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Session Title: Cross-linking
Session Date/Time: Monday 07/10/2013 | 14:30-16:30
Paper Time: 15:14
Venue: Elicium 2 (First Floor)
First Author: : G.Schmidinger AUSTRIA
Co Author(s): :
Corneal thinning is a well-recognized safety issue with current riboflavin solutions using 20% dextran as an additive. In this trial we evaluated the changes in corneal pachymetry with a new riboflavin solution using HMPC (hydroxpropyl methylcellulose) as an additive.
Medical University of Vienna, Department of Ophthalmology
In a prospective, clinical trial 30 eyes of 30 patients with progressive keratoconus underwent corneal crosslinking (CXL). All CXL treatments included corneal abrasion under topical anaesthesia with subsequent installation of riboflavin 0,1 % with 20% dextran (MedioCross, Medio-Haus GmbH) (group 1), riboflavin 0,12% with 10% dextran (group 2) and riboflavin 0,1% with HMPC (Vibex Rapid, Avedro) solution for 30 minutes. In patients with corneas thinner than 400µm after the loading phase, hypotonic riboflavin was used to swell the corneas for 10 minutes. Pachymetry was measured at the thinnest point with ultrasound (SP-2000, Tomey, Inc.) preaoperatively, after epithelium removal, and every 10 minutes thereafter.
The mean preoperative pachymetry in group 1 was 463±21 µm, 479±29 µm in group 2 and 459±18 in group 3. After removal of the epithelium the pachymetry was 415±20 µm, 430±35 µm and 423±16 in group 1,2 and 3, respectively. In group one and two a continuous thinning of the cornea was observed during the loading phase. In group three a slight increase in pachymetry was observed during the loading phase, resulting in a pachymetry of 454±29 µm. Swelling with hypotonic riboflavin solution for ten minutes resulted in a mean increase of the pachymetry of 57 µm in group one and two. During the irradiation phase, a significant and fast reduction of the pachymetry was found in group one and two. Pachymetry remained stable throughout the irradiation phase in group three.
Endothelial damage has been reported after CXL. It is well documented that the use of current riboflavin solutions with 20% dextran results in corneal thinning. The new riboflavin solution with HPMC as an additive provides stable pachymetry readings during the whole procedure. This new solution adds significant safety to the CXL procedure.
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