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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)
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).
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.
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).
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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