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Post Info TOPIC: mini ASARK and selective deep cross-linking


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Posts: 397
Date: Mon Feb 16 3:50 PM, 2009
mini ASARK and selective deep cross-linking

The following text is taken from a powerpoint presentation given by Prof. Massimo Lombardi at the 2008 Dresden Cross-linking conference. It points to his use of a variation of crosslinking in conjunction with mini ASRK:

Mini  A.S.R.K. + S.A.D.C.L.

“Alternative surgery for radical treatment of Keratoconus. The technique of Mini ASRK and  Selective, Asymmetric Deep Cross Linking”

An Asymmetric Corneal Explosive Deformation. In our experience, the  best treatment is not a Symmetric surgery, but an Asymmetric one.
Thinking Asymmetric introduces the:

Selective Asymmetric Deep Cross Linking and
Mini Selective  Asymmetric  Radial  Keratotomy.
S.A.R.K.,  in our experience is the only Implosive Surgery till today.
S.A.D.C.L.,  by itself, is an Implosive Medical Treatment.

Together they improve the results in a remarkable way because they use the same logic.

Corneal surface is better restored and refractive error is better corrected
So we suggest you:      THINK ASYMMETRIC!

for Selective Asymmetric Deep Cross Linking.

+ Patients affected by Keratoconus, clinically and instrumentally documented.

+ Patients with normal or induced 400 central microns of thickness before  the UV-A Treatment, detectable with electronic pachimeter.

+ Patients with fairly transparent corneal optical zone.
+ Patients already operated with Mini ARK or submitted to the Mini A.S.R.K. operation and in the same session to S.A.D.C.L.
+ Patients who have regularly subscribed the specific informed consent  model.


+ Patients whose corneal thickness, taken before the beginning of the  treatment, did not reach the 400 microns limit.

+ Patients affected by herpetic keratitis (not definitively resolved) or  affected by virus, parasite  etc..  ocular infections in act.

+ Patients affected with heavy dry eye syndrome.

+ Patients with central scars inhibiting the visual capability.

This work wants to pay the attention on the concepts of : 
“Asymmetrical, Selective and Deep Treatment”  with S.A.D.C.L. associated  with Mini-A.S.R.K.  microsurgery technique, because both have as objective the reduction of the ECTASIA and the partial or total correction of the  relative AMETROPY.

Our  study  has  been  led  on  a  sample  of  200  eyes  with  both  sex  patients  (100  males and  70  females),  aged  between  17  and  50  years:

no.  15  eyes  treated  only  with  S.A.D.C.L.  without  the  Mini S.A.R.K.  method.

no.  20  eyes operated with the Mini S.A.R.K. method and submitted  to  S.A.D.C.L.  treatment during the same session.

no.  40  eyes operated with the Mini ARK method and submitted to  S.A.D.C.L.  treatment at different time intervals.

no.  125 eyes previously operated with the sole Mini ARK method.

Patients have been monitored over a 24-months observation period with  the below follow up list :

the  first  within  1  month  following  either  treatment  or  surgery  plus  treatment;

the  second  after  6  months;

the  third  after  12  months;

the  fourth  and the  last  one  after   the  24  months.

Standard protocol for the Cross Linking

To  remove  the  epithelium
To  instill  the  Riboflavin  into the  whole  corneal surface
To  expose  with  UV-A  on  the  whole  corneal surface

DIFFERENCE between Standard Cross Linking and SADCL

NO  disepithelization
Visual  rehabilitation maximum  10-15  gg
We  use  corneal lenses  which act  as  masks  to  restrict the treatment  only  to  the  desired area.


This  Selective  and  Asymmetrical  Treatment  has allowed  us  to  exercise  an  effect  of  APPLANATION  and  then  of  GREATER CORRECTION  of  the  Ectasia  and  of  the  secondary  Ametropy  caused by Ectasia  itself,  with  very,  very  good  refractive  results  remarkably  higher   than   those   obtained  with  the traditional  Dresden  Protocol.

In fact, we have  been  able   to  operate  with  such technique  also  the  Keratoconus  of  3°  and  4°  type, CORRECTING TILL 19-20 DIOPTRES.

Furthermore  we have  obtained  the  WIDENING OF THE OPTICAL ZONE, WITH A RESULTING GREEN-BLUE COLOUR IN THE CORNEAL MAP, FOR OVER 6 MM OF DIAMETER  :  this measure is  larger than necessary, WITHOUT PERIPHERAL DISTORTIONS  due  to  the  Ectasia  itself.




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Posts: 152
Date: Mon Feb 16 6:06 PM, 2009

Thanks for posting that Hari !



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Posts: 397
Date: Mon Feb 16 8:07 PM, 2009

You are very welcome Remo... Some of the text is a little hard to follow as it was cut and pasted from a power-point presentation, but its a very interesting line of treatment nonetheless.
I underwent Prof. Lombardi's mini ARK procedure about 4 years ago now and I remember he was even then talking about these new advances that were to come.
As always with keratoconus, I believe, the more treatments and research out there the better... it was not so long ago that our options as patients were tied to contact lenses and the graft (Any deviation from these rock standard options were generally cast under a very sceptical light).
I am very happy that now we have a far greater set of options.



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Posts: 18
Date: Sat Jul 4 10:29 AM, 2009

I am thinking about getting a soft contact lense fitted --it has been 5 months after my mini ark op--- does anybody done thi --- cheers .Archie


Senior Member

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Posts: 148
Date: Sat Jul 4 8:14 PM, 2009

Hi Archie,

I would ask Dr Lombadri if its ok to, and if so, see if you can wear a daily soft toric disposable type because there said to be the safest type. If you can wear glasses also by some way thats a great situation to be in too, as you can switch between them.

Many mini ark patients are doing so well they don't come by as much as they used to, doing well,  thats what its all about, but what are left are their posts from where you can contact them through their members profile.

Best to you




Status: Offline
Posts: 18
Date: Mon Jul 6 10:53 PM, 2009

thanks for the tips Kane, I will definitely be seeing dr.Lombardi before commiting to any further decisions.. ... all the best

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