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Andres Codriansky, Marcelo Coria, Bernardita Alamos, Paulina Riquelme; Shorter UVA Light Exposure Protocol for Crosslinking in Keratoconus. 17 Months Follow up Results. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1109.
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© ARVO (1962-2015); The Authors (2016-present)
To establish the safety and efficacy of a shortened UVA light exposure protocol to treat Keratoconus.
Case series of patients with progressive keratoconus. Corneal Topography was done with the orbscan II system. Patients were treated with crosslinking procedure as follows: 7mm central epithelium mechanical debridement, instillation of isotonic riboflavin 0,1% with dextran 20% solution every 3 minutes for 30 minutes, verification of riboflavin in the anterior chamber was performed with a slit lamp microscope, then exposure to 3mw/cm2 UVA Light for 20 minutes while instilling riboflavin drops every 3 minutes. Patients were patched and seen the day after, at day 3, 7, 30, 3- 6 months, at one year and then accordingly to the physician criteria. Clinical charts were review in a retrospective manner.
22 Eyes, of 20 patients treated between July 2008 and May 2010. Age average 23,5 years, 59% female, follow up was from 5 to 25 month average: 17 months, mean K pre op and post op changed from an average of 48,43 to 47,62 elevation difference calculated with the orbscan software showed a flattening of 4,5um at the corneal center and 6,14um at the conus apex. BCVA improved in 31% of patients, and no patient showed a decreased in BCVA, overall VA improved from an average of 0,34 LogMAR to 0,22 LogMAR. Adverse events were mainly haze in nearly all cases, and 6% of corneal infiltrates associated with bandage contact lens, successful treatment. In one case, confocal microscopy was done before, at one week and one month from the procedure, it showed no depletion of keratocites but a very high citoplasmatic reflectivity compatible with high metabolic activity.
This shortened protocol, seems effective and halting the progression of keratoconus, with less UVA exposure and with little or no keratocites depletion. It saves time and in the author’s opinion, decreases the amount of haze seen post-op. A prospective, double blind randomize study is needed to confirm what was seen in our preliminary study.
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