April 2011
Volume 52, Issue 14
ARVO Annual Meeting Abstract  |   April 2011
Corneal Collagen Crosslinking Outcomes With and Without Stromal Swelling with Hypotonic Riboflavin
Author Affiliations & Notes
  • Steven A. Greenstein
    Cornea and Laser Eye Institute, The Albert Einstein College of Medicine, Teaneck, New Jersey
  • Kristen L. Fry
    Cornea & Laser Eye Institute, UMDNJ New Jersey Med School, Teaneck, New Jersey
  • Peter S. Hersh
    Ophthalmology, Cornea and Laser Eye Institute, Teaneck, New Jersey
  • Footnotes
    Commercial Relationships  Steven A. Greenstein, None; Kristen L. Fry, None; Peter S. Hersh, Avedro, Inc. (C)
  • Footnotes
    Support  Avedro Inc., Boston, Massachusetts, Peschke Meditrade, GmbH, Zurich, Switzerland, Research to Prevent Blindness, Inc., New York, New York
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 5195. doi:
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      Steven A. Greenstein, Kristen L. Fry, Peter S. Hersh; Corneal Collagen Crosslinking Outcomes With and Without Stromal Swelling with Hypotonic Riboflavin. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5195.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : It has been suggested that hypotonic riboflavin can be used to swell the corneal stroma to a safe level in order to perform corneal collagen crosslinking (CXL). In this investigation, we compare 1 year CXL clinical outcomes, using hypotonic riboflavin for corneal swelling vs. standard riboflavin dextran solution only.

Methods: : 103 eyes underwent CXL for keratoconus (n=68) or ectasia (n= 35) in a prospective, randomized controlled trial. Riboflavin (0.1% in 20% dextran T500 solution) was administered topically for 30 minutes. If the cornea was <400µm after this dosing, hypotonic riboflavin (0.1% in sterile water) was given, 1 drop every 10 seconds for 2 minute rounds, and ultrasonic pachymetry (U/S) was performed until the stroma had swollen to >400µm. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), maximum keratometry (Kmax), corneal haze, and thinnest pachymetry (Pthin) were compared between riboflavin groups.

Results: : In the riboflavin dextran only group (n=42), UCVA (logMAR change=-.07±0.19,p=.04), BCVA (logMAR change=-.09±0.17,p<.01), and Kmax (change=-1.2±1.9D,p<.01) significantly improved, and corneal haze returned to baseline at 1 year (p=.1). Preoperative Pthin was 468.2±48.2µm, and at 1 year was slightly thinner (458.2±47.5µm,p<.01). In the hypotonic group (n=61), preoperative U/S, U/S after 30 minutes of riboflavin dextran administration, and U/S after hypotonic riboflavin administration, was 423.9±53.7µm, 340.9±45.1µm, and 413.6±11.1µm, respectively. On average, 3.1±2.2 rounds of hypotonic drops were required to swell the cornea ≥400µm. In this group, UCVA (logMAR change=-.09±0.28,p=.01), BCVA (logMAR change=-.1±0.18,p<.01), and Kmax (change=-1.9±4.0D,p<.01) significantly improved, and corneal haze remained slightly above baseline at 1 year (p<.01). Preoperative Pthin was 423.1±51.1µm, and at 1 year returned to preoperative measurement (420.9±51.7µm,p=.4). There was no significant difference between the two riboflavin groups, when comparing the changes in any of these clinical outcomes at 1 year (PUCVA =.5, PBCVA =.6, PKmax = .2, PHaze =.1, PPthin = .1).

Conclusions: : Administration of hypotonic riboflavin to swell the corneal stroma does not appear to affect 1 year clinical outcomes compared to standard riboflavin/dextran alone.

Clinical Trial: : http://www.clinicaltrials.gov NCT00647699 & NCT00674661

Keywords: keratoconus • cornea: clinical science • clinical (human) or epidemiologic studies: outcomes/complications 

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