Intraoperative Corneal Thickness Monitoring During Corneal Collagen Cross-Linking With Isotonic Riboflavin Solution With and Without Dextran

Oltulu, Refik; Şatırtav, Günhal; Donbaloğlu, Meryem; Kerimoğlu, Hürkan; Özkağnıcı, Ahmet; Karaibrahimoğlu, Adnan

doi:10.1097/ico.0000000000000249

Cited by 33 publications

(32 citation statements)

References 17 publications

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“…Previous studies and the standard CXL procedure have generally used an iso-osmolar riboflavin 0.1% solution containing 20% dextran (402.7 mOsmol/L), which exerts a temporary dehydrating effect and consequent corneal thinning. In contrast, we performed the CXL procedure with a dextran-free isotonic riboflavin solution and observed that the corneal thickness increased throughout the procedure, in agreement with the results of a previous study (14) . However, the safety CXL in the presence of an artificially swollen cornea remains con troversial because the lower concentration of collagen fibers in the hydrated stroma is expected to weaken the crosslinking effect of UVA, as demonstrated in experiments with collagen gels (15) .…”

Section: Discussionsupporting

confidence: 73%

“…Furthermore, we reported that the use of a dextran-free iso-osmolar riboflavin solution during CXL induced a steady increase in corneal thickness throughout the procedure. This finding might be beneficial with respect to an in creased indication for CXL in patients with thin corneas, as it removes the concern of unpredictable intraoperative thinning below the sa fety margin reported in our other study (14) . We note that the impro vements in visual acuity and keratometry readings were found to occur progressively throughout the postoperative follow-up pe riod, suggesting that a longer follow-up is needed to determine the total functional and anatomic effects of CXL and to obtain stable functional and keratometric values.…”

Section: Discussionmentioning

confidence: 89%

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Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution

Oltulu¹,

Şatırtav²,

Donbaloğlu³

et al. 2016

Arquivos Brasileiros De Oftalmologia

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Keratoconus is a bilateral, asymmetric, non-inflammatory, and slowly progressive corneal disease with an approximate incidence of 1 in 2000 individuals. This condition is characterized by corneal thinning and protrusion, progressive myopia, and irregular astigmatism (1) and has conventionally been treated using modalities, such as rigid contact lenses, intrastromal corneal ring segment implantation, and keratoplasty. However, current treatment objectives include not only improved visual acuity but also the prevention of disease progression (2) . Accordingly, corneal cross-linking (CXL) is a relatively new treatment method designed to increase the mechanical and biochemical strength of the stromal tissue via exposure of the ectatic cornea to riboflavin and ultraviolet-A (UVA) light (3) . This procedure is the only currently available semisurgical therapeutic approach for patients with progressing keratoconus and has been shown to delay ABSTRACT Purpose: To analyze the short-term clinical and topographic outcomes in patients with keratoconus after corneal collagen cross-linking treatment (CXL) with dextran-free isotonic riboflavin solution. Methods: In this retrospective case series, 26 eyes from 26 patients with keratoconus were studied. The best corrected visual acuity (BCVA) and refractive and topographic findings were analyzed at a 6-month follow-up. Results: The mean BCVA (Snellen lines) values before and 1, 3, and 6 months after CXL were 0.51 ± 0.2, 0.48 ± 0.2, 0.57 ± 0.2, and 0.64 ± 0.2, respectively, and the difference between the preoperative and 6-month values was statistically significant (p=0.006). The mean spherical equivalent refraction decreased from -5.6 ± 2.4 diopters (D) preoperatively to -5.0 ± 2.1 D, and mean simulated ke ratometry decreased from 48.5 ± 2.5 D to 47.8 ± 2.6 D at 6 months. (p=0.145 and p=0.001, respectively). In addition, the maximum keratometry decreased progressively and significantly from the preoperative value during follow-up (p=0.003). The central and minimal corneal thicknesses, including those of the epithelium, also decreased from 442.8 ± 25.6 μm and 430.5 ± 23.9 μm preoperatively to 420.7 ± 31.8 μm and 409.3 ± 28.7 μm at the most recent follow-up (p<0.001), respectively. No intraoperative or postoperative complications were observed. Conclusions: CXL with dextran-free isotonic riboflavin solution appears to be a safe treatment alternative for keratoconus and yields sustained short-term improvements in visual acuity, keratometric readings, and corneal thickness. However, long-term results are needed to confirm these outcomes.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 89%

Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution

Oltulu¹,

Şatırtav²,

Donbaloğlu³

et al. 2016

Arquivos Brasileiros De Oftalmologia

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“…Using methylcellulose rather than dextran in the riboflavin solution has the advantage of increasing intraoperative central corneal thickness (CCT) during CXL (Oltulu et al. ; Zaheer et al. ).…”

Section: Introductionmentioning

confidence: 99%

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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“…More recent studies have utilized isoosmolar riboflavin without Dextran to allow corneal thickening [20]. For all iatrogenic thickened corneas, concern exists for safety and efficacy.…”

Section: Corneal Cross-linking Safety Parametersmentioning

confidence: 99%

Current and future applications of corneal cross-linking

Khandelwal

Randleman

2015

Current Opinion in Ophthalmology

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Intraoperative Corneal Thickness Monitoring During Corneal Collagen Cross-Linking With Isotonic Riboflavin Solution With and Without Dextran

Cited by 33 publications

References 17 publications

Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution

Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution

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

Current and future applications of corneal cross-linking

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