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Natalia Paulina Quiroz-Casian, Omar Santana-Cruz, Alejandro Navas, Arturo J Ramirez-Miranda, Enrique O Graue-Hernandez; Optimizing time in crosslinking: scleral lens based riboflavin impregnation.
A pilot study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):337.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the feasibility of optimizing impregnation time by using scleral lenses as a riboflavin reservoir.
Pilot study : Case series of consecutive patients with progressive bilateral keratoconus Surgical technique: epithelium was removed with a blade in both eyes, a scleral lens filled with isotonic riboflavin 0.1% solution (the Vibex Rapid kit, Avedro, Waltham, MA) was applied to the eye. This was performed simultaneously in both eyes. After a 10-minute simultaneous riboflavin soaking time of both eyes, one scleral lens was removed and biomicroscopy confirmed rapid homogeneous riboflavin saturation (yellow Tyndall), subsequently irradiation was performed (4 minutes with a exposure of 30 mw/cm2 UVA). Immediately after the second eye scleral lens was removed, irradiation was performed. Changes to uncorrected (UCVA), corrected distance visual acuity (CDVA), refraction, keratometry (K), corneal thickness, Sirius corneal topography and optical coherence tomography demarcation line measurement were evaluated.
Twenty consecutive eyes of 21 patients with progressive keratoconus I-III of Amsler classification were included (7 female and 14 male) with a mean age of 24,1 years (range 18-28). Anterior segment optical coherence tomography revealed a mean demarcation line depth of 203.8 mm. Mean UCVA was unchanged (20/160) as well as BSCVA (20/25) , minimum mean reduced from 45.21 to 45,07 and maximum mean K reduced from 49.81 to 49.84 D. No ectasia progression was noted during the follow-up. The mean thinnest corneal thickness appeared to initially reduce at 1 month (from 468 mm to 449mm). Total procedure time of both eyes reduced from 34 minutes to 20 minutes compared to Avedro’s accelerated protocol. No adverse effects were noted in any of the cases studied.
This novel rapid soak method of riboflavin impregnation allows for bilateral simultaneous impregnation thus effectively reducing procedure time and is likely more comfortable for the patient. This technique may prove useful high volume clinics where operating room time is needed for other purposes thus freeing human and infrastructure resources for other surgical pathologies.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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