Cross linking dogs_cats_famose_ecvo
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Transcript of Cross linking dogs_cats_famose_ecvo
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* EVALUATION OF ACCELERATED-CXL FOR THE TREATMENT OF MELTING KERATITIS IN 8 DOGS AND 10 CATS
* Collagen Cross-Linking
Dr Frank FAMOSE – Toulouse - [email protected] 2013
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Melting keratitis
MMP imbalance
Infectious and non-infectious origin
Treatment : antibiotics& anticollagenases
Evolution : perforation
Surgery
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Collagen reticulation
Anti-infectious effects
Keratocyte apoptosis
Photochemicalprocess
CXL
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Background
StandardProtocol30min 3mW/cm²
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Aim of this study
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Inclusion criteria
Dogs and cats
Corneal melting
Poor response to medical treatment
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Inclusion criteria
Epithelial loss
Cellular infiltration andstromal dissolution
Minimal Corneal thickness> 300 µm
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Protocol
Generalanesthesia
Cornealcleaning
Riboflavinesoaking
ExpositionUVA 365 nm
Post-CXLtreatment
OCT
MedetomidineKetamineIsoflurane
Debris removalBact. sampling
PCR (FHV1)
RF 0,1% 20% dextran(VibexTM)
1 drop ev. 2 min30 minutes
30 mW/cm�3 min
5,4J/cm�
TobrexTM BID7 days
Accelerated protocol(KXLTM – Avedro)
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Follow-up
Inclusion D4 D8 D15 D31
Pain and clinical score
Fluorescein test
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Follow-up
0 : absent1 : light2 : moderate3 : severe
0 : absent1 : present
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Results
Pretreatment data
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Results
8 Dogs 10 Cats
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Corneal infiltration
D1 D8
8/8 dogs – 10/10 cats 0/8 dogs – 0/10 cats
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Corneal vascularization
D1 D31
8/8 dogs – 10/10 cats 2/8 dogs – 3/10 cats
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Corneal vascularization
D1 D31
8/8 dogs – 10/10 cats 2/8 dogs – 3/10 cats
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Corneal scar
D1 D31
8/8 dogs – 10/10 cats
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Corneal scar
D1 D31
8/8 dogs – 10/10 cats
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Discussion
Reduction of clinicaland pain score
UV light - Free radicals ?
Physical modifications of the cornea
Biological responses of the cornea ?
No Control Group
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Standard or accelerated protocol ?
Standard3 mW/cm²30 minutes
« Flash »30 mW/cm²3 minutes
5,4 J/cm²
Total durationabout 1h20
Total durationabout 40 min
Samebiologicaleffects ?
Same energydelivered
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Adverse reactions
Infections
Herpesvirus reactivation
Endothelial damage
In humans
No adverse reaction attributableto the treatment
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Conclusion
Efficacy
No adverse reaction
Shorteranesthesia
duration
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Impending perforation ?
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5,4J/cm²
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Are antibioticsstill necessary after CXL?
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Long term ? Corneal sensitivity ?Drug penetration ?
Normal cat
3 monthsPost CXL
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Thank you.