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Cross linking-sferov-2012

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Cross linking-sferov-2012

  1. 1. *CXL* Collagen Cross-Linking PROTOCOLE FLASH CHEZ LE CHIEN ET LE CHAT Dr Frank FAMOSE – Toulouse frankfamose@gmail.com
  2. 2. Principe du CXL D’après Krueger (2008)
  3. 3. Indications Kératocône Ectasie post-LASIK Kératopathie bulleuse Kératites bactériennes Dégénérescence marginale pellucide
  4. 4. Adaptation aux Carnivores ? 2 Indications 2 ProtocolesKératites bactériennes Standard (3mW/cm² 30 min) (S. Pot – ECVO – Berlin 2011)Kératopathies bulleuses Flash (30mW/cm² 3 min)
  5. 5. Groupe kératitesKératites bactériennes« compliquées »Perte épithéliale > 1mmInfiltration cellulaireEp. cornéenne > 300 µm 4 chats et 4 chiens
  6. 6. Groupe « Ulcères »Ulcère cornéen superficielrécidivant après chirurgieUlcère strictement épithélialŒdème cornéenEp. cornéenne > 300 µm 4 chiens
  7. 7. Protocole OCT OCTAnesthésie Nettoyage Instillation Exposition Traitement générale Cornée Riboflavine UVA 365 nm médical Medetomidine Rinçage RF 0,1% 20% dextran 30 mW/cm² Lentille Ketamine débridement (Vibex ND) 3 min collagène Isoflurane Microsponge Une goutte tte les 2 min Tobrex 2/j 20 minutes 7 jours Rinçage BSS
  8. 8. Suivi Kératites et ulcères UlcèresInclusion J7 J15 J30 J90 Ex ophtalmo Test Fluo Test Fluo Test Fluo Test Fluo Test Fluo OCT Traitement Positif Poursuite Tobrex Arrêt Tobrex Négatif Maxidex si néc.
  9. 9. Résultats Kératites bactériennes9 8/8 8/88 J7765 5/8 J0 4/8 4/8 J743 3/8 J15 2/8 J30 J1521 1/80 0/8 0/8 Ulc. Épith Infiltration Vascularisation J30 J0
  10. 10. Résultats Œdème cornéen J0 - préop4.5 4/4 4/4 43.5 3 J0 J72.5 2 2/4 J15 J301.5 J0 – post-op J90 1 1/40.5 0/4 0/4 0/4 0 Ulc. Épith Vascularisation Œdème cornée J0 J90
  11. 11. Discussion : kératitesbactériennes Effet direct des UV Guérison Effet des Radicaux libres Modifications biochimiques et physiques de la cornée Modifications réponses biologiques de la cornée J0 J30
  12. 12. Discussion : ulcères superficiels Guérison Modifications biochimiques et clinique physiques de la cornée Modifications hydratation cornéenne J0 J30
  13. 13. Protocole standard ou flash ? Standard Flash3 mW/cm² 5,4 J/cm² 30 mW/cm²30 minutes 3 minutes Durée totale Durée totale env. 1h20 env. 40 min
  14. 14. Effets secondaires Chez l’Homme Infections Réactivation Herpes V Lésions endothélialesAucun effet secondaire observé dans notre étude
  15. 15. PerspectivesEchantillon Kératites Ulcères cornéens+ important bactériennes chroniques Cornées minces Suivi plus long Amincissement Traitement de cornéen préalable première intention Inj. intrastromale
  16. 16. ?

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