Official ESCRS | European Society of Cataract & Refractive Surgeons


Corneal cross-linking (CXL) with two different riboflavin solutions: a randomised controlled trial

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Session Details

Session Title: Corneal Cross-Linking

Session Date/Time: Monday 16/09/2019 | 16:00-18:00

Paper Time: 16:48

Venue: South 5

First Author: : G.Schmidinger AUSTRIA

Co Author(s): :    N. Pircher    S. Holzer    J. Lammer                        

Abstract Details


Riboflavin solutions with HPMC instead of dextran have been shown to have no effect on corneal thickness during treatment. However, worse clinical outcomes have been postulated using this solution. This study was initiated to evaluate the clinical outcome of corneal crosslinking using Riboflavin with 20% dextran or Riboflavin with HPMC for the treatment of progressive keratoconus.


Medical University of Vienna


Eyes were randomized to receive corneal crosslinking using Riboflavin with 20% dextran or with HPMC. Irradiations were performed with a device using 9mW/cm2 for 10 minutes. Main outcome measure after 12 months was ΔK-max in diopters (D). Further, differences of the mean keratometric values in a zone of 2.5 mm (K2.5) around the K-max were evaluated as well. Additional outcome parameters were ΔCDVA (LogMAR), pachymetry (thinnest corneal point in micrometer) and higher order aberrations (HOA) given as RMStotal. The failure was defined as the percentage of eyes with an increase in Kmax and the K2.5-values of more than one diopter.


Twenty eyes were treated with Riboflavin/20% dextran and 23 eyes with riboflavin/HPMC. Changes of all parameters after one year are given for Dextran group (mean ± standard deviation)/HPMC group (mean ± standard deviation). Kmax: -1.85 D ± 1.98 D/-0.73 D ± 1.55 D (p=0.40). K2.5: -1.19 D ± 1.59 D/-0.42 D ± 1.00 D (p=0.09). LogMAR: -0.02 ± 0.16/-0.12 ±0.19 (p=0.07). Pachymetry: -10 ± 20/+0.7 ±1.5 (p=0.06) and HOA: -1.7 ± 3.9/-1.16 ± 1.7 (p=0.60). The failure rate for Kmax was 5 % in the Dextran group and 9% in the HPMC group. For K2.5 no failures were observed.


Eyes treated with Riboflavin/20% Dextran showed a more pronounced reduction of the K-readings than eyes treated with Riboflavin/HPMC. These preliminary results support retrospective data that showed a weaker effect when eyes were treated with Riboflavin/HPMC.

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