A Study Comparing Standard and Transepithelial Collagen Cross-Linking Riboflavin Solutions: Epithelial Findings and Pain Scores

Yüksel, Erdem; Novruzlu, Shahin; Özmen, Mehmet Cüneyt; Bi̇lgi̇han, Kamil

doi:10.1089/jop.2014.0090

Cited by 18 publications

(13 citation statements)

References 20 publications

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“…Not only did 24% of eyes in this series progress with an increase in Kmax greater than 1.0 D at 12 months, but almost 50% of eyes had epithelial defects on the first day due to epithelial toxicity from prolonged BAC application. Such findings of epithelial damage are consistent with the study by Yuksel et al (119), who found higher pain scores on day 1 and longer epithelialization times with epithelium-on treatments.…”

Section: Epithelium-on Cxl: Chemical Enhancerssupporting

confidence: 92%

Corneal Collagen Crosslinking for Corneal Ectasias: A Review

O’Brart

2016

European Journal of Ophthalmology

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Section: Epithelium-on Cxl: Chemical Enhancerssupporting

confidence: 92%

Corneal Collagen Crosslinking for Corneal Ectasias: A Review

O’Brart

2016

European Journal of Ophthalmology

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“…Additionally, epi-off CXL increases the risk of complications including pain, corneal haze, corneal melt, infection, and endothelial decompensation. [8][9][10][11][12][13][14][15] For these reasons, there is an incentive to perform epi-on CXL.…”

Section: Discussionmentioning

confidence: 99%

Epithelium-on Corneal Cross-linking for Progressive Keratoconus: Two-year Outcomes

Cummings¹,

Shaw²,

Kelly³

2018

International Journal of Keratoconus and Ectatic Corneal Diseases

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Corneal cross-linking (CXL) has been established as a successful treatment tool for the treatment of progressive keratoconus in terms of slowing or halting progressive corneal steepening and thinning and even on some occasions, reversing the steepening. To date the Dresden epithelium-off protocol is regarded as the gold standard and the epithelium-on (epi-on) approaches have met with less success. Both doctors and patients would welcome an epi-on CXL procedure that provided good outcomes as the morbidity with epi-on CXL is so much less and the safety is enhanced. Patient comfort is greater with the epi-on techniques when compared to epi-off. This study looked at 82 eyes that had documented progression of keratoconus and then underwent epi-on CXL using the CXLO system. The results show that corneal steepening can be halted and even reversed over a 2-year follow-up period with no complications noted. Over the 24 months post treatment on average there was a decrease in all keratometry values, BAD and ISV when compared to before treatment with IHD being marginally increased.Further studies over a longer follow-up period are required but recent publications using the same approach are validating the findings seen in this study.

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“…37 Moreover, epithelial disruption or postoperative epithelial sloughing with some permeation enhancers (eg, benzalkonium chloride) or iontophoresis leads to inadvertent partial or complete epi-off procedures. [38][39][40] Other alternative approaches such as injection of riboflavin solution into an intrastromal pocket, 41,42 topical application of riboflavin nanoemulsions [43][44][45] or oral administration of riboflavin followed by sunlight exposure 46 still await confirmation of effectiveness.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Sodium Iodide on Stromal Loading, Distribution and Degradation of Riboflavin in a Rabbit Model of Transepithelial Corneal Crosslinking

Rubinfeld¹,

Gum²,

Talamo³

et al. 2021

OPTH

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Purpose: To evaluate effects of sodium iodide (NaI) on riboflavin concentration in corneal stroma before and during ultraviolet A (UVA) light exposure using a novel transepithelial corneal collagen crosslinking (CXL) procedure (EpiSmart CXL system, CXL Ophthalmics, Encinitas CA). Methods: Riboflavin solutions with NaI (Ribostat, CXL Ophthalmics, Encinitas CA) and without NaI were used for CXL in rabbits using EpiSmart. A pilot study determined sufficient riboflavin loading time. Four rabbits were dosed and monitored. Riboflavin fluorescence intensity was assessed from masked slit-lamp photos. A 12 min loading time was selected. Sixteen additional rabbits received the two formulae in contralateral eyes for CXL. Riboflavin uptake was assessed at 0, 10, 15, 20, 25, and 30 min of UVA exposure using a scale for riboflavin fluorescence previously validated against stromal concentration. Post sacrifice, corneal stromal samples were analyzed for concentrations of riboflavin and riboflavin 5ʹ-phosphate. Results: Eyes dosed with NaI riboflavin had higher riboflavin grades compared to eyes dosed with the NaI-free riboflavin formulation immediately after riboflavin loading and persisting throughout UVA exposure, with significantly higher (P < 0.01 to < 0.05) riboflavin grades from 15 through 25 min of UVA exposure. Riboflavin grades decreased more slowly in eyes dosed with NaI riboflavin through 25 minutes of UVA exposure. Minor conjunctival irritation was noted with or without NaI. Conclusion:The addition of NaI to riboflavin solution is associated with increased riboflavin concentration in corneal stroma throughout a clinically relevant time course of UVA exposure. This effect may be a combination of enhanced epithelial penetration and reduced riboflavin photodegradation and should enhance intrastromal crosslinking.

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A Study Comparing Standard and Transepithelial Collagen Cross-Linking Riboflavin Solutions: Epithelial Findings and Pain Scores

Cited by 18 publications

References 20 publications

Corneal Collagen Crosslinking for Corneal Ectasias: A Review

Corneal Collagen Crosslinking for Corneal Ectasias: A Review

Epithelium-on Corneal Cross-linking for Progressive Keratoconus: Two-year Outcomes

The Effect of Sodium Iodide on Stromal Loading, Distribution and Degradation of Riboflavin in a Rabbit Model of Transepithelial Corneal Crosslinking

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