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A. Ehmann, C. Winkler von Mohrenfels, A. Huber, C. P. Lohmann; Crosslinking for Patients With Keratoconus. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1845.
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Keratoconus is a bilateral, and progredient corneal ectasia with an incidence of approximately 1 per 2,000 in the general population. The cornea develops a conical shape, due to thinning of the corneal stroma with subsequent irregular astigmatism and myopia. Previous therapies included hard contact lenses, intra stromal rings, and keratoplasty. A new approach is the riboflavin cross linking. In this technique the corneal rigidity is increased with riboflavin and the radiation of UV light. The aim of this study was to evaluate the effect of riboflavin cross lining in patients withprogressive keratoconus patients.
20 patients with progressive keratoconus where included in this study. The patients had no other corneal diseases, for example ocular infections and no previous surgeries. The patients underwent a mechanical epithelial debridement (central 8mm), followed by application of riboflavin/dextran drops, which were given until seen in the anterior chamber. The eyes were lightened with UVA light (360nm) for 30 minutes, while Riboflavin drops were installed every 5 minutes. The patient got postoperative a bandage soft contact lens for 5 days and Kombi stulln, Vidisic drops. Objective and subjective refraction, visual acuity (UCVA, BSCVA), slit lamp examination, corneal pachymetry, ocular pressure, pain, corneal topography were evaluated before and 1 week, 1 month, 3 and 6 months after surgery.
All patients described foreign body sensation (up to pain) and blurred vision during the first five days. After removal of the contact lens the visual acuity raised continuously. The visual acuity (UCVA, BCVA) was one months after surgery equal or better than before surgery. During the first 4 weeks all patients suffered from a mild dry eye . The corneal topography showed in all cases a reduction of the k values. Before surgery the average K values were 48,20 D and 1 month after surgery 47,90D. The topographic astigmatism was reduced from 2,01 D to 1,61 D.
Riboflavin/UVA Crosslinking seems to be a safe procedure to stabilize keratoconus without any side effects in the first month. Longer follow ups are necessary to assure its safety and also to prove its efficacy in controlling keratoconus.
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