Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas
Leopoldo Spadea,1 Rita Mencucci2
1University of L'Aquila, Department of Biotechnological and Applied Clinical Sciences, Eye Clinic, L'Aquila, 2University of Florence, Department of Oto-Neuro-Ophthalmological Surgical Sciences, Eye Clinic, Florence, Italy
Background: The purpose of this paper was to report the results of transepithelial corneal collagen cross-linking (CXL) with modified riboflavin and ultraviolet A irradiation in patients affected by keratoconus, each with thinnest pachymetry values of less than 400 µm (with epithelium) and not treatable using standard de-epithelialization techniques.
Methods: Sixteen patients affected by progressive keratoconus with thinnest pachymetry values ranging from 331 µm to 389 µm underwent transepithelial CXL in one eye using a riboflavin 0.1% solution in 15% Dextran T500 containing ethylenediamine tetra-acetic acid 0.01% and trometamol to enhance epithelial penetration. The patients underwent complete ophthalmological examination, including endothelial cell density measurements and computerized videokeratography, before CXL and at one day, one week, and one, 6, and 12 months thereafter.
Results: Epithelial healing was complete in all patients after one day of use of a soft bandage contact lens. No side effects or damage to the limbal region was observed during the follow-up period. All patients showed slightly improved uncorrected and spectacle-corrected visual acuity; keratometric astigmatism showed reductions (up to 5.3 D) and apical ectasia power decreased (Kmax values reduced up to 4.3 D). Endothelial cell density was unchanged.
Conclusion: Application of transepithelial CXL using riboflavin with substances added to enhance epithelial permeability was safe, seemed to be moderately effective in keratoconic eyes with ultrathin corneas, and applications of the procedure could be extended to patients with advanced keratoconus.
Keywords: keratoconus, pachymetry, topography, transepithelial corneal collagen cross-linking, thin cornea
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]