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Accelerated corneal crosslinking with 20'-soaking hydroxypropyl methyl cellulose/riboflavin vs conventional
Lily M Chacra1, Chadi Helwe, Jad F Assaf
1From the Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon (Chacra, Assaf, Yehia, Baroud, Awwad); Department of Computer Sciences, American University of Beirut Medical Center, Beirut, Lebanon (Helwe); ELZA Institute, Dietikon/Zurich, Switzerland (Torres-Netto, Hafezi); Laboratory of Ocular Cell Biology, CABMM, University of Zurich, Zurich, Switzerland (Torres-Netto, Hafezi); Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil (Torres-Netto); Department of Ophthalmology, University of Wenzhou, Wenzhou, China (Hafezi); Faculty of Medicine, University of Geneva, Geneva, Switzerland (Torres-Netto, Hafezi).
Purpose:
To evaluate and compare functional and structural outcomes of accelerated corneal crosslinking (A-CXL) using riboflavin with hydroxypropyl methyl cellulose (HPMC) vs conventional corneal crosslinking (C-CXL) using riboflavin with dextran.
Setting:
American University of Beirut Medical Center, Beirut, Lebanon.
Design:
Retrospective analysis.
Methods:
Retrospective analysis of 83 eyes of 73 patients with mild to moderate keratoconus. First group (n = 44 eyes) underwent C-CXL using a 30-minute riboflavin/dextran soaking between June 2014 and March 2016. Second group (n = 39 eyes) underwent A-CXL using a 20-minute riboflavin/HPMC soaking between April 2016 and December 2017. Patients were evaluated preoperatively and at 1, 3, and 12 months postoperatively. Main outcome measures were simulated keratometry (simK), maximum axial keratometry (Kmax), demarcation line depth, and haze intensity measured using optical coherence tomography-based image analysis software.
Results:
Demarcation line (DL) was 298.30 ± 64.60 μm and 335.61 ± 99.76 μm for C-CXL and A-CXL groups, respectively ( P = .04). Haze profile was similar for both groups. The mean simK values were reduced from 46.93 ± 3.50 and 46.44 ± 2.93 preoperatively to 46.18 ± 3.65 and 45.54 ± 2.78 at 12 months postoperatively, for C-CXL and A-CXL, respectively ( P = .003 for both groups). The mean Kmax decreased from 52.46 ± 4.82 and 51.50 ± 3.87 preoperatively to 51.30 ± 4.42 and 50.30 ± 3.52 postoperatively, for the C-CXL and A-CXL, respectively ( P < .001 for both groups). There was no difference in the simK and Kmax changes between the C-CXL and A-CXL groups ( P = .814 and P = .913), visual acuity, and refraction between the 2 groups ( P > .05).
Conclusions:
A-CXL with a 20-minute riboflavin/HPMC soaking produced deeper DL and similar corneal haze, topographic, refractive, and visual results to C-CXL with a 30-minute riboflavin/dextran soaking.
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