AAO-ESCRS Joint Symposium at ESCRS 2024: Innovations and Controversies in CXL
Epi-on CXL Revisited
Swiss expert Prof. Farhad Hafezi MD, PhD, FARVO discussed the evolution of epi-on cross-linking (CXL) for keratoconus. Despite the method’s historically challenging reputation, Prof. Hafezi expressed confidence in its future, noting that its simplified, pulsed protocol now eliminates the need for additional oxygen or iontophoresis. He emphasized the importance of optimizing the balance between light, oxygen, and riboflavin, issues that were resolved over time. He pointed out that the technique could significantly improve accessibility and affordability by reducing the need for an operating room.
Balancing the Pros and Cons of CXL
Italian expert Dr. Paolo Vinciguerra examined the strengths and limitations of CXL, noting that the procedure is time-consuming, and recovery can take months. He underscored the role of the corneal epithelium in reshaping the corneal curvature, which influences higher-order aberrations. Dr. Vinciguerra reported long-term stability in corneal flattening, especially in pediatric patients, using high-resolution wavefront-guided systems linked to excimer lasers.
CXL for Keratoconus: Protocol Comparisons
Dr. Jose De la Cruz from the U.S. reviewed advancements in CXL for keratoconus and started his presentation with the standard Dresden protocol, which remains the most commonly performed CXL protocol in the U.S. This method involves epithelial removal followed by riboflavin and UVA exposure. Dr. De la Cruz discussed accelerated protocols that reduce treatment time while maintaining safety and effectiveness. Both the standard and accelerated methods yield similar outcomes in terms of topographic and refractive improvements. However, he stressed that patient-specific factors, such as age and family history, must guide treatment decisions.
New Frontiers: CXL for Infectious Keratitis
CAKE reported that in the symposium’s final session, Dr. Jennifer Rose-Nussbaumer (USA) explored the use of CXL in treating infectious keratitis, particularly cases resistant to antibiotics. She presented a case involving pseudomonas keratitis, which was unresponsive to standard treatments and required a therapeutic transplant. Dr. Rose-Nussbaumer highlighted CXL’s antimicrobial effects, its role in reducing inflammation, and its potential to increase corneal resistance. Early research into PACK-CXL cross-linking for bacterial and fungal keratitis showed promise, and ongoing trials are expected to provide further insights.
The symposium showcased how CXL continues to evolve, offering hope for improving both keratoconus management and treatment options for infectious keratitis. The session also underscored the need for individualized approaches and the potential for new frontiers in corneal medicine.
