If the cornea is under 400 micron CXL cannot be performed safely. The use of a hydrophilic contact lens adds 120 microns of corneal thickness and permits the treatment .

1. CROSSLINKING UNDER A HYDROPHILIC CONTACT
LENS IN VERY THIN CORNEAS.
( UP TO FIVE YEAR´S FOLLOW UP )
Jose I. Recalde
Juan San Cristóbal
Rafael Recalde
Iñaki Rodríguez-Agirretxe
Instituto Clínico-Quirúrgico de Oftalmología
University of the Basque Country
Bilbao, Spain
5th Eucornea Congress London 2014

2. • Six post-Lasik ectasia eyes (five patients) with very thin corneas, underwent
crosslinking following the parameters of the Dresden Protocol.
• As the cornea was not thick enough to fulfill the requirements of the
procedure, a contact lens was placed upon the cornea. This provided 150 µm
extra corneal thickness and the procedure could be performed as usual (albeit
through the hydrophilic contact lens).
• These patients, not eligible for CXL because the cornea was under 400 µm
thickness, would possibli have need of a corneal transplant in time.
• The procudures and postoperative course were uneventful in all the cases.
5th Eucornea Congress London 2014

3. 0.0%
16.7%
33%
17%17%
0%
17%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Loss 3 or MoreLoss 2 Loss 1No ChangeGain 1 Gain 2Gain 3 or More
%OfEyes
Change in Snellen Lines of CDVA
2 lines lost 17%
5th Eucornea Congress London 2014
RESULTS AT TWO, THREE AND FIVE YEARS ( TWO EYES IN EACH GROUP ).
Best corrected visual acuity improved 4 lines in one case, one line in one
case, remained stable in one case, decreased one line in two cases and
one case lost two lines

4. Safety
0
2000
4000
1 2 3 4 5 6
Endothelial cell count
PreOp PostOp
5th Eucornea Congress London 2014
No significant loss of endotelial cells was found in any case

5. Topographic changes in Kapex and Kmax
44
46
48
50
52
54
56
58 Kapex
5th Eucornea Congress London 2014
40
42
44
46
48
50
52
54
Kmax
With three to five year´s follow up, topographic analysis demonstrated:
• K-apex mean deviation of 0.4 D (range 0 to 1).
• Mean deviation of K-max 0.6 D (range -0.8 to 2.6).
• Only one eye ( red line ) worsened at 5 years postoperative.
STABILITY

6. 5th Eucornea Congress London 2014
Conclusion
The apposition of a hydrophilic contact lens prior to the cross-
linking treatment, were we not able to swell the cornea by
other means, is a safe procedure; effective to contain the usual
worsening of the ectasia, according to the reported data.