July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Cool Crosslinking: " Riboflavin at 4o C for the Management of Pain After Crosslinking for Keratoconus Patients.”
Author Affiliations & Notes
  • Enrique O Graue-Hernandez
    Lentes de contacto, Instituto de Oftalmologia, Mexico City, DF, Mexico
  • Laura Elisa Toro Giraldo
    Lentes de contacto, Instituto de Oftalmologia, Mexico City, DF, Mexico
  • Arturo J Ramirez-Miranda
    Lentes de contacto, Instituto de Oftalmologia, Mexico City, DF, Mexico
  • Andrew Olivo-Payne
    Lentes de contacto, Instituto de Oftalmologia, Mexico City, DF, Mexico
  • Aida Jimenez-Corona
    Lentes de contacto, Instituto de Oftalmologia, Mexico City, DF, Mexico
  • Alejandro Navas
    Lentes de contacto, Instituto de Oftalmologia, Mexico City, DF, Mexico
  • Omar Santana-Cruz
    Lentes de contacto, Instituto de Oftalmologia, Mexico City, DF, Mexico
  • Footnotes
    Commercial Relationships   Enrique Graue-Hernandez, None; Laura Toro Giraldo, None; Arturo Ramirez-Miranda, None; Andrew Olivo-Payne, None; Aida Jimenez-Corona, None; Alejandro Navas, None; Omar Santana-Cruz, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 6321. doi:
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      Enrique O Graue-Hernandez, Laura Elisa Toro Giraldo, Arturo J Ramirez-Miranda, Andrew Olivo-Payne, Aida Jimenez-Corona, Alejandro Navas, Omar Santana-Cruz; Cool Crosslinking: " Riboflavin at 4o C for the Management of Pain After Crosslinking for Keratoconus Patients.”. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6321.

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

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Abstract

Purpose : To evaluate the effect of the application of riboflavin at 4oC in the perception of postoperative pain in subjects with keratoconus after corneal collagen crosslinking (CXL).

Methods : Prospective, comparative, randomized, interventional study of 196 eyes of 98 subjects older than 18 years with a diagnosis keratoconus on which progression was documented and 0pithelium-off accelerated crosslinking was indicated. The central 8 mm corneal epithelium was removed. Impregnation was performed with 0.1% Riboflavin, Saline, HPMC (Vibex Rapid, AVEDRO) for 10 minutes and the cornea irradiated with 30mw for 4 minutes (AVEDRO). Group 1 0.1% Riboflavin, Saline, HPMC was stored at room temperature, Group 2 0.1% Riboflavin, Saline, HPMC was stored at 4oC and mantained with ice covering during the procedure. A bandage contact lens was placed after the procedure. Postoperative treatment included moxifloxacin) (Vigamox, Alcon) 1 gtt every 8 hours, fluormetholone (Flarex, Alcon) every 8 hours hyaluronic acid drops 0.15% (Thea) as needed and ketorolac 10mgs (Supradol,Liomont) as needed. A previously validated visual analog scale pain scale and questionnaire was applied, 2 hours after surgery and in the postoperative days from 1 to 5. A single blind investigator conducted all the questionnaires. The demarcation line was measured between postoperative month 1 to 3 . Statistical analysis was performed with STATA v.13.

Results : We included 98 subjects (196 eyes) . Mean pain value at 2 hours postoperatively in the group 1 was 8.08 and 3.8 (p = 0.0005) in group 2. Other symptoms included in the test (tearing, photophobia, foreign body sensation and irritation) also showed statistically significant improvement in group 2 at 2 hours postoperatively (p = 0.0005, p = 0.01, p = 0.0003, p = 0.0004, respectively). Pain was statiscally signficantly greater in postoperative day 1, 2, and 4 in group 1(p = 0.028, p = 0.05, p = 0.05, respectively). Depth of demarcation line measured at average 1.5 months postop was 279.32 μm and 279.66 μm in group 1 and 2 respectively (p =0.93).

Conclusions : Riboflavin at 4oC significantly reduced pain perception after crosslinking for keratoconus

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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