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A. Hoyer, F. Raiskup-Wolf, E. Spörl, L. E. Pillunat; Collagen Crosslinking With Riboflavin and UVA-Light in Endothelial-Epithelial Decompensation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5473.
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With photooxidative collagen crosslinking, additional covalent bindings between collagen molecules can be achieved which stabilizes the collagen scaffold and therewith might induce a mechanical barrier which inhibits aqueous influx.Aim of this pilot study was to prove the effect of collagen crosslinking in patients with a symptomatic endothelial-epithelial decompensation.
10 patients were included in this ethics committee-approved study. The maximum follow-up time was 9 months. In all patients we examined besides slitlamp biomicroscopy, refraction, best corrected visual acuity, corneal topography, corneal thickness and endothelial cellcount. The crosslinking was done according to the standard developed for the treatment of keratoconus: after topical anesthesia and removal of the epithelial tissue 0.1% riboflavin solution was applied to the cornea for 20 minutes. Then the central cornea was irradiated with UVA light with a wavelength of 370 nm and an irradiance of 3 mW/cm2 for 30 minutes. During irradiation, drops of riboflavin solution again were applied to the cornea every 4 to 5 minutes to sustain the necessary concentration of the riboflavin and prevent desiccation of the cornea.
The preoperative mean values recorded were for corneal thickness 840±274.17µm, for best-corrected visual acuity 0.1±0.05 lines and for endothelial cellcount 1450±173.21/mm2. Already one week after treatment patients reported on relief of their complaints. After one month a plain but not yet significant decrease of corneal thickness of 40µm was noticed. The vision remained stable (i.e. no line loss). The endothelial cellcount showed a not significant decrease by 150 cells/mm2. At month 9 we recorded a significant decline in corneal thickness by an average of 125µm (Wilcoxon-Test, p<0.05) and an improvement in vision by an average of one line. The densitiy of endothelial cells was equivalent to the preoperative value.
Our results indicate that collagen crosslinking might be an effective, worthwhile palliative therapeutical option for patients suffering from symptomatic endothelial-epithelial decompensation.
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