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Customized corneal crosslinking using different
UVA beam profiles
Presenting Author: Natasha Pahuja
Co authors: Rohit Shetty, Roshan T, Rashmi Deshmukh, Mathew Francis, Abhijit Sinha Roy
Narayana Nethralaya, Bangalore, India
Financial disclosures: Nil
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A new era of cross linking
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W I L L
T H I S
W O R K?
ApplicationCross linking current lacunae
Future
Information from cell biology
Biomechanics & newer insights
Research Question
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W I L L
T H I S
W O R K?
ApplicationCross linking current lacunae
Future
Information from cell biology
Biomechanics & newer insights
Research Question
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Observations in Imaging Lab
Brillouin Spectrometer
The Biomechanical profile is ‘differential’ in keratoconus
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W I L L
T H I S
W O R K?
ApplicationCross linking current lacunae
Future
Information from cell biology
Biomechanics & newer insights
Research Question
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Inflammation Driving Keratoconus Possible structural molecules affected by disease process!
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Observations in our Molecular biology Lab
Epithelium over cone
Epithelium over non-ectatic area
Biorepository
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Gene expression analysis
• MMP9 • IL6 • TNFa
• LOX • TIMP-1
• Col I A1 • Col IV A1
The molecular structure profile is ‘differential’ in keratoconus
differential
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KC Grade I KC Grade II KC Grade III KC Grade IV
Localised disease
Observations in Clinic
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W I L L
T H I S
W O R K?
ApplicationCross linking current lacunae
Future
Information from cell biology
Biomechanics & newer insights
Research Question
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But still….
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W I L L
T H I S
W O R K?
ApplicationCross linking current lacunae
Future
Information from cell biology
Biomechanics & newer insights
Research Question
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Localised disease
Uniform UVA irradiation?
Programmable beam pattern with differential surface dose?
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Beam Profiles
Tangential Map
Axial Map
Uniform beamSectoral
beamRings beam
Axial Map
Rings beam
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(n=20) (n=18) (n=20)(n=18)
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Case examples
Pre opTreatment planPost op 6 monthsDifference map
Pre opTreatment planPost op 6 monthsDifference map
Pre opTreatment planPost op 6 monthsDifference map
Pre opTreatment planPost op 6 monthsDifference map
Pre opTreatment planPost op 6 monthsDifference map
Pre opTreatment planPost op 6 monthsDifference map
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(n=20) (n=18) (n=20)(n=18)
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Pre-op Post op
12 monthsp value
Deformation ampitude
1.3 ±0.1 1.2 ± 0.1 0.07
Specular CD 2704±359 2658 ± 430 0.69
Corneal biomechanics Specular microscopy
Safe
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Molecularsignature-Clinicaloutcomes
KXL2 – Bad prognosis (n= 6 eyes)KXL2 – Good prognosis (n=70 eyes)
➢ We studied the epithelium of the cone area in these eyes collected during the surgery
➢ Eyes were categorized into good prognosis (Kmax difference post-op minus pre-op ≥ 0 and bad prognosis if its < 0).
P>0.05
Trend shows increased expression of LOX in patients with good outcomes as compared to the patients with bad outcomes
Whereas TNFα expression is less in patients with good outcomes as compared to the patients with bad outcomes
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Discussion
Clinic Advance Imaging
Cellular Biology
Customised Beam profile
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W I L L
T H I S
W O R K?
ApplicationCross linking current lacunae
Future
Information from cell biology
Biomechanics & newer insights
Research Question
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Masking
Future
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OCT based Topography
PentacamAnteriorSurface
OCTAnteriorSurface
OCTBowman’sInterfaceSurface
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PentacamOCTAir-Epithelium
InterfaceOCTEpithelium-
Bowman’sInterface
Kmax~55.5D Kmax~58.5D Kmax~60.5D
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Programmable beam pattern with differential surface dose?
Topography OCT- tomography
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Thank you
Clinicians Scientists
Basic Scientists
GROW
enes,epair & Regeneration inphthalmicorkstation
Translating Research in to Practice
Dr. Rohit Shetty Dr. Abhijit Sinha Roy
Mathew Francis Dr. Arkasubhra Ghosh
Grace Lytle Fellow colleagues