cross linking-iontophoresis-cats famose-ecvo_v2

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  1. 1. EVALUATION OF ACCELERATED-CXL* AFTERIONTOPHORESISFOR THE TREATMENT OF MELTING KERATITISIN 6 CATS* Collagen Cross-LinkingDr Frank FAMOSE Toulouse - FrancePierre ROY Paris - FranceLondon 2014
  2. 2. Melting keratitisMMP imbalanceHigh perforation riskTreatment : antibiotics& anticollagenasesTectonic SurgeryCXL
  3. 3. CXLPhotochemicalprocessCollagen reticulationAnti-infectious effectsKeratocyte apoptosis
  4. 4. CXL: protocol modificationsEpithelium RF distribution UVA irradiation
  5. 5. IontophoresisApplication of a constant electriccurrent to enhance penetrationof a ionized substance through atissue
  6. 6. Aim of this studyTo evaluate the clinical outcomeof feline melting keratitistreated by accelerated CXLafter iontophoresis of riboflavin
  7. 7. Inclusion criteriaCatsCorneal meltingPoor response tomedical treatment
  8. 8. Inclusion criteriaEpithelial lossCellular infiltration andstromal dissolutionMinimal Corneal thickness> 300 m (OCT)
  9. 9. ProtocolGeneralanesthesiaCornealcleaningRiboflavineimpregnationExpositionUVA 365 nmPost-CXLtreatmentOCTMedetomidineKetamineDebris removalBact. samplingPCR (FHV1)RF 0,1% (Ricrolin TM)Iontophoresis5 min 1mA/min30 mW/cm3 min5,4J/cmTobrexTM BID7 daysAccelerated protocol(KXLTM Avedro)
  10. 10. Iontophoresisdevice
  11. 11. Follow-upInclusion D1 D4 D8 D15 D31Pain and clinical scoreUlceration and infiltration surfaces
  12. 12. Follow-up0 : absent1 : light2 : moderate3 : severe0 : absent1 : presentClinical score(0-18)Pain score(0-7)Mucopurulent dischargeCorneal edemaCorneal vascularizationConjunctivitisBlepharitisUveitisProstrationAggressive behaviorBlepharospasmEnophtalmosPhotophobiaOcular pruritusDefense reaction
  13. 13. Results Mean evolution time40 daysUlcer depth 21-54%2/6 Persian1/6 positive bacterialculture1/6 FHV1 positive 6 cats
  14. 14. 121086420Evolution ofAverage scoresD1 D4 D8 D15 D31Clinical score Pain score35302520151050Evolution ofAverage surfaces (mm)D1 D4 D8 D15 D31Ulcer surface Infiltration surface
  15. 15. Cornealvascularization
  16. 16. Discussion : efficacyReduction of clinicaland pain scoreComplete EpithelialhealingResolution of corneal melting
  17. 17. Comparison to conventionalimpregnation of RF
  18. 18. Distribution of RF ?Clear cornea KeratitisHuman and rabbit studies(fluorometry, histology,HPLC, OCT)Anterior stroma (150 m) :Cinstillation= 2x CiontophoresisLess uniform diffusion?
  19. 19. Adverse effects of iontophoresisElectric burnsHigh intensity currentChemical burns High or low pH solutionsNot observed in humanpatients with I < 4mA/minPain
  20. 20. Duration of treatment ?Instillation30 minIontophoresis5 minIrradiation30 minAccelerated CXL3-10 minConventional protocolDuration > 1 hourIonto + acc. CXL protocolDuration < 20 min.
  21. 21. Conclusion: IONTOPHORESISResolution of corneal meltingResults similar toconventional instillationNo adverse reaction or painReduction ofprocedure duration
  22. 22. Perspectives: IONTOPHORESISEnhanced penetration of RFor other therapeutic agents?
  23. 23. Thank you.