Eyeworld

EW REFRACTIVE 62 June 2017 The Chateaux Deer Valley Park City, Utah Interactive and engaging, with Q&A, video case presentations, a regulatory update by ASCRS, and panel discussions designed to provide you with valuable pearls and insights. Registration Now Open! View program updates and book housing at: SurgicalSummit.EyeWorld.org The 2018 Surgical Summit will be: CME EDUCATION ASCRS This activity is approved for AMA PRA Category 1 Credits.™ Questions? Contact SurgicalSummit@EyeWorld.org Join us at the Chateaux " This is a chance to interact personally with a number of really trusted and valued mentors. " — Louis Alpern, MD, El Paso, Texas by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer the correction of low grade myo- pia in patients reliant on glasses or contact lenses who are either ineligible for laser vision correction or uncomfortable with the idea of invasive eye surgery, or for post-cat- aract patients with a small degree of residual, uncorrected myopia, which in one study was shown to be ±1.0 D in roughly 25% of post-cataract patients. 1 What is PiXL? PiXL is a simple two-step proce- dure involving the application of riboflavin (vitamin B2) eye drops, a naturally occurring non-toxic pho- tosensitizer, onto the cornea with subsequent ultraviolet A (UVA) light irradiation of the riboflavin-saturat- ed cornea, which strengthens and reshapes the cornea by crosslinking corneal collagen fibers. Efforts to clarify the advantages of PiXL treatments performed with the epithelium on or off are under- way that take into consideration potential limiting factors such as epithelial riboflavin absorption, oxygen diffusion, and incoming light absorption by the epithelial cells. Riboflavin needs to be ab- sorbed through the epithelium to be effective, evoking questions regarding the best type of riboflavin to use and the duration of riboflavin exposure on the cornea. One study revealed that the effects of PiXL in eyes with keratoconus that received a prolonged preoperative riboflavin application of 2 hours achieved sim- ilar depth of effect in the stroma and less pronounced confocal micro- scopic changes as eyes treated with standard crosslinking with epithelial debridement. 2 As oxygen availability plays an important role in crosslink- ing, altering the effects on diffusion through the epithelial layer by the removal of the epithelium should be carefully considered. High oxygen versus room air The preliminary data from an on- going Swedish study showed better myopia reducing effects using high oxygen compared to room air with epi-on PiXL, according to a presen- tation from the 21st Winter Meeting of the European Society of Cataract and Refractive Surgeons (ESCRS), in Maastricht, Holland. "This is some- thing quite new and exciting, as I see it," said Anders Behndig, MD, P hotorefractive intrastromal crosslinking (PiXL, Avedro, Waltham, Massachusetts) is a procedure that offers a non-surgical option for Preliminary data shows corrections of more than 1.0 D in cases of low-grade myopia using 4 mm epi-on PiXL under high oxygen conditions High oxygen enhances epi-on PiXL efficacy

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