Accelerated CXL for the treatment of bullous keratopathy

Dr Frank Famose – DVM - DESV

Toulouse – France

frankfamose@gmail.comZürich November 5th, 2014

Outline

What is bullouskeratopathy (BK) ?

What are the treatments ?

BK and CXL

Definition

Chronic superficialcorneal ulceration

Intense corneal edema

Ocular pain

Loss of vision

Endothelial impairment

Stromal edema

Epithelial edema

Bullae

Ulceration

The endothelial failure

Endothelialdystrophy

Degenerative

Post-surgical

Glaucoma

AnteriorUveitis

Feline « bullous keratopathy »

Corneal hydrops

Treatment

Chronic superficialcorneal ulceration

Intense corneal edema

Surfacetreatments

TopicalHyperosmoticdrugs

Stromal abrasion

Conjunctival grafts

Thermokeratoplasty

Poor results

BK and CXL : the Human experience

Compaction of the

corneal stroma

Decreased thickness

Improved transparency

Reduced anterior

stromal pressure

Temporary symptomatic relief

and visual improvementMore than 30 publications

since 2007

BK and CXL : the veterinary experience

2 case series

10 dogs, no cats

2 different protocols

Does it work ?

Protocol

Dogs with BK

No glaucoma

Failure of Previous treaments

Accelerated CXL(30 mW/cm²)

No hyperosmoticpreparation

6 Months Follow-up

Results

UlcerationResolved in 1 week

Discussion : epithelial healing

Early healing

Pain resolution

6 months duration

Same results in the 2 case reports

Discussion : corneal thickness and edema

Early improvement

Return to baseline

Visual improvement ?

Same results in the 2 case reports

Conclusion

CXL useful for BK-inducedcorneal ulceration

Short-lasting actionon corneal edema

Protocol adaptations

More cases…

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