Abstract | PURPOSE: To evaluate the safety and efficacy of staged ultraviolet A (UVA) cross-linking following intrastromal 0.1% riboflavin administration in eyes with advanced corneal edema. METHODS: Ten eye bank corneas divided in two groups (n = 5) were placed on a pressurized artificial anterior chamber following Descemet's membrane stripping. Two consecutive corneal pockets (350- and 150-microm depth) were sequentially created using a femtosecond laser. Sequential intrastromal injections of 0.1% riboflavin (0.2 mL) followed by either UVA irradiation (15 mW/cm2) for 7 minutes or exposure to air were performed for each pocket. Corneal clarity and central thickness were measured before and after the two UVA cross-linking steps. The same steps were clinically applied in an 84-year-old woman with bullous keratopathy prior to corneal transplantation and followed for 6 months. RESULTS: The corneal clarity improved in the treated but not the control eyes. The mean central corneal thickness was significantly reduced by 256 microm (ultrasound, P = .0002) and 273 miccrom (Scheimpflug, P = .0004) in treated eyes, but only 100 microm (ultrasound, P = .048) and 107 microm (Scheimpflug, P = .075) in the control eyes. The clinical treatment of corneal edema showed improved clarity and reduced central corneal thickness from 675 to 550 microm (ultrasound) and 696 to 571 microm (Scheimpflug) at 1 month. Best spectacle-corrected visual acuity improved from finger counting to 20/80 at 1 week and beyond, postponing corneal transplantation for > 6 months. CONCLUSIONS: Staged UVA cross-linking (15 mW/cm2) with femtosecond laser facilitated intrastromal 0.1% riboflavin administration may be a safe (no corneal scarring) and effective (marked reduction of edema) temporizing alternative method for managing bullous keratopathy.
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Authors | Ronald R Krueger, Jerome C Ramos-Esteban, A John Kanellopoulos |
Journal | Journal of refractive surgery (Thorofare, N.J. : 1995)
(J Refract Surg)
Vol. 24
Issue 7
Pg. S730-6
(Sep 2008)
ISSN: 1081-597X [Print] United States |
PMID | 18811120
(Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Photosensitizing Agents
- Collagen
- Riboflavin
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Topics |
- Aged, 80 and over
- Collagen
(metabolism)
- Corneal Diseases
(diagnosis, drug therapy, metabolism)
- Corneal Edema
(diagnosis, drug therapy, metabolism)
- Corneal Stroma
(drug effects, metabolism, radiation effects)
- Corneal Topography
- Female
- Humans
- Models, Biological
- Photochemotherapy
- Photosensitizing Agents
(therapeutic use)
- Riboflavin
(therapeutic use)
- Ultraviolet Rays
- Visual Acuity
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