Bullous keratopathy in dogs. Treatment with accelerated cross-linking

1. Accelerated CXL for the
treatment of bullous keratopathy
Dr Frank Famose – DVM - DESV
Toulouse – France
frankfamose@gmail.com
Zürich November 5th, 2014

2. Outline
What is bullous
keratopathy (BK) ?
What are the
treatments ?
BK and CXL

3. Definition
Chronic superficial
corneal ulceration
Intense corneal
edema
Ocular pain
Loss of vision

4. Stromal edema
Epithelial edema
Endothelial impairment
Ulceration
Bullae

5. The endothelial failure
Endothelial
dystrophy
Degenerative
Post-surgical
Glaucoma
Anterior
Uveitis

6. Feline « bullous keratopathy »
Corneal hydrops

7. Treatment
Chronic superficial
corneal ulceration
Intense corneal
edema
Surface
treatments
Topical
Hyperosmotic
drugs
Stromal abrasion
Conjunctival grafts
Thermokeratoplasty
Poor results

8. BK and CXL : the Human experience
Compaction of the
corneal stroma
Decreased thickness
Improved transparency
Reduced anterior
stromal pressure
Temporary symptomatic relief
and visual improvement
More than 30 publications
since 2007

9. BK and CXL : the veterinary experience
2 case series
10 dogs, no cats
2 different protocols
Does it work ?

10. Protocol
Dogs with BK
No glaucoma
Failure of
Previous treaments
Accelerated CXL
(30 mW/cm²)
No hyperosmotic
preparation
6 Months Follow-up

11. Results
Ulceration
Resolved in 1 week

12. Discussion : epithelial healing
Early healing
Pain resolution
6 months duration
Same results in the 2 case reports

13. Discussion : corneal thickness and edema
Early improvement
Return to baseline
Visual improvement ?
Same results in the 2 case reports

14. Conclusion
CXL useful for BK-induced
corneal ulceration
Short-lasting action
on corneal edema
Protocol
adaptations
More
cases…

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