EyeWorld Asia-Pacific December 2015 Issue

55 EWAP CORNEA December 2015 or DALK, is indicated [when a] patient’s visual acuity may not be improved using glasses or contact lenses,” Dr. Fontana said. “In keratoconus a patient’s ectatic cornea profile may be improved surgically by means of intracorneal ring segment implantation or customized surface ablation using an excimer laser.” Crosslinking for corneal ectasia Paolo Vinciguerra, MD , Milan, Italy, discussed crosslinking for the treatment of corneal ectasia. Currently, he said there are three main crosslinking protocols: epi-on, epioff, and iontophoresis with epi-on. Epi-off uses 30 minutes of soaking time and a demarcation line between 230 and 320 microns. Epi-on has a demarcation line between 50 and 100 microns. The iontophoresis protocol uses a demarcation line between 230 and 320 microns. The real differentiating factor is the demarcation line, Dr. Vinciguerra said. “The demarcation line is the depth reached in the crosslinking process.” The deeper and larger the percentage of tissue involved, the stronger the cornea, he said. Dr. Vinciguerra shared his general guidelines for deciding which protocol is best suited for the patient. He said that normally in the decision-making process, he would choose the standard epi-off MORIA S.A. 15, rue Georges Besse 92160 Antony FRANCE Phone: +33 (0) 1 46 74 46 74 - Fax: +33 (0) 1 46 74 46 70 moria@moria-int.com - www.moria-surgical.com THE MORIA OPTION FOR SBK Make your own comparisons between the One Use- Plus and a femtosecond laser in terms of capital investment, disposables per patient, and annual maintenance. www.moria-surgical.com Think Thin Thin, 100-micron, planar flaps Accuracy and predictability equivalent to Femto-SBK Smoother stromal bed No femto-complications … At a fraction of the cost Watch me in action protocol for younger patients, or those under 18 years of age. For patients older than 45, epi-on can be a good option. He suggested iontophoresis with epi-on for patients older than 30. In the future, Dr. Vinciguerra expects crosslinking will progress with different riboflavin concentrations, different soaking times, customized beams and more effective lasers in the periphery. He added that more advanced nomograms are needed. The crosslinking treatment varies depending on the disease being treated, whether it’s keratoconus or other ectatic conditions. In other ectatic disorders (not keratoconus), Dr. Vinciguerra said the deepest possible demarcation line is needed to be effective, which can be achieved with epi-off and a long soaking time. The laser is not as effective for many reasons on the corneal periphery for focusing and beam energy density. “So we should focus [on the] periphery and offset the laser beam inferiorly,” he said. EWAP Editors’ note: Drs. Fontana and Rootman have no financial interests related to this article. Dr. Vinciguerra has financial interests with Nidek (Fremont, Calif.), Oculus (Arlington, Wash.), and Schwind eye-tech solutions (Kleinostheim, Germany). Contact information Fontana: luifonta@gmail.com Rootman: d.rootman@utoronto.ca Vinciguerra: paolo.vinciguerra@humanitas.it