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    A closer look at riboflavin application for corneal collagen crosslinking

    Researchers, clinicians analyze best approaches for faster, safer treatment

     

    An emerging treatment using riboflavin is iontopheresis, a CXL approach developed by SOOFT Italia and CE-marked in Europe. Iontophoresis has been in development for a number of years for other applications, in addition to riboflavin delivery, and has compelling results, Dr. Waring said. The use of this approach was based on preclinical data with rabbits and evaluated riboflavin concentration in the stroma in rabbits treated with transepithelial CXL compared with those that had only saline treatment.

    Yet another approach Dr. Waring shared was LASIK Plus/LASIK Extra, which involves combining LASIK with a brief application of riboflavin and UV light. “The potential benefit here is clear. Borderline candidates for LASIK may benefit and in a study we conducted with Minoru Tomita in a large series at the Shinagawa clinic in Japan, the combined treatment was safe and we observed refractive stability, and this may be a benefit in populations where regression rates may be higher,”2 Dr. Waring stated.

    Ultimately, researchers and clinicians still have some work to do to determine the best method for CXL and riboflavin application, Dr. Waring concluded.

    Corneal collagen crosslinking is not approved in the U.S. by the Food and Drug Administration, although there are a number of ongoing trials for it.

    References

    1. Mita M, Waring GO 4th, Tomita M. High-irradiance accelerated crosslinking for the treatment of keratoconus: Six-month results. J Cataract Refract Surg. 2014;40:1032-1040.
    2. Tomita M, Yoshida Y, Yamamoto Y, Mita M, Waring G 4th. In vivo confocal laser microscopy of morphologic changes after simultaneous LASIK and accelerated collagen crosslinking for myopia: one-year results. J Cataract Refract Surg. 2014;40:981-990.

     

    George O. Waring IV, MD, FACS

    E: [email protected]

    This article was adapted from Dr. Waring’s presentation at the American Society of Cataract and Refractive Surgery annual meeting in San Diego earlier this year. His presentation was part of a symposium on CXL and was entitled “New Technologies on Riboflavin Formulation”

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