Comparison of Corneal Riboflavin Gradients Using Dextran and HPMC Solutions

Ehmke, Tobias; Seiler, Theo; Fischinger, Isaak; Ripken, Tammo; Heisterkamp, Alexander; Frueh, Béatrice E.

doi:10.3928/1081597x-20160920-03

Cited by 42 publications

(46 citation statements)

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“…reported lower corneal riboflavin concentration using dextran–riboflavin compared to methylcellulose–riboflavin in porcine corneas (Ehmke et al. ). Very low concentration of riboflavin has also been shown in the posterior stroma after dextran–riboflavin soaking in the posterior human cornea in vitro (Sondergaard et al.…”

Section: Discussionmentioning

confidence: 99%

“…measured corneal riboflavin concentration and UVA absorption without a precorneal riboflavin film in porcine corneas (Ehmke et al. ), Wollensak et al. measured the thickness of the precorneal riboflavin film and also the UVA absorbance in human corneas (Wollensak et al 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Due to a higher intracorneal concentration of riboflavin with time, this probably means that a higher intrastromal concentration of riboflavin causes a deeper effect (Ehmke et al. ). These findings add an interesting perspective to the effect of soaking time.…”

Section: Discussionmentioning

confidence: 99%

“…), a faster diffusion time (Ehmke et al. ) and probably an increased precorneal UVA absorbance due to a thicker riboflavin film compared to dextran–riboflavin (Wollensak et al. ).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, we changed our CXL protocol to 0.1% riboflavin with methylcellulose as the main supplement (methylcelluloseriboflavin) in 2012. In addition, it seems that methylcellulose-riboflavin provides a higher riboflavin concentration in the cornea after soaking (Hammer et al 2016), a faster diffusion time (Ehmke et al 2016) and probably an increased precorneal UVA absorbance due to a thicker riboflavin film compared to dextran-riboflavin (Wollensak et al 2010). These different characteristics between the riboflavin solutions may all affect the clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

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Superior outcome of corneal collagen cross‐linking using riboflavin with methylcellulose than riboflavin with dextran as the main supplement

Thorsrud

Hagem

Sandvik

et al. 2018

Acta Ophthalmologica

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Purpose To compare the effect of corneal collagen cross‐linking (CXL) on progressive keratoconus using 0.1% riboflavin with either dextran or methylcellulose as the main supplement. Methods In a comparative case series, CXL was performed in 40 patients (40 eyes) using a riboflavin solution containing either dextran (dextran–riboflavin; n = 20) or methylcellulose (methylcellulose–riboflavin; n = 20). Changes in central corneal thickness (CCT), Scheimpflug tomography, maximal keratometry reading (Kmax), visual acuity (VA) and endothelial cell density (ECD) were recorded. Stromal changes one month after surgery were analysed using optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). Results The CCT was significantly higher in the methylcellulose–riboflavin group during the CXL procedure. The IVCM demarcation line depth was 274 ± 80 (SD) μm in the dextran–riboflavin group and 442 ± 80 μm in the methylcellulose–riboflavin group (p < 0.001). Complete absence of keratocytes in the pre‐endothelial stroma was found in none of the corneas treated with dextran–riboflavin and in 42% of the corneas treated with methylcellulose–riboflavin. Visibility of the OCT demarcation line was significantly lower in the methylcellulose–riboflavin group. Kmax and corrected distance visual acuity were improved in the methylcellulose–riboflavin group and stable in the dextran–riboflavin group after 2 years. Endothelial cell density (ECD) was stable in both groups. Conclusion We found deeper structural changes in the methylcellulose–riboflavin group than in the dextran–riboflavin group. This may be explained by different riboflavin solution properties and raises safety concerns. The study also indicates improved effect using methylcellulose–riboflavin than dextran–riboflavin, possibly explained by deeper stromal CXL effect.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…), a faster diffusion time (Ehmke et al. ) and probably an increased precorneal UVA absorbance due to a thicker riboflavin film compared to dextran–riboflavin (Wollensak et al. ).…”

Section: Introductionmentioning

confidence: 99%