cross linking dogs_cats_famose_ecvo

* EVALUATION OF ACCELERATED-CXL FOR THE TREATMENT OF MELTING KERATITIS IN 8 DOGS AND 10 CATS

* Collagen Cross-Linking

Dr Frank FAMOSE – Toulouse - Francefrankfamose@gmail.comBarcelona 2013

Melting keratitis

MMP imbalance

Infectious and non-infectious origin

Treatment : antibiotics& anticollagenases

Evolution : perforation

Surgery

Collagen reticulation

Anti-infectious effects

Keratocyte apoptosis

Photochemicalprocess

CXL

Background

StandardProtocol30min 3mW/cm²

Aim of this study

Inclusion criteria

Dogs and cats

Corneal melting

Poor response to medical treatment

Inclusion criteria

Epithelial loss

Cellular infiltration andstromal dissolution

Minimal Corneal thickness> 300 µm

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)

Follow-up

Inclusion D4 D8 D15 D31

Pain and clinical score

Fluorescein test

Follow-up

0 : absent1 : light2 : moderate3 : severe

0 : absent1 : present

Results

Pretreatment data

Results

8 Dogs 10 Cats

Corneal infiltration

D1 D8

8/8 dogs – 10/10 cats 0/8 dogs – 0/10 cats

Corneal vascularization

D1 D31

8/8 dogs – 10/10 cats 2/8 dogs – 3/10 cats

Corneal vascularization

D1 D31

8/8 dogs – 10/10 cats 2/8 dogs – 3/10 cats

Corneal scar

D1 D31

8/8 dogs – 10/10 cats

Corneal scar

D1 D31

8/8 dogs – 10/10 cats

Discussion

Reduction of clinicaland pain score

UV light - Free radicals ?

Physical modifications of the cornea

Biological responses of the cornea ?

No Control Group

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

Adverse reactions

Infections

Herpesvirus reactivation

Endothelial damage

In humans

No adverse reaction attributableto the treatment

Conclusion

Efficacy

No adverse reaction

Shorteranesthesia

duration

Impending perforation ?

5,4J/cm²

Are antibioticsstill necessary after CXL?

Long term ? Corneal sensitivity ?Drug penetration ?

Normal cat

3 monthsPost CXL

Thank you.