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Effect of the continuous application of riboflavin in an accelerated pulsed-light collagen cross-linking on the progression of keratoconus

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Session Details

Session Title: Cross-Linking Protocols

Session Date/Time: Monday 24/09/2018 | 14:00-16:00

Paper Time: 14:12

Venue: Room A3, Podium 3

First Author: : C.Kim SOUTH KOREA

Co Author(s): :    M. Kim                    

Abstract Details


To investigate the efficacy and safety of the continuous application of 0.1% Riboflavin in an accelerated pulsed-light collagen cross-linking on the progression of keratoconus


This study included 21 eyes of 19 patients with progressive keratoconus who received collagen cross-linking at Seoul National University Hospital by a single surgeon (MK Kim). The medical records of 19 patients were retrospectively reviewed.


0.1% Riboflavin (Vibex Rapid, Avedro Inc., Waltham, MA, USA) containing hydroxypropyl methylcellulose was continuously applied for 10 minutes using 8.0 mm retention ring after epithelial peeling. The patients received accelerated cross-linking with 30 mW pulsed-ultraviolet light at wavelength 365 nm (Avedro Inc) for 8 minutes [1 second on/1 second off; 30 mW/cm2, cumulative dose of 7.2J/cm2], During the ultraviolet exposure, central trephined ultraviolet-blocking contact lens (trephined diameter; 8.5 mm) was applied to cover the limbal area. Visual acuity, refractive error, topographic index, corneal thickness, and endothelial cell density were evaluated at pre-operation, and postoperative 1, 3, 6, and 12months.


Best corrected visual acuity in LogMAR improved from preoperative 0.41 to 0.18 in 12 months. Maximum keratometry decreased from 52.2D to 50.2D at 6months (p=0.0062) and 50.3D at 12months (p=0.0004). Minimum keratometry decreased from 46.51D to 46.38D at 12month (p=0.0162). Astigmatism decreased from preoperative 5.6D to 3.9D at 12months (p=0.0008). Spherical equivalents were not significantly different. Thinnest corneal thickness decreased at 3 (p=0.0120) and, 6months (p=0.0054), but recovered in 12 months (p>0.05). Endothelial cell density decreased from 2731/mm2 to 2382/mm2 at 1month (p=0.0218) but gradually recovered in 12 months (2548/mm2, p>0.05 ).


Continuous application of Riboflavin using retention ring in an accelerated pulsed-light collagen cross-linking seems to be effective and safe on halting the progression of the keratoconus.

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