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Bullous keratopathy in dogs. Treatment with accelerated cross-linking
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Accelerated CXL for the treatment of bullous keratopathy
Dr Frank Famose – DVM - DESV
Toulouse – France
frankfamose@gmail.comZürich November 5th, 2014
Outline
What is bullouskeratopathy (BK) ?
What are the treatments ?
BK and CXL
Definition
Chronic superficialcorneal ulceration
Intense corneal edema
Ocular pain
Loss of vision
Endothelial impairment
Stromal edema
Epithelial edema
Bullae
Ulceration
The endothelial failure
Endothelialdystrophy
Degenerative
Post-surgical
Glaucoma
AnteriorUveitis
Feline « bullous keratopathy »
Corneal hydrops
Treatment
Chronic superficialcorneal ulceration
Intense corneal edema
Surfacetreatments
TopicalHyperosmoticdrugs
Stromal abrasion
Conjunctival grafts
Thermokeratoplasty
Poor results
BK and CXL : the Human experience
Compaction of the
corneal stroma
Decreased thickness
Improved transparency
Reduced anterior
stromal pressure
Temporary symptomatic relief
and visual improvementMore than 30 publications
since 2007
BK and CXL : the veterinary experience
2 case series
10 dogs, no cats
2 different protocols
Does it work ?
Protocol
Dogs with BK
No glaucoma
Failure of Previous treaments
Accelerated CXL(30 mW/cm²)
No hyperosmoticpreparation
6 Months Follow-up
Results
UlcerationResolved in 1 week
Discussion : epithelial healing
Early healing
Pain resolution
6 months duration
Same results in the 2 case reports
Discussion : corneal thickness and edema
Early improvement
Return to baseline
Visual improvement ?
Same results in the 2 case reports
Conclusion
CXL useful for BK-inducedcorneal ulceration
Short-lasting actionon corneal edema
Protocol adaptations
More cases…
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