Corneal cross-linking for bacterial keratitis at the slit lamp

Professor Farhad Hafezi, chief medical officer at the ELZA Institute, speaks to OT  about the future of cross-linking and treating bacterial keratitis at the slit lamp

KY slit lamp

Earlier this year, the team at the ELZA Institute in Switzerland performed what it described as the world’s first crosslinking at the slit lamp, using the Emagine C-Eye Device.

The team believe this new method could “democratise” access to treatment and they are working to make the procedure more “straightforward.”

Professor Farhad Hafezi, chief medical officer at the ELZA Institute, explained that the team’s research into cross-linking is focused on making the treatment more accessible and also extending the range of applications from keratoconus to infectious keratitis.

With corneal cross-linking (CXL) procedures not only stiffening the cornea, but also killing bacteria and fungi at the same time, Professor Hafezi explained that this led to the question of why the procedure is carried out in an operating theatre and not at the slit lamp, commenting: “Why do you take a septic eye into an aseptic operating theatre to perform an antiseptic procedure?”

This question led to work on a concept to bring cross-linking to the slit-lamp, Professor Hafezi said, adding: “Fast forward eight years and we now have the machine ready to be used at the slit lamp effectively.”

Emagine’s CE-marked C-Eye device can be mounted to a slit lamp, or to a table mount to deliver cross-linking in both a seated or lying position.

The technicalities of performing the cross-linking procedure are essentially the same as those developed for the classic approach, Professor Hafezi suggested, but this machine offers the opportunity to carry out the procedure at the slit lamp.

The cross-linking procedure could also offer additional benefits for treating bacterial keratitis, in addition to stiffening the cornea, such as killing bacteria and fungi in infections, as well as increasing the tissue resistance to digestion, which Professor Hafezi suggested could result in a smaller scar.

“This is an added value that probably plays a much bigger role than we think now,” he explained.

Professor Hafezi suggested that taking a slit lamp approach could “massively affect the number of people that have access to this technology.”

Asked about the potential for this technology, Professor Hafezi said: “We call it democratising CXL.”

With work ongoing into effective epi-on technologies, Professor Hafezi suggested: “If you look into the near-future we will be able to do epi-on cross-linking at the slit lamp. If there is no more surgical gesture that removes the epithelium then for keratoconus treatment the risk profile is even better.

“So taking it out to the slit lamp means democratising access and increasing global coverage,” Professor Hafezi added.

The team are also working on steps to make the procedure more straightforward to perform.

“We are steadily working at making the procedure more standardised and we are trying to omit steps that lead to increased risk,” Professor Hafezi explained.

Treating bacterial keratitis at the slit lamp