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Seite 1 Peripheral optimized CXL and high power Peripheral optimized CXL and high power Theo Seiler Theo Seiler I nstitut für R efraktive und O phthalmo-

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Presentation on theme: "Seite 1 Peripheral optimized CXL and high power Peripheral optimized CXL and high power Theo Seiler Theo Seiler I nstitut für R efraktive und O phthalmo-"— Presentation transcript:

1 Seite 1 Peripheral optimized CXL and high power Peripheral optimized CXL and high power Theo Seiler Theo Seiler I nstitut für R efraktive und O phthalmo- C hirurgie (IROC ) and University of Zürich

2 Seite 2 thinnest point steepest pointPMD

3 Seite radial distance to apex / mm thinnest pachymetry / μm PMD KC PMD vs KC

4 Seite 4PMD

5 Seite 5PMD

6 Seite 6 In the majority of the keratectasia cases the weakest point of the cornea that needs CXL most is 1 to 3 mm away from the center CXL

7 Seite 7 radial distance / mm relative depth in % th th 1 m avstudy OCT 1 month post CXL, 10 eyes, inhomogeneity of the beam in curve th 1

8 Seite 8 In order to create a homogeneous CXL-effect also in the periphery of the cornea the periphery of the cornea irradiation with a top hat-profile is not good enough. irradiation with a top hat-profile is not good enough. 3 mm away from the center the light intensity needs to be increased by at least 25% proposal

9 Seite 9profile I0I0I0I0 UV-X1000 UV-X2000 Avedro 0 4mm 8mm

10 Seite 10profile Crosslinking profile of the UV-X2000

11 Seite 11CXL-typesvolume-type 0μm 100μm 200μm 300μm 400μm 500μm 600μm 30 min 3.00 mW/cm² 9min mW/cm² surface-type 0.1% 30 min 0.5% 2 min

12 Seite 12 Pseudo-BowmansCXL-types

13 Seite 13CXL-types

14 Seite 14 CXL-types volume-type CXL-depth 250 to 330 μm

15 Seite 15CXL-types Applications volume-type (homogeneous riboflavin, low power) infectious keratitis infectious keratitis melting diseases melting diseases keratoconus ? keratoconus ? Applications surface-type (high riboflavin gradient, high power) refractive laser surgery refractive laser surgery customized CXL customized CXL

16 Seite 16conclusion 1.In the majority of the cases a peripheral CXL is mandatory 2.Second generation CXL lightsources need an optimized beam profile 3.The surface-type CXL works only if the central irradiance guarantees an illumination time of 10 min and less


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