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Karen Schaeffer, John Jarstad, Alan Schaeffer, Lindsey McDaniel; Topographic Corneal Changes Induced by Oral Riboflavin in the Treatment of Corneal Ectasia. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1413.
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Cornea collagen cross-linking has emerged as a highly successful treatment for keratoconus and post-refractive surgery ectasia. The use of topical concentrated riboflavin along with long-wave ultraviolet light has been shown to stiffen the corneal stroma by cross-linking the collagen fibers. In many cases, this will reduce progressive corneal steepening and, in some cases, flatten the curvature of the cornea. While cornea cross-linking has recently been approved by the FDA, the cost of the treatment has limited patients’ access to this new modality. We report three cases at three institutions where patients ingested high doses of dietary riboflavin and experienced a significant amount of corneal flattening when measured with corneal topography.
The patients either on their own accord or at the suggestion of their ophthalmologist ingested riboflavin 400mg qd (case 1), 500mg qd (case 2), and 400 mg BID or TID (case 3). Ambient sunlight provided the UV exposure. Topographic changes were obtained prior to the initiation of treatment and 6 months after treatment (patients 1 and 2) and 1 month after treatment (patient 3).
Patient 1 had 1.2 diopters of topographical flattening in both eyes and visual acuity improved from 20/40 OD 20/30 OS to 20/25 in each eye. Patient 2 had no flattening of the right eye and .55 diopters of flattening in the left eye. Visual acuity improved from 20/40 OD and 20/25 OS to 20/20 OD and 20/15 OS. Patient 3 had 2.17 diopters of flattening in the right eye and 1.33 diopters of flattening in the left eye. Best corrected vision improved from 20/50 OD and 20/70 OS to 20/30 OD and 20/40 OS.
This study suggests that the ingestion of high dose oral riboflavin and ambient UV light exposure results in topographic corneal flattening in patients with corneal ectasia. We believe this flattening results from collagen cross-linking. This treatment may provide a cost-effective alternative that has fewer risks than the approved riboflavin crosslinking procedure currently available. The amount of flattening seen in these three patients is similar to prior cross-linking studies (1.5 diopters). For further evaluation, Author JJ is currently enrolling cornea ectasia patients in an IRB-approved study.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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