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Customized Corneal Cross-Linking

  • Cosimo Mazzotta
  • Miguel Rechichi
  • Marco Ferrise
Chapter

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.

Keywords

Accelerated crosslinking Pachymetry-guided CXL Customized CXL Customized crosslinking nomogram M nomogram 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Cosimo Mazzotta
    • 1
    • 2
  • Miguel Rechichi
    • 3
    • 4
  • Marco Ferrise
    • 2
    • 3
    • 5
  1. 1.Post-Graduate Ophthalmology SchoolUniversity of SienaSienaItaly
  2. 2.Siena Crosslinking Center®, OcuMedical VisionSienaItaly
  3. 3.Eye Center®CatanzaroItaly
  4. 4.Centro Polispecialistico MediterraneoCatanzaroItaly
  5. 5.Studio Oculistico FerriseLamezia TermeItaly

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