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Transepithelial Corneal Cross-linking Using an Enhanced Riboflavin Solution.

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    Journal of Refractive Surgery (Thorofare, N.J. : 1995)
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    This study found that a modified riboflavin solution for transepithelial corneal cross-linking (CXL) did not stop keratoconus progression and caused significant epithelial damage.

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    Area of Science:

    • Ophthalmology
    • Corneal Surgery
    • Biomaterials

    Background:

    • Keratoconus is a progressive corneal ectasia.
    • Corneal cross-linking (CXL) aims to halt keratoconus progression.
    • Transepithelial CXL offers a less invasive approach.

    Purpose of the Study:

    • To evaluate the efficacy of a modified high-concentration riboflavin solution with benzalkonium chloride for transepithelial corneal cross-linking (CXL).
    • To assess the impact of this enhanced solution on keratoconus progression and corneal health.

    Main Methods:

    • A prospective, interventional multicenter cohort study included 26 eyes with progressive keratoconus.
    • Transepithelial CXL was performed using the modified riboflavin solution.
    • Follow-up included visual acuity, keratometry (Kmax), pachymetry, and slit-lamp examination at 6 and 12 months.

    Main Results:

    • No significant changes in Kmax or corneal thinnest point were observed postoperatively.
    • 46% of eyes showed progression (Kmax increase > 1.00 diopter) at 12 months.
    • Significant postoperative corneal epithelial defects (46%) and epitheliopathy (23%) were noted.

    Conclusions:

    • Transepithelial CXL with the enhanced riboflavin solution was ineffective in halting keratoconus progression.
    • The treatment resulted in notable corneal epithelial damage in the immediate postoperative period.