Pack iontophoresis-cats famose-cxl_zurich_2014
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Présentation faite au Xème congrés international sur le cross-linking du collagène cornéen (Zurich 5-6 décembre 2014). Lecture given during the Xth international congress of corneal collagen cross-linking, (Zurich 5-6 th december 2014)
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Pack iontophoresis-cats famose-cxl_zurich_2014
- 1. EVALUATION OF PACK-CXL AFTER IONTOPHORESIS FOR THE TREATMENT OF MELTING KERATITIS IN 10 CATS Dr Frank Famose – Toulouse - France Zürich – december 6th, 2014 Pierre Roy – Paris - France
- 2. PACK-CXL Valuable tx for melting keratitis Sedation Shortening of the procedure
- 3. Iontophoresis Application of a constant electric current to enhance penetration of a ionized substance through a tissue
- 4. Aim of this study To evaluate the clinical outcome of feline melting keratitis treated by accelerated CXL after iontophoresis of riboflavin
- 5. Inclusion criteria Cats Corneal melting Minimal Corneal thickness > 300 μm
- 6. Protocol Riboflavine impregnation Exposition UVA 365 nm Post-CXL treatment RF 0,1% (Ricrolin +TM) Iontophoresis 5 min 1mA/min 30 mW/cm² 3 min 5,4J/cm² TobrexTM BID 7 days Accelerated protocol (KXLTM – Avedro)
- 7. Follow-up Inclusion D1 D4 D8 D15 D31 Pain (0-7) and clinical (0-18) scores Ulceration and infiltration surfaces
- 8. 12 10 8 6 4 2 0 Evolution of Average scores D1 D4 D8 D15 D31 Clinical score Pain score 35 30 25 20 15 10 5 0 Evolution of Average surfaces (mm²) D1 D4 D8 D15 D31 Ulcer surface Infiltration surface
- 9. Discussion : efficacy Reduction of clinical and pain score Complete Epithelial healing Resolution of corneal melting
- 11. Duration of treatment ? Instillation 30 min Iontophoresis 5 min Irradiation 30 min Accelerated CXL 3-10 min Conventional protocol Duration > 1 hour Ionto + acc. CXL protocol Duration < 20 min.
- 12. Conclusion: IONTOPHORESIS Resolution of corneal melting Results similar to conventional instillation No adverse reaction or pain Reduction of procedure duration
Notes de l'éditeur
- Good afternood Ladies and Gentlemen, before talking about iontophoresis and its application to corneal cross-linking, I’d like to thank the ECVO comitee for allowing me to present these results.
- As you know, melting keratitis is a serious condition which is considered as an ocular emergency due to the high risk or corneal perforation. The melting of the cornea is due to metalloproteinase imbalance in relation with infectious or not infectious conditions. When the medical treatment, based on antibiotics and anticollagenases doesn’t succeed, surgery is indicated for tectonic purposes. Corneal collagen cross-linking is used for the treatment of infectious or melting keratitis in humans for some years and more recently for dogs, cats and horses.
- The principle of iontophoresis is to increase the penetration of a ionized substance through a tissue by the application of a constant electric current. It has been used for first time in ophthalmology in the beginning of the 20th century. Many studies have been conducted since 1990 for the delivery of many drugs in the eye (like steroids and so on). The first use of iontophoresis for riboflavin delivery was published recently for the treatment of keratoconus. For the moment, no veterinary clinical use of ionto has been described and no data for keratitis treatment is available.
- The aim of this study is to evaluate the clinical outcome after treatment of melting keratitis after iontophoresis of riboflavin and cross-linking in feline patients.
- Inclusion criteria were represented by feline patients presenting with corneal melting with poor response to previous medical treatment
- On day one, cats under general anesthesia have their cornea cleaned and sampled. Riboflavin impregnation by iontophoresis and an accelerated cross-linking.
- Follow-up was conducted for one month with evaluation of pain and clinical score and measurement of ulceration and infiltration surface.
- After treatment, we see a rapid reduction in pain and clinical score and disappearance of the ulcer and of the zone of infiltration. You see that there is a positive clinical score à one month, this is due to
- The aim of this study was to evaluate the efficacy of cross-linking after iontophoresis of riboflavin. We have observed the resolution of corneal melting with complete epithelial healing and reduction of clinical and pain scores in all cases.
- … we see that all the criteria have a similar progression in both groups during the follow-up period.
- If we consider the duration of treatment, we see that conventional protocol takes more than an hour to be completed. With iontophoresis and accelerated cross-linking the duration of treatment can fall under 20 minutes according to the intensity of UVA you’re using. This has the advantage to shorten the duration of anesthesia.
- In a first step, we can conclude that iontophoresis of riboflavin followed by accelerated cross-linking was associated with a good outcome in the resolution of corneal melting in cats. That these results are similar to conventional instillation with a shorter treatment duration and no adverse reaction.
- Thank you for your attention. I’ll be happy to answer to any question.