Transepithelial corneal collagen cross-linking in keratoconus.

PURPOSE To evaluate the clinical effects of transepithelial corneal cross-linking (CXL) on keratoconic eyes pre-treated with substances enhancing epithelial permeability. METHODS Prospective, consecutive, single-masked, paired-eye study on 51 patients. The eye with more severe keratoconus was treated; the fellow eye served as the control. Gentamicin, benzalkonium chloride, and ethylenediaminetetraacetic acid were instilled for 3 hours, then oxybuprocaine for 30 minutes. Riboflavin 0.1% in 20% dextran T500 and oxybuprocaine were instilled for 30 minutes. Finally, ultraviolet A irradiation to the central 7.5 mm of the cornea was applied for 30 minutes, while riboflavin was instilled every 5 minutes. RESULTS Mean corrected distance visual acuity improved by 0.036 logMAR after CXL and worsened by 0.039 logMAR in the control eyes (P<.05). Safety index was 1.05 after CXL and 0.96 in the control group. Mean spherical equivalent refraction decreased by 0.35 D (less myopic) after CXL and increased by 0.83 diopters (D) in the control eyes (P<.05). Mean apex curvature on tangential videokeratography increased by 0.51 D after CXL and by 1.61 D in the control eyes (P=.16). Mean average simulated keratometry decreased by 0.10 D after CXL and increased by 0.88 D in the control eyes (P<.05). Mean index of surface variance increased (worsened) by 0.9 after CXL and 5.3 in the control eyes (P<.05). Mean endothelial cell density was unchanged. CONCLUSIONS A limited but favorable effect of transepithelial CXL was noted on keratoconic eyes, without complications. The effect appears to be less pronounced than described in the literature after CXL with de-epithelialization.

[1]  J. Alió,et al.  Microbial keratitis after corneal collagen crosslinking. , 2009, Journal of cataract and refractive surgery.

[2]  C. Mazzotta,et al.  Corneal crosslinking: Riboflavin concentration in corneal stroma exposed with and without epithelium , 