NOV 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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42 EW FEATURE Corneal crosslinking November 2013 Crosslinking continued from page 40 look at crosslinking for infections, but they were not FDA trials," he said. "They were just studies that were performed." He said that because of the price and difficulty in running an FDA trial, it would be a very long time before this type of trial is done. Dr. Moshirfar said there have been mixed results so far. "But I still believe that if you have an exceptional situation that you are dealing with, an infection that is not responding to the existing antimicrobials or antifungals, I think [crosslinking] can be considered in those exceptional situations," he said. He said studies so far have suggested positive results for patients with some multi-drug resistant bacteria and for some patients with severe fungal keratitis, but results have been mixed for using crosslinking for Acanthamoeba. Dr. Moshirfar said caution is needed when using crosslinking for patients with certain conditions because even if it gives temporary improvement, the patient may still need additional surgery such as corneal transplantation later on, depending on the severity of the condition. There are still many questions to be answered about crosslinking for non-ectatic indications, includ- LET'S TALK SOLUTIONS We understand that space is critical in today's modern eye care facilities. The Accutome B-Scan and UBM Plus are portable, high-definition probes that provide remarkable image quality. The units link directly to a PC, laptop or tablet. We also ofer unlimited software licenses, so you can be ready to scan in any exam room. Accutome, Keeler, Volk AAO Booth #2245 Three great companies combining booth space to provide a wide array of products and the best customer experience. SKU 24-6300 SKU 24-6100 ing addressing the dosage of riboflavin, how many minutes of exposure are needed, and how thick a cornea must be for the procedure to be truly safe. "I think the take-home message should be that we need more data," Dr. Moshirfar said. Contraindications for patients Although crosslinking could be a plausible treatment for a number of conditions, there are contraindications. Dr. Stulting said patients with thin corneas might not be able to undergo crosslinking with the classic Dresden technique because it could possibly cause endothelial cell damage. In addition, patients with predictable problems with epithelial healing might be at higher risk for complications if epithelium is removed. Those may include tear deficiency, very steep corneas, and exposure keratopathy. For thin corneas, hypotonic riboflavin or transepithelial techniques might be indicated. "One of the problems with the use of collagen crosslinking in nonectatic conditions is that many of these patients have thinner corneas, and they may already have some corneal melts," Dr. Moshirfar said. "So you have to be careful because if you use the UV light on someone whose cornea is already thin because of some melt or necrosis, you can damage the endothelium." Additionally, Dr. Moshirfar said patients with poor epithelial healing and conditions like limbal stem cell deficiency might not be good candidates for crosslinking. He said to exercise caution as well with patients who have herpes zoster, herpes simplex, or if a patient has a corneal melt that has reached the point where the cornea is thinner than 250 to 300 microns. Dr. Donnenfeld said crosslinking will be more effective in some patients than others. "The experience has been limited," he said. "But my advice is that for patients who are not responding to conventional therapy to consider crosslinking as a viable alternative or adjunct to conventional therapy." EW Editors' note: Drs. Stulting, Moshirfar, and Donnenfeld have no financial interests related to this article. Contact information www.accutome.com/product/ubm-plus www.accutome.com/product/b-scan-plus 3222 Phoenixville Pike, Malvern, PA 19355 USA • 800-979-2020 • 610-889-0200 • FAX 610-889-3233 • www.accutome.com Donnenfeld: ericdonnenfeld@gmail.com Moshirfar: majid.moshirfar@hsc.utah.edu Stulting: dstulting@woolfsoneye.com

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