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Riboflavin iontophoresis cross-linking 6 month follow-up with SD OCT: a pilot study

Poster Details

First Author: G.Capello ITALY

Co Author(s):    A. Papayannis   F. Pellegrini   D. Bonsanto   G. Prosdocimo     

Abstract Details



Purpose:

to evaluate the efficacy of the new technique of corneal collagen trans epithelial cross-linking (CXL) performed by iontophoresis to enhance penetration of riboflavin through intact epithelium, in the management of progressive keratoconus

Setting:

The department of Ophthalmology in the Hospital 'De Gironcoli' in Conegliano Veneto (TV) Italy.

Methods:

Prospective case series study. nineteen eyes of 18 patients with progressive keratoconus (1 to 3 of Krumeich classification of keratoconus) were included. Corneal collagen crosslinking was performed under topical anaesthesia and corneas were soaked with a specifically formulated solution of riboflavin 0.1% using a iontophoresis system (I-ON CXL ® and Ricrolin + ® -SOOFT Italia S.p.A-) to allow quick passage into the corneal stroma through intact epithelium. The soaking time lasts 5 minutes and the irradiation is performed for 9 minutes using a solid-state UV-A illuminator at 370 nm, with an irradiance of 10 mW/cm2 at a distance of about 5 cm. The follow-up was at 1st, 3rd and 6th month with visual acuity, corneal map and pachymetry performed with CASIA SD OCT, and endothelial cell count

Results:

mean best spectacle-corrected visual acuity (BSCVA) improved from 0.198 ± 0.703 up to 0.165 ± 0.667 (LogMAR). Corneal topographic analysis of treated eyes showed a stabilization of the average keratometry 6 month after the procedure from 46.52 ± 3.37 to 46.56 ± 3.49 diopters, as well as the mean posterior keratometry (from -6.73 ± 0.73 to -6.73 ± 0.72). Corneal astigmatism decreased from 2.94 ± 1.39 to 2.71 ± 1.16 diopters. Also the thinnest point of the cornea remained substantially unchanged (from 465 ± 39.73 µm to 463 ± 40.95 µm). Intraocular pressure, endothelial cell count, lens and fundus didn't change significantly at 6 months follow-up

Conclusions:

CXL improved BSCVA as well as stabilize the average k-readings at 6 month postoperatively in our cohort. Iontophoresis seems to be a safe and promising procedure to stop the progression of keratoconus, allowing intrastromal riboflavin diffusion, while keeping the corneal epithelium on: combining the efficiency of the standard procedure without the side effects of epithelial debridement. Further long-term studies are necessary to complete the evaluation of the efficacy and risk spectrum of this faster technique FINANCIAL INTEREST: NONE

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