Integrated Protocols

C-Eye Protocols

C-Eye Device has a number of preset CXL and PACK-CXL epi-on and epi-off protocols available for your convenience.

Please find below a summary of the recommendations and uses of corneal cross-linking settings displayed in the scientific literature.

Protokoll 1

  • The so-called «Dresden protocol» is the original epi-off CXL protocol that started corneal cross-linking in 1999.
  • The «Dresden protocol» currently (2020) represents the benchmark in terms of biomechanical stiffness effect in CXL
  • This protocol is most often used for the following Indications when the strongest biomechanical effect is needed:
    • Aggressive progression of keratoconus
    • Keratoconus in children and adolescents
    • Pellucid marginal degeneration
    • Ectasia after LASIK/PRK/SMILE
    • Bullous keratopathy
    • Sterile corneal melting

Protokoll 2

  • Accelerated epi-off CXL protocol with 10 minutes irradiation time and standard fluence (5.4 J/cm2).
  • This protocol is most often used for the following indications:
    • Moderately progressive keratoconus in adults
    • Pellucid marginal degeneration
    • Ectasia after LASIK/PRK/SMILE

Protokoll 3

  • Accelerated epi-off CXL protocol with 5 minutes irradiation time and standard fluence (5.4 J/cm2).
  • This protocol is most often used for the following indications:
    • Moderately progressive keratoconus in adults
    • Pellucid marginal degeneration
    • Ectasia after LASIK/PRK/SMILE

Protokoll 4

  • Accelerated high-fluence PACK-CXL protocol with high fluence (7.2 J/cm2).
  • This protocol is currently used in:
    • Infectious keratitis of bacterial and fungal origin
    • Sterile corneal melting

Protokoll 5

  • Accelerated pulsed epi-off CXL protocol with standard fluence (5.4 J/cm2).
  • This protocol is most often used for the following Indications:
    • Moderately progressive keratoconus in adults
    • Pellucid marginal degeneration
    • Ectasia after LASIK/PRK/SMILE

References

Krueger RR, Herekar S, and Spoerl E, First proposed efficacy study of high versus standard irradiance and fractionated riboflavin/ultraviolet a cross-linking with equivalent energy exposure. Eye Contact Lens, 2014. 40(6): p. 353-7. 

Protokoll 6

  • Accelerated pulsed epi-on CXL protocol with high fluence (7.2 J/cm2).
  • This protocol is most often used for the following indications: :
    • Progressive keratoconus in adults
    • Pellucid marginal degeneration

References

1. Mazzotta C, Bagaglia SA, Vinciguerra R, Ferrise M, and Vinciguerra P, Enhanced-Fluence Pulsed-Light Iontophoresis Corneal Cross-linking: 1-Year Morphological and Clinical Results. J Refract Surg, 2018. 34(7): p. 438-444. 

2. Mazzotta C, Bagaglia SA, Sgheri A, Di Maggio A, Fruschelli M, Romani A, Vinciguerra R, Vinciguerra P, and Tosi GM, Iontophoresis Corneal Cross-linking With Enhanced Fluence and Pulsed UV-A Light: 3-Year Clinical Results. J Refract Surg, 2020. 36(5): p. 286-292.

Protocol 7

  • Accelerated pulsed epi-on CXL protocol with high fluence (7.2 J/cm2).
  • This protocol is most often used for the following indications: :
    • Progressive keratoconus in adults
    • Pellucid marginal degeneration

References

1. Mazzotta C, Traversi C, Paradiso AL, Latronico ME, and Rechichi M, Pulsed Light Accelerated Crosslinking versus Continuous Light Accelerated Crosslinking: One-Year Results. J Ophthalmol, 2014. 2014: p. 604731. 

2. Mazzotta C, Traversi C, Caragiuli S, and Rechichi M, Pulsed vs continuous light accelerated corneal collagen crosslinking: in vivo qualitative investigation by confocal microscopy and corneal OCT. Eye (Lond), 2014. 28(10): p. 1179-83. 

3. Belviranli S and Oltulu R, Efficacy of pulsed-light accelerated crosslinking in the treatment of progressive keratoconus: Two-year results. Eur J Ophthalmol, 2019: p. 1120672119872375.