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Safety and efficacy of CA-CXL in keratokonus with thin cornea

Poster Details

First Author: S.Yurttaser Ocak TURKEY

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Abstract Details


To evaluate the efficacy and safety of contact lens assisted CXL (CACXL) using iso-osmolar riboflavin 0.1% in Hydroxy-propyl Methyl Cellulose (HPMC) solution without dextran in keratokonus with thin cornea.


A prospective study, conducted at University of Health Sciences, Okmeydanı Training and Research Hospital, İstanbul, Turkey.


Twenty eyes with progressive keratokonus with thin cornea (350 to 400 µ) were included in this study. Intraoperative pachymetric changes were measured using ultrasonic pachymetry by Pocket II (Quantel Medical, Cedex, France). 70 µ thick contact lens (CL) with no UV blokage (samfilcon A, B&L, USA) was put post priming in CACXL through the accelerated UV irradiation (9 mW/cm² - 10 minutes). Postoperative outcomes were measured at 6 months.


Mean preoperative corneal thickness was 373 ± 8.76 with reduced to 332 ± 10.3 post epithealial removal. Intraoperative functional corneal thickness increased significantly by 30 µ ±0.3 in iso-osmolar riboflavin 0.1% in HPMC solution. Thick CL was put in CACXL through the UV A irradiation. A significant decrease in steep keratometry was seen postoperatively. The mean postoperative depth of stromal demarcation line was obtained at 252.9 ± 40.8 μm . No significant decrease in endothelial cell density was noted at 6 months. Significant improvement in BCVA was seen at 6 months (p:0.04).


Intraoperative functional corneal thickness increased significantly post iso-osmolar riboflavin 0.1% in HPMC solutions. Thick CL was put through procedure to save the tissues of the eye. Demarcation line was seen at an adequate dept with no significant decrease in endothelial count. However iso-osmolar riboflavin 0.1% in HPMC procedure is safe and effective with CA CXL for thin corneas up to 350 µ with epithelium. However in terms of visual outcome and flattening of cornea, riboflavin solution in HPMC assisted CXL may be preferrable procedure over CACXL in keratokonus with thin cornea.

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