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Post Info TOPIC: Crosslinking studies going on


Ophthalmologist

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Date: Fri May 16 7:18 AM, 2008
Crosslinking studies going on
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Collagen cross-linking shows encouraging results in French study

PARIS — UV corneal collagen cross-linking is showing encouraging results in patients with keratoconus and post-LASIK ectasia, according to the results of a study conducted at two centers in France.

David Touboul, MD, and Pierre R. Fournié, MD, respectively under the direction of Joseph Colin, MD, in Bordeaux, and François Malecaze, MD, in Toulouse, discussed favorable experimental results with cross-linking, which they think could change the outcomes for many keratoconus patients.

"To date, there is no device that can measure the changes in corneal stiffness in vivo, but laboratory ex vivo studies have largely demonstrated that the treatment indeed produces a cross-linking of collagen fibers that leads to increased corneal rigidity and re-structuring," Dr. Fournié said here at the French Society of Ophthalmology meeting.

What is seen clinically is a halting of keratoconus progression in most patients, he said.

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"Results are not uniform," Dr. Touboul said. "The individual response to the treatment is quite variable, for reasons that are still unknown; however, in most patients, keratoconus progression is halted or at least slowed down, and visual acuity increases quite a few lines."

Both physicians pointed out that it is still early to draw definitive conclusions, and although UV cross-linking so far has been shown to cause no complications apart from transient haze in some cases, they recommended caution. The treatment should be administered only in cases of proven keratoconus progression, and patients with corneal thickness that is 400 µm or less should not be candidates for the procedure because riboflavin, and consequently UV light penetration, in these thin corneas would cause severe damage to the epithelium.

"Hopefully, we will be able to produce new molecules that will allow us to safely use the procedure also in thinner corneas," Dr. Touboul said.

No limitations seem to be necessary in terms of age, but early stages of keratoconus appear to respond better, he said.

While the IROC system was initially used in both centers, Dr. Touboul said that best results were obtained with the new CBM X Linker[/u], which may be more user-friendly and more precise.

Accurate antiseptic measures were recommended, as well as the application of a therapeutic contact lens and the use of topical antibiotic and corticosteroid therapy after the treatment.

"In spite of the cornea being disepithelialized and remaining exposed for 1 whole hour, we had no case of infection," Dr. Touboul said.


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Juan


Ophthalmologist

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Date: Fri May 16 7:20 AM, 2008
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Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: Long-term results

Frederik Raiskup-Wolf, MD, Anne Hoyer, MD, Eberhard Spoerl, PhD, Lutz E. Pillunat, MD
Accepted 27 December 2007.

Purpose

To prove the long-term dampening effect of riboflavin- and ultraviolet-A-induced collagen crosslinking on progressive keratoconus.

Setting

Department of Ophthalmology, C.G. Carus University Hospital, Dresden, Germany.

Methods

Four hundred eighty eyes of 272 patients with progressive keratoconus were included in this long-term retrospective study. The maximum follow-up was 6 years. At the first and all follow-up examinations, refraction, best corrected visual acuity (BCVA), corneal topography, corneal thickness, and intraocular pressure were recorded.

Results

The analysis included 241 eyes with a minimum follow-up of 6 months. The steepening decreased significantly by 2.68 diopters (D) in the first year, 2.21 D in the second year, and 4.84 D in the third year. The BCVA improved significantly (1 line) in 53% of 142 eyes in the first year, 57% of 66 eyes in the second year, and 58% of 33 eyes in the first year or remained stable (no lines lost) in 20%, 24%, and 29%, respectively. Two patients had continuous progression of keratoconus and had repeat crosslinking procedures.

Conclusions

Despite the low number of patients with a follow-up longer than 3 years, results indicate long-term stabilization and improvement after collagen crosslinking. Thus, collagen crosslinking is an effective therapeutical option for progressive keratoconus.

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Juan


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Posts: 124
Date: Sat May 17 2:49 AM, 2008
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Hello people,

Dr Juanito thank you for the scientific research studies you have posted.


Mainly,we should stick to the second research,meaning the Germans because they are the founders of collagen crosslinking and with the most experience since 1996.

We should not conducting experiments with crosslinking,meaning other Crosslinking machines and riboflavin solutions because uncertain things might happen.Dr Theo Seiler showed us the path and his guidelines,so dont experiment because afterall it is the patients corneas that are at risk.

The French doctors should explain to patients the different protocols that use for the collagen crosslinking.


All the best,

P.S Pay attention to everything a doctor use and ask why it is using that and mainly trust the German technology.





-- Edited by Zeus at 02:51, 2008-05-17

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Ophthalmologist

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Date: Fri May 30 5:01 PM, 2008
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Dear Zeus:

Our work as physicians is to investigate and progress in the field of Medicine. Many basic research ( basic means in laboratory ) is going on in several countries with different substances, exposure times and wavelengths to stop keratoconus, to increase scleral rigidity to stop other diseases as high myopia, to crosslink some specific areas trying to expand the sclera to compensate presbyopia, to make a deep femtosecond laser cut to allow B2 to easily enter the cornea and shorten the UV exposure time ( this experimental procedure is being evaluated in human patients by your doctor...not following Seiler´s guidelines) etc... Have you heard anything about pulsed UV emission to shorten the exposure time and allowing the free radicals to increase their xlink effects with less potentially harmful side effects? This is being investigated by a California based company.

