Potential Use of Riboflavin/UVA Cross-Linking in Bullous Keratopathy

Abstract

Background: Collagen cross-linking of the cornea has been shown by us to have an antiedematous effect in the cornea. The aim of the present study was to examine if this effect can be used for the treatment of bullous keratopathy. Methods: This clinical interventional case series included 3 patients (3 eyes) with bullous keratopathy due to pseudophakia, corneal transplant rejection, and Fuchs’ endothelial dystrophy. After dehydration for 1 day using 40% glucose, the central 8 mm of the cornea were abraded and cross-linked with the photosensitizer riboflavin and UVA (370 nm, 3 mW/cm²) for 30 min. Optical coherence tomography pachymetry measurements of the central cornea were performed at various time intervals. Results: Corneal thickness was reduced by 90.33 ± 17.04 μm on average 3 days after cross-linking and by 93.67 ± 14.22 μm after 8 months. The bullous changes of the epithelium were markedly improved, resulting in loss of pain and discomfort. Visual acuity was significantly improved in the case without prior stromal scarring. Conclusions: Cross-linking might become another useful tool in the treatment of bullous keratopathy. It is primarily suited for patients with pain symptoms, restricted visual prognosis or to extend the time interval for an upcoming corneal transplantation.

Effect of Corneal Collagen Cross-Linking on Quality of Life in Patients with Bullous Keratopathy

“…4 Bullous keratopathy, caused by endothelial dysfunction, leads to chronic corneal edema, epithelial bullae, recurrent erosions, and subsequent visual impairment and ocular discomfort. 5 With the deterioration of the endothelial pump function, fluid accumulates in the extracellular spaces between the collagen fibers and lamellae. CXL re- duces this corneal edema by inducing more concentrated cross-linked fibers and reducing possible gaps for fluid accumulation.…”

“…CXL re- duces this corneal edema by inducing more concentrated cross-linked fibers and reducing possible gaps for fluid accumulation. [5][6][7][8] Bullous keratopathy is one of the leading indications for keratoplasty all over the world. 6,9 Although, the main indication for keratoplasty in these patients is visual loss due to hazy cornea, the secondary indication for keratoplasty is the disabling pain that restricts their daily life.…”

“…[1][2][3] Although, the genesis aim of CXL procedure was the treatment of keratoconus, a role for CXL has also been suggested as a promising alternative method in managing bullous keratopathy by reducing ocular discomfort, increasing visual acuity and probably postponing or even eliminating the need for corneal transplantation. [4][5][6][7] In the present study we evaluated the effects of UVA CXL following intrastromal 0.1% riboflavin administration on quality of life in patients with bullous keratopathy.…”

“…7 In another study, CXL was performed in 3 patients with bullous keratopathy and the bullous changes of the epithelium markedly improved in the following 8 months, resulting in loss of pain and discomfort in all patients. 5 However, no objective evaluation scale was used in neither of these studies. 5,7 Ghanem et al performed CXL on 14 painful patients with pseudophakic bullous keratopathy and used "National Pain Education Council" for the measurement of ocular pain intensity.…”

“…5 However, no objective evaluation scale was used in neither of these studies. 5,7 Ghanem et al performed CXL on 14 painful patients with pseudophakic bullous keratopathy and used "National Pain Education Council" for the measurement of ocular pain intensity. They reported a significant reduction in pain scores at the first month, but this improvement declined and returned back to baseline values by the 6 th month.…”