Pentazocine transport by square-wave AC iontophoresis with an
Cross linking-iontophoresis-cats famose-ecvo_v2
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Transcript of Cross linking-iontophoresis-cats famose-ecvo_v2
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EVALUATION OF ACCELERATED-CXL* AFTER
IONTOPHORESISFOR THE TREATMENT OF MELTING KERATITIS
IN 6 CATS
* Collagen Cross-Linking
Dr Frank FAMOSE – Toulouse - France
Pierre ROY – Paris - FranceLondon 2014
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Melting keratitis
MMP imbalance
High perforation risk
Treatment : antibiotics& anticollagenases
Tectonic Surgery
CXL
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Collagen reticulation
Anti-infectious effects
Keratocyte apoptosis
Photochemicalprocess
CXL
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CXL: protocol modifications
ConventionalProtocol
Modifications"Epi-On"
"Epi-Off"(epithelialremoval)
UV exposition3mW/cm² - 30 min.
(5,4J/cm²)
Riboflavininstillation
(30 minutes)
Low or highosmolarity RFNanostructures,adjuvants
Intrastromal injectionsIontophoresis
AcceleratedCXL9-30mW/cm²
(5,4J/cm²)
Epithelium RF distribution UVA irradiation
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Iontophoresis
Application of a constant electric
current to enhance penetration of a ionized substance through a tissue 2013
Iontophoresisof RF forCXL(keratoconus)
From 1990
SteroidsAntibioticsAntifungal
AntimetabolitesOligonucleotides
DiscoveryWirz 1908
No veterinaryclinical use
(Bikbova et al.Mastropasqua et al.Touboul et al.)
No data forkeratitis
treatment
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Aim of this study
To evaluate the clinical outcome of feline melting keratitis treated by accelerated CXL
after iontophoresis of riboflavin
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Inclusion criteria
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 (OCT)
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Protocol
Generalanesthesia
Cornealcleaning
Riboflavineimpregnation
ExpositionUVA 365 nm
Post-CXLtreatment
OCT
MedetomidineKetamine
Debris removalBact. sampling
PCR (FHV1)
RF 0,1% (Ricrolin TM)Iontophoresis5 min 1mA/min
30 mW/cm²3 min
5,4J/cm²
TobrexTM BID7 days
Accelerated protocol(KXLTM – Avedro)
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Iontophoresisdevice
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Follow-up
Inclusion D1 D4 D8 D15 D31
Pain and clinical score
Ulceration and infiltration surfaces
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Follow-up
0 : absent1 : light2 : moderate3 : severe
0 : absent1 : present
Clinical score(0-18)
Pain score (0-7)
Mucopurulent discharge
Corneal edema
Corneal vascularization
Conjunctivitis
Blepharitis
Uveitis
Prostration
Aggressive behavior
Blepharospasm
Enophtalmos
Photophobia
Ocular pruritus
Defense reaction
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Results Mean evolution time 40 days
Ulcer depth 21-54%
2/6 Persian
1/6 positive bacterial culture
1/6 FHV1 positive6 cats
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D1 D4 D8 D15 D310
2
4
6
8
10
12
Evolution ofAverage scores
Clinical score Pain score
D1 D4 D8 D15 D310
5
10
15
20
25
30
35
Evolution of Average surfaces (mm²)
Ulcer surface Infiltration surface
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Cornealvascularization
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Discussion : efficacy
Reduction of clinicaland pain score
Complete Epithelial healing
Resolution of corneal melting
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Comparison to conventional impregnation of RF
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Distribution of RF ?
Human and rabbit studies(fluorometry, histology, HPLC, OCT…)
Clear cornea Keratitis
Anterior stroma (150 µm) :Cinstillation= 2x Ciontophoresis
Less uniform diffusion
?
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Adverse effects of iontophoresis
Electric burns
Not observed in humanpatients with I < 4mA/min
High intensity current
Pain
High or low pH solutionsChemical burns
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Duration of treatment ?
Instillation30 min
Iontophoresis5 min
Irradiation30 min
Accelerated CXL3-10 min
Conventional protocolDuration > 1 hour
Ionto + acc. CXL protocolDuration < 20 min.
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Conclusion: IONTOPHORESIS
Results similar to conventional instillation
Resolution of corneal melting
No adverse reaction or pain
Reduction of procedure duration
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Perspectives: IONTOPHORESIS
Enhanced penetration of RF…
…or other therapeutic agents
?
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Thank you.