Several events have marked the ophthalmological practice in
this year 2016, in terms of innovation, equipment and consumables
as well as diagnosis and treatment.
One of the most striking facts is the obtaining, in April, of the
FDA authorization for corneal collagen cross-linking (CXL) in
the treatment of keratoconus, when this process is widely
used outside the United States since its Developed in Germany
by Dr Theo Seiler in 1998. This technique allows the stabilization
of the evolution of the keratoconus by stiffening the
cornea. Under the effect of UVA, the riboflavin instilled on the
cornea generates free radicals at the origin of covalent bonds
from the corneal collagen. Several studies have demonstrated
the effectiveness of this technique; variants of the procedure
have been proposed to bypass certain difficulties encountered
during the CXL. The accelerated CXL (by increasing the intensity
and reducing the exposure time) makes it possible to reduce
the total time of the procedure; the use of a contact lens
makes it possible to propose this treatment even in the case
of thin pachymetry.
CXL alone or in combination with other processes (PRK, intracorneal
rings) becomes essential in the management of keratoconus;
it is the first step from the age of 12 years, before the
introduction of an optical treatment.
Today, several companies offer more and more efficient devices;
it is even possible to use a removable CXL device mounted
on the slit lamp for easier handling and better performance.
The use of CXL has demonstrated its destructive effect on living
organisms and keratocytes. Therefore, PACK-CXL (photo
activated chromophore for infectious keratitis) has been proposed
for the treatment of corneal infections, in the case of
severe ulcers and then alone as a first-line treatment for bacterial infections. It may help reduce the global burden of microbial
resistance to antibiotics and other therapeutic agents.
The celebration of the World Keratoconus Day, for the first
time this year on November 10th, testifies to the interest of
the medical ophthalmological community in keratoconus and
the need to support patients, who are often helpless in the
face of the multiplicity of solutions and the lack of a single
consensus of care.
The keratoconus, far from being a fashionable phenomenon,
remains a potentially blinding capricious disease requiring
precise and early clinical and therapeutic diagnosis and whose
treatment will firstly involve corneal cross-linking to stabilize
the disease and then discuss on a case by case basis the different
solutions (Glasses, lenses, PRK, rings or implants) to
obtain optimal refraction. A long way over but much remains
to be done.
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