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    A closer look at riboflavin application for corneal collagen crosslinking

    Researchers, clinicians analyze best approaches for faster, safer treatment

    Take-home message: Corneal collagen crosslinking with riboflavin works well but requires further exploration to identify the best approach for various types of patients.


    New riboflavin formulations for corneal collagen crosslinking (CXL) could make the procedure more effective for keratoconus and ectasia, said George O. Waring IV, MD, FACS, director of refractive surgery, Storm Eye Institute, Medical University of South Carolina, Charleston, and adjunct assistant professor of bioengineering, Clemson University, Clemson, S.C.

    Dr. Waring pointed to published studies that have found positive results from different CXL approaches involving riboflavin. One such study that Dr. Waring participated in along with Japanese researchers focused on the effectiveness of accelerated CXL with riboflavin for keratoconus.1 Researchers evaluated the change in dioptric power and corneal topography.

    The study involved accelerated CXL treatments using a 10-minute riboflavin soak and three minutes of ultraviolet-A radiance at 30 mW/cm,2 which corresponded to 5.4 J/cm.2 In the 22 patients (39 eyes), the mean uncorrected distance visual acuity had a statistically significant improvement from 1.11 logMAR preoperatively to 0.89 logMAR at six months postoperatively. Mean maximum keratometry readings also improved. Researchers concluded that accelerated CXL had similar results to conventional CXL and that the procedure has the potential to treat and stop the progression of keratoconus.

    Dr. Waring also addressed results related to transepithelial CXL ‒ also known as epi-on, which involves leaving the epithelium intact during treatment.

    “We’re getting more and more signals that this approach seems to work, but the question is, does it work as well as epi-off?” he said. “Sufficient exposure time for increased riboflavin delivery and oxygen exposure during treatment is required to get a meaningful effect.”



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