Reduction of the TRUE NET power of the keratoconus overtime
49.3 D 48.8 D 46.0 D 46.3 D
Pre op cxl 1 mos post cxl 3 mos post cxl 6 mos post cxl 46.8 D 46.1 D
12 mos post cxl 24 mos post cxl
pt n° 75
Differential map from pre op cxl to 2 yrs post cxl
Reduction of the area/power of the keratoconus overtime
BSCVA is better, even if curvature pattern improvement is not so big
Reduction of pachimetry map over time of the keratoconus post cxl with expansion
+3.65 D -4.15 D -6.18 D Pre cxl
0.4 -3.00 sph
1 mos post cxl
0.4 -3.00 sph
3 mos post cxl
0.4 -3.00 sph
8 mos post cx
0.9 +0.75 3.00(115) Pre cxl 1 mos post cxl 3 mos post cxl 9 mos post cxl
2,117 μ 1,403 μ 0,555 μ 0,349 μ Reduction of the 83,5% (‐1,768μ)
from pre op to 4 mos post ptk+ cxl
Visual acuity over time Pre op 3 day post ptk+ cxl
0,1 -7.00 (-2.00)30 0,4 -4.00 (-1,50)38 2 mos post ptk+cxl 4 mos post ptk+cxl
0,5 -2,75(-2.00)11 0,6 -1,50 (-1,50)20
III. Simoultaneous Custom Ablation and Cross-Linking
Simultaneous Custom and
CXL
Number of eyes pre OP: 9
age@OP average 35 years (from 22 to 44)
sex female 22,2% or 2 eyes male 77,8% or 7 eyes
pre SR equiv: mean -3,00 D ± 3,83 D (from -8,25 to 2,63) pre SR sph: mean -1,83 D ± 3,98 D (from -7,00 to 4,50) pre SR cyl: mean -2,33 D ± 1,70 D (from -5,00 to 0,00)
month (eyes)
60%
50%
40%
30%
20%
10%
38%
33%33%
25%
17%
25%
1
33%
50% 1
33%
13%
Paolo Vinciguerra M.D.# eyes 3 m: 6 (follow up rate 66,7%)
1 (8) 3 (6) 0 0
Silvia Trazza Orth.#
# Istituto Clinico Humanitas University of Milan , Italy
post SR equiv: mean -0,67 D ± 1,54 D (from -3,75 to 0,50) post SR sph: mean -0,04 D ± 1,47 D (from -2,75 to 1,50) post SR cyl: mean -1,25 D ± 1,30 D (from -3,50 to 0,00)
0% 9 (3) 12 (2)
Change in BSCVA - Percentage 'SAFETY'
Fluctuation of zernike ab over time
Paolo Vinciguerra M.D.
Fluctuation Wf/Corn/tot over time Change in refraction over time Patient n°1 ♂ 44 aa
Pt F:V:
Fingerprint Keratopaty + keratoconus Pre op 4 mos post ptk+ cxl
