Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

The overall goal of this procedure is to present the advantages and major drawbacks of three different protocols of corneal collagen, cross-linking, conventional cross-linking, accelerated cross-linking, and cross-linking by iontophoresis. This method can help answer key questions in the keratoconus treatment field, such as which protocol of corneal collagen cross-linking is more accurate to have the progression of this corneal ectasia. The main advantage of this technique is that we compare the proceedings and the results of those three different protocols of Corne College cross-linking to highlight the usefulness of each one To carry out conventional corneal collagen, cross-linking, or CCXL.

After treating the eye for five days with 1%pilocarpine, according to the text protocol in the operating room, under aseptic conditions, instruct the patient to lay on his or her back, administer a topical anesthesia such as 0.4%oxy but propane. To remove the epithelium, use a circle corneal marker to mark the central nine millimeter of the cornea with a blunt spatula. Remove the central seven to nine millimeter of the corneal epithelium by mechanical debridement.

Then every minute for the next 20 minutes, apply 0.1%to riboflavin with 20%dextrin to the cornea using a 370 nanometer wavelength. UVA light irradiate the cornea at an irradiance of three milliwatts per square centimeters and a five centimeter working distance for 30 minutes. During the irradiation apply riboflavin drops to the cornea every five minutes.

After the procedure, apply antibiotic drops and artificial tears into the irradiated eye. Apply a soft bandage until re epithelialization is complete and provide post-surgical treatment according to the text protocol to perform accelerated corneal collagen cross-linking, or A CXL after five days of pilocarpine treatment and removing the corneal epithelium via mechanical debridement as just demonstrated in this video, apply 0.1%riboflavin without dextrin every two minutes for 10 minutes with a 370 nanometer wavelength, UVA light at an radiance of 30 milliwatts per square centimeters and a five centimeter working distance. Irradiate the cornea for three minutes, add antibiotic drops and artificial tears into the operated eye before applying a soft bandage contact lens until reepithelialization is complete.

To carry out iontophoresis, cross-linking, or ICXL after topical anesthesia as shown earlier in this video, position the iontophoresis device without epithelial debridement by first applying the sticky passive electrode on the forehead. Under the operative field. Apply the active electrode, which is a suction ring to the open eye, centering the suction ring on the periphery of the cornea before releasing the suction.

Then fill the suction ring with hypo osmolar 0.1%riboflavin without dextrin. Start the electrical current at 0.2 milliamps and gradually increase to one milliamp for a total iontophoresis time of five minutes. Then irradiate the eye for nine minutes after irradiation, apply antibiotic drops and artificial tears and perform post-surgical treatment.

According to the text protocol as demonstrated here, the corneal demarcation line was visible in an anterior segment optical coherence tomography scan in 92%of the cases with a mean death of 301.6 micrometers one month after CCXL. Whereas after A CXL, it was seen in 85.5%of the cases at a mean depth of 183.1 micrometers after ICXL. The corneal demarcation line was only seen in 46.5%of cases at a mean depth of 214 micrometers.

This table shows that no intra or postoperative complications were detected in patient follow-ups within six months after application of any of the three protocols, including no significant differences in endothelial cell counting. In addition, the maximum K value remained stable for each of the protocols after a six month follow up for each of the protocols in the one to three month postoperative period. Anterior stromal edema with extracellular LE QA and fragmented keratocytes nuclei was observed with in vivo confocal microscopy at six months, repopulation of the anterior stroma with cyte nuclei was seen and was greater after ICXL than after the two other protocols.

Following procedures, other meters could be performed in order to answer additional questions like whether the effectiveness of GTO psoriasis could be improved by changing some technical parameters such as the ince of UVA light or the lengths of re flavin penetration after its development. Corneal collision, cross-linking, paved the way for researcher in the field of keratoconus treatment to explore the pathophysiology of this completely unknown disease in human beings. After watching this video, you should have a good understanding of how to perform a corneal collision, cross-linking, using whichever protocol you choose to treat your patients.

Don't forget that working with UVA light machines can be extremely hazardous and precautions such as device calibration and checks should always be taken while performing this procedure.