Comparison of 2 Riboflavin Formulations in Patients Having Epithelial-On Corneal CXL for Keratoconus
Narrative Responses:
Purpose
To compare two formulations of riboflavin, each with a different UV light energy level, for Epithelial-ON CXL for keratoconus patients, with evaluation of speed of corneal loading with riboflavin as well as patient corneal and visual outcomes.
Methods
Eyes enrolled in this single center, non-randomized study underwent Epithelial-On crosslinking, with two versions of preservative-free riboflavin. Riboflavin loading was stopped once the cornea was determined to be saturated. 3mW of UV light was initiated for 30 minutes for group 1, while 4mW for 30 minutes was used for formulation 2. Post-Op measures included UCVA, BCVA, spherical equivalent, and change in KMax at three, six and 12 months.
Results
There were 177 eyes with riboflavin formulation 1, 166 eyes with formulation 2. The average time to corneal loading was 59.3 minutes for formula 1, versus 27.2 minutes for formula 2. The average improvement in KMax for formula 1 was 0.22D, 0.56D, and 0.66D at 3, 6 and 12 months, respectively, compared to an average improvement with formula 2 of 0.31D, 0.97D, and 0.98D. BSCVA improved by 1 or more lines with formula 1 in 40.1%, 45.6%, and 52.7% at 3, 6 and 12 months, compared to 47.2%, 52.6% and 53.2% at 3, 6 and 12 months with formula 2
Conclusion
Epithelial-on corneal collagen cross-linking appears to be a safe and effective treatment for patients with Keratoconus. Modification of the Riboflavin formulation can increase the speed of loading time, and modification of the riboflavin formulation plus UV light energy and can be associated with improved patient outcomes