Comparison of transepithelial corneal collagen crosslinking with epithelium-off crosslinking in progressive keratoconus

Koçak, İbrahim; Aydın, Ahmet; Kaya, Faruk; Koç, Hacı

doi:10.1016/j.jfo.2013.11.012

Cited by 49 publications

(42 citation statements)

References 23 publications

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“…[8][9][10][11][12][13][14][15][16][17][18][19][20] The only comparative study in adults comparing the topography indices of a transepithelial CXL group with those of an epithelium-off CXL group 13 reported an increase of 1.00 D or more in the apical K value in 65% of patients 12 months after transepithelial CXL; however, the report is not in English. Magli et al 16 compared transepithelial CXL with epithelium-off CXL in a pediatric population; the 2 treatments showed similar effectiveness.…”

Section: Discussionmentioning

confidence: 99%

“…In 5 studies including a total of 141 eyes, topographic parameters worsened. 9,10,[12][13][14] In the remaining 8 studies involving 223 eyes, the topographic parameters improved or stabilized. 8,11,[15][16][17][18][19][20] In 5 studies including a total of 244 eyes, the follow-up was 12 months, 8,15,[17][18][19] and in 3 studies including a total of 86 patients it was 18 months.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16][17][18][19][20] The underlying mechanism and its effects on topographic indices are not completely understood, and there have been no adequate comparisons of the 2 modalities. To our…”

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confidence: 99%

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Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus

Çerman

Toker

Özcan

2015

Journal of Cataract and Refractive Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus

Çerman

Toker

Özcan

2015

Journal of Cataract and Refractive Surgery

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“…6,[25][26][27][28] Twelve-month results from one recently published randomized controlled trial 6 concluded that transepithelial CXL using Ricrolin TE (Sooft Italia S.p.A.) was not effective at stabilizing corneal shape compared with epithelium-off treatment. For iontophoresis, up to 15-month followup data have been published, with reported cessation of disease progression and improvements in keratometric and visual parameters.…”

Section: Discussionmentioning

confidence: 99%

Transepithelial Riboflavin Absorption in an Ex Vivo Rabbit Corneal Model

Gore

O’Brart

French

et al. 2015

Invest. Ophthalmol. Vis. Sci.

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Citation: Gore DM, O'Brart D, French P, Dunsby C, Allan BD. Transepithelial riboflavin absorption in an ex vivo rabbit corneal model. Invest Ophthalmol Vis Sci. 2015;56:5006-5011. DOI:10.1167/iovs.15-16903 PURPOSE. To measure depth-specific riboflavin concentrations in corneal stroma using twophoton fluorescence microscopy and compare commercially available transepithelial corneal collagen cross-linking (CXL) protocols. METHODS.Transepithelial CXL riboflavin preparations-MedioCross TE, Ribocross TE, Paracel plus VibeX Xtra, and iontophoresis with Ricrolinþ-were applied to the corneal surface of fresh postmortem rabbit eyes in accordance with manufacturers' recommendations for clinical use. Riboflavin 0.1% (VibeX Rapid) was applied after corneal epithelial debridement as a positive control. After riboflavin application, eyes were snap frozen in liquid nitrogen. Corneal cross sections 35-lm thick were cut on a cryostat, mounted on a slide, and imaged by two-photon fluorescence microscopy. Mean (SD) concentrations were calculated from five globes tested for each protocol.RESULTS. Peak riboflavin concentration of 0.09% (60.01) was observed within the most superficial stroma (stromal depth 0-10 lm) in positive controls (epithelium-off). At the same depth, peak stromal riboflavin concentrations for MedioCross TE, Ricrolinþ, Paracel/Xtra, and Ribocross TE were 0.054% (60.01), 0.031% (0.003), 0.021% (60.001), and 0.015% (60.004), respectively. At a depth of 300 lm (within the demarcation zone commonly seen after corneal cross-linking), the stromal concentration in epithelium-off positive controls was 0.075% (60.006), while at the same depth MedioCross TE and Ricrolinþ achieved 0.018% (60.006) and 0.016% (0.002), respectively. None of the remaining transepithelial protocols achieved concentrations above 0.005% at this same 300-lm depth. Overall, MedioCross TE was the best-performing transepithelial formulation.CONCLUSIONS. Corneal epithelium is a significant barrier to riboflavin absorption into the stroma. Existing commercial transepithelial CXL protocols achieve relatively low riboflavin concentrations in the anterior corneal stroma when compared to gold standard epithelium-off absorption. Reduced stromal riboflavin concentration may compromise the efficacy of riboflavin/ultraviolet corneal CXL.

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“…Despite these chemical enhancers, results in clinical studies with transepithelial riboflavin preparations have been equivocal: Some studies report similar efficacy to epithelium-off CXL, 14,15 but most report inferior results. [10][11][12][16][17][18] Iontophoresis, in which an electrical gradient is used to drive negatively charged riboflavin molecules across the intact epithelium, may further enhance riboflavin penetration in transepithelial CXL. Laboratory studies of iontophoresis have been encouraging, demonstrating enhanced transepithelial riboflavin penetration and improvement of corneal biomechanics.…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Different Corneal Iontophoresis Protocols for Promoting Transepithelial Riboflavin Penetration

Gore

O’Brart

French

et al. 2015

Invest. Ophthalmol. Vis. Sci.

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Citation: Gore DM, O'Brart DP, French P, Dunsby C, Allan BD. A comparison of different corneal iontophoresis protocols for promoting transepithelial riboflavin penetration. Invest Ophthalmol Vis Sci. 2015;56:7908-7914. DOI:10.1167/iovs.15-17569 PURPOSE. To measure corneal riboflavin penetration using different transepithelial iontophoresis protocols. METHODS.Freshly enucleated rabbit eyes were divided into nine treatment groups of 4 eyes. One group, in which 0.1% wt/vol riboflavin was applied for 30 minutes without iontophoresis after corneal epithelial debridement, acted as a control. The remaining groups were treated with an intact epithelium using different riboflavin formulations and varying iontophoresis current, soak, and rinse times. After riboflavin application, eyes were snap frozen in liquid nitrogen. Corneal cross sections 35 lm thick were then imaged immediately by two-photon fluorescence microscopy, using image processing software to quantify stromal riboflavin concentration at different corneal depths.RESULTS. In the epithelium-on iontophoresis treatment groups, greater stromal riboflavin penetration was achieved with higher-concentration riboflavin solutions, greater iontophoresis dosage, and longer solution contact times. A protocol utilizing 0.25% wt/vol riboflavin with benzalkonium chloride (BAC) 0.01% and two cycles of applied current and subsequent soaking (1 mA 5 minutes, soak 5 minutes; 0.5 mA 5 minutes, soak 5 minutes) achieved similar stromal riboflavin penetration to epithelium-off controls. The best-performing non-BACcontaining protocol produced stromal riboflavin penetration approximately 60% that of epithelium-off controls. Riboflavin solutions containing saline resulted in minimal stromal penetration. Riboflavin loading within the epithelium was equivalent to or higher than that in the subjacent stroma, despite rinsing the ocular surface with balanced salt solution.CONCLUSIONS. Modified iontophoresis protocols can significantly improve transepithelial riboflavin penetration in experimental corneal collagen cross-linking.

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Comparison of transepithelial corneal collagen crosslinking with epithelium-off crosslinking in progressive keratoconus

Cited by 49 publications

References 23 publications

Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus

Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus

Transepithelial Riboflavin Absorption in an Ex Vivo Rabbit Corneal Model

A Comparison of Different Corneal Iontophoresis Protocols for Promoting Transepithelial Riboflavin Penetration

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