“This is now my go-to treatment in all my cases where I don’t need the Dresden protocol,” said Farhad Hafezi, FARVO, MD, PhD, of office-based corneal crosslinking (CXL) at the slit lamp. He spoke during Friday’s Refractive Surgery Subspecialty Day.
The procedure represents a paradigm change from the traditional OR technique because it can be performed in an office setting and holds the promise of increasing accessibility and affordability for patients around the world. To make this procedure possible, Dr. Hafezi and colleagues developed a special device, the C-EYE, that attaches to the slit lamp.
Steps in the process. After topical anesthesia is administered, the epithelium is removed (“epi-off” technique) at the slit lamp. Riboflavin is then instilled with the patient in a reclining chair—“no surgical bed is needed,” said Dr. Hafezi. After the appropriate duration of riboflavin contact, the patient returns to the slit lamp for ultraviolet irradiation using the selected protocol on the CXL device.1
Fixation keeps the patient from moving. The slit lamp has the added advantage of a fixation light, which helps the patient to relax and remain still during the procedure.
Low infection rates. In a retrospective cohort study of 501 patients who received the in-office procedure, infection rates were 2%, no higher than the OR-based procedure.2
Advantages of “epi-on” approach. Traditionally, CXL has been an “epi-off” procedure, but Dr. Hafezi has also been performing this slit-lamp procedure “epi-on,” without requiring additional oxygen or iontophoresis. This approach keeps the patient more comfortable and further reduces the risk of infection.
Can be used to treat bacterial/fungal corneal infections. A single treatment may be equivalent to 10 days of antibiotics in bacterial ulcers up to 4 mm.
—Reena Mukamal
1 Hafezi F et al. J Refract Surg. 2021;37(2):78-82.
2 Hafezi F et al. Eye Vis. 2023;10:36.
Financial disclosures: Dr. Hafezi: EMAGine AG: P; Light for Sight Foundation: S; Schwind Eye-tech-Solutions GmbH: S; Velux Foundation: S.
Disclosure key: C = Consultant/Advisor; E = Employee; EE = Employee, executive role; EO = Owner of company; I = Independent contractor; L = Lecture fees/Speakers bureau; P = Patents/Royalty; PS = Equity/Stock holder, private corporation; S = Grant support; SO = Stock options, public or private corporation; US = Equity/Stock holder, public corporation For definitions of each category, see aao.org/eyenet/disclosures.
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