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Evaluation of intrastromal riboflavin application using femtolaser-created intrastromal channels: a solution to the trans-epithelial cross-linking dilemma?

Poster Details

First Author: G.Schmidinger AUSTRIA

Co Author(s):    I. Fischinger   T. Seiler Jr.   T. Seiler        

Abstract Details


Corneal crosslinking with removal of the epithelium still remains the gold standard. Trans-epithelial procedures using solutions with enhancers have been shown to be less effective. In this study we evaluate the effect of intra-stromal riboflavin application.


IROC Institute, Zurich, Switzerland


In freshly enucleated porcine eyes three intra-stromal channels were created using a femto-second laser (FS 200, Alcon). A 0.5% riboflavin solution without additives was injected. Diffusion of the riboflavin in the corneal stroma was evaluated using Scheimpflug imaging. A crosslinking procedure was performed in half of the eyes using the UVX 2000 device (Innocros, Swizerland). Thereafter stress-strain measurements were performed in treated eyes and control eyes (U-Strech, Cellscale, Canada). Additionally, we evaluated the absorption coefficient of eyes treated with intra-stromal riboflavin application.


The intra-stromal application of riboflavin solution into femto-second laser created channels showed to be a simple procedure. It took up to one hour until a homogenous riboflavin distribution was reached after intrastromal riboflavin application. The absorption coefficient in study-eyes was about twice as high (44/cm) as with the standard epi-off protocol (22/cm). A statistically significant increase in Youngá¹€s modulus was found in the study eyes. These results were comparable to the increase of eyes treated with the standard epi-off protocol.


Intrastromal application of riboflavin using femto-laser created intra-stromal pockets showed to be effective in terms of achieved intra-stromal riboflavin concentration and the increase of corneal biomechanical properties. Future work will focus on optimized channel design, ideal riboflavin concentration and optimization of total applied UV-A energy as well as safety studies.

Financial Disclosure:


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