accelerated cxl for the treatment of infectious keratitis

ACCELERATED-CXL FOR THE

TREATMENT OF INFECTIOUS

KERATITIS

Lessons from animal studies

Dr Frank FAMOSE

DVM – DESV ophtalmologie

Toulouse - France

frankfamose@gmail.comBarcelona 2014

Avedro’s 3rd International Congress on Advanced Corneal Cross-Linking

Surgical

treatment

Medical

treatment

Success

Failure

Conjunctival

graftsEnucleation

Visual loss

Antibiotics

Anticollagenases…

Observance

Evolution of infectious keratitis in dogs & cats

Unmet needs…Single treatment

High rate of success

Light post-op Tt

Vision preservation

Background

StandardProtocol30min 3mW/cm²

Inclusion criteria

Dogs and cats

Corneal melting

Poor response to

medical treatment

Minimal corneal thickness>300 µm

Protocol

General

anesthesia

Corneal

cleaning

Riboflavine

soaking

Exposition

UVA 365 nm

Post-CXL

treatment

OCT

Medetomidine

Ketamine

Isoflurane

Debris removal

Bact. sampling

PCR (FHV1)

RF 0,1% 20% dextran

(VibexTM)

1 drop ev. 2 min

30 minutes

30 mW/cm²

3 min

5,4J/cm²

TobrexTM BID

7 days

Accelerated protocol

(KXLTM – Avedro)

Results

8 Dogs* 10 Cats**

No adverse reaction *Famose F. Veterinary ophthalmology 2013** Famose F. Veterinary ophtalmology 2013

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

Accelerated CXL

Single treatment with high rate of

success

Vision preservation

No specialized technical skills

Shortening of procedure duration

Are antibioticsstill necessary after CXL?

Could CXL be a first

intention treatment ?

Could we use

higher fluences?

Could we use

Iontophoresis?

Thank you.