Technology will improve and new devices, protocols and therapeutic options will improve the clinical results in the patients. And nobody can stop it. First intraocular PMMA lens was first implanted by Sir Harold Ridley in England. Nowadays thousands of different intraocular lens materials, designs and optics are being implanted worlwide. It has been a long run but the cataract extraction surgery is today much much much better than in the 50´s. What if we had stopped performing the same surgery as in the 50´s? You can imagine.
Should we drive a belgium car only because the belgium designer Etienne Lenoir first patented the explosion engine in 1860 ? Of course not.

We will see improvements in Xlinking as well in the future. And we don´t have to close the doors to progress. If it means that other devices, substances and protocols prove to be better than those we are using today, then they will be welcome. Now we are conducting in our Institution a comparative study between the two devices approved for human use in Europe and with the apropriate follow up time we will publish the results in a peer reviwed medical journal.

We are doctors without any commercial interest in selling any device and our obligations are to treat the patients the best we know and tell other doctors our results. That´s what French doctors explain in their article.

All the best



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Juan
mz


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Date: Tue Jun 3 3:04 PM, 2008
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From: http://www.osnsupersite.com/view.asp?rid=28382


OSN SuperSite Breaking News 5/21/2008

Physicians have much to learn to optimize cross-linking

GOIANIA, Brazil — Cross-linking is an exciting procedure that has yet to be optimized, a researcher said here at the International Congress of Cataract and Refractive Surgery.

"We are in the infancy of evaluating the effectiveness of cross-linking and even understanding the biomechanical evolution of keratoconus," said Cynthia J. Roberts, PhD, associate director of the biomedical engineering department at Ohio State University and this year's recipient of the Barraquer Lecture Award.

There are many areas to consider in the subject of cross-linking. "For example, if keratoconus is caused by differential properties — that is, one weak area, not an entire weak cornea — the most appropriate way to do cross-linking might be with differential treatment instead of an all-over treatment," she said.

In addition, it has not been considered if cross-linking is uniform or if there are parts of the cornea that are more susceptible to cross-linking than others, which is critical to understanding the response to the procedure. Dr. Roberts said that work is also being done to determine the spatial location of cross-linking.

Dr. Roberts said that, contrary to what some surgeons said at the American Society of Cataract and Refractive Surgery meeting in Chicago, cross-linking does not freeze the shape of the cornea but instead changes the properties of the cornea. Recognizing that concept is important in understanding the new cross-linking applications being done in Denmark, where it is being used in patients with Fuchs' dystrophy.

"When you use cross-linking in a very edematous cornea, it squeezes the lamellae together, reduces the thickness of the cornea, improves clarity in Fuchs' patients and prevents transplants," she said. "We have to look at fundamental mechanisms, understand it better and then work to optimize it."



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Senior Member

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Posts: 124
Date: Mon Jun 9 3:01 PM, 2008
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Dear Dr Juanito,


I can understand the scientific research that you mention but you are looking from the point of view as a doctor.

A patient with keratoconus need to be safe with the crosslinking procedure.He or she doesnt care about experimental protocols or something else.With the experiments you mention a patient have highly chances to be UNDERXLINKED!!Thats why it is an experiment and not the MD Theo Seiler principles.He is the founder.Dont forget that.Ever.

Do you think people is willing to experiment with their eyes??

Poor rabbits were used to discover and develop the crosslinking method.I dont think that someone is planning to put people instead of rabbits dont you think?

Anyway,i dont want to hear this way of thinking because we are talking about humans and moreover our precious eyes.People should be awared of the experimental methods but frankly i think they dont have a clue when they are going into a doctors office.They are full with stress emotions and incapable sometimes of thinking and choosing a doctor.

It is you the doctors that need to explain and present the whole picture.Because as i said before a keratoconus patient want to play it safe and by performing crosslinking to preserve his/her precious cornea.Not to participate in a experiment.

So,if you experiment with the crosslinking the result will be uncertain no matter what.And moreover this means UNDERXLINKED or OVERXLINKED and that is bad news for the patient.Crosslinking is beyond you,me and every doctor that wants i r know what to achieve by changing from Seilers principles.


All the best,

P.S The years and experience a doctor has at crosslinking and the number of patients has treated are also very important.







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mz


Member

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Posts: 12
Date: Tue Jun 24 3:49 PM, 2008
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CROSS-LINKING STUDIES FOR KERATOCONUS AND ECTASIA BEGIN IN THE
UNITED STATES
http://www.nkcf.org/images/Advertisement5567744.0CROSSLINKINGSTUDIESFORKERATOCONUSAsSubmitted.PDF


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