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Jennifer Loh, William Trattler, Roy Rubinfeld, Gabriela Perez, Eduardo J Polania, Rosane Correa; Evaluation of Transepithelial Corneal Collagen Cross-Linking (CXL) at 6 months and 1 year Follow Up in Patients with Different Proprietary Transepithelial Riboflavin Solutions. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4220.
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Transepithelium corneal cross linking has been reported to be ineffective. The purpose of this analysis was to demonstrate efficacy and compare operative procedure time relative to standard crosslinking in a clinical setting.
Patients with a diagnosis of keratoconus or post-Lasik ectasia who had undergone Transepithelial CXL in one or both eyes were included in this analysis. Patients with previous RK, INTACS, repeat CXL procedures, and/or patients who were pseudo-phakic or had a diagnosis of cataract were excluded from this analysis. Outcome measures included intraoperative transepithelial corneal stromal riboflavin loading times, and UCVA, BSCVA, and K Max at 6 months and 1 year follow up visits. Corneal stromal loading was assessed by slit lamp examination.
199 eyes were treated with proprietary riboflavin formulation 1. Loading time ranged from 30 to 100 minutes (average 56.3 minutes). 70% of these eyes were male and the average age was 35.7 years old. 84% of eyes had a pre-Op diagnosis of keratoconus. 127 eyes were treated with proprietary riboflavin formulation 2. Loading time ranged from 8 to 60 minutes (average 22.17 minutes). 70% of these eyes were male and the average age was 36 years old. 88% of eyes had a pre-Op diagnosis of keratoconus. At 6 months post-CXL, 52% and 52% of eyes (formulation 1) and 45% and 47% of eyes (formulation 2) improved 1 or more lines in UCVA and BSCVA from pre-Op. Patients treated with formulation 1 and formulation 2 experienced 0.24D flattening and 1.36D in K Max, respectively, at 6 months follow-up. At 1 year follow up, 59% and 55% of eyes (formulation 1) and 63% and 50% of eyes (formulation 2) experienced 1 or more lines of improvement in UCVA and BSCVA. Patients treated with formulation 1 and formulation 2 experienced 0.52D flattening and 2.00D flattening, respectively, in K max from Pre-Op.
The efficacy of trans-epithelium corneal cross linking depends on the formulation and the application of the solution. The presented results demonstrate that trans- epithelium cross linking with an appropriate formulation can provide an efficacy that is comparable to the epi-off Dresden protocol without substantial increase in the loading time.
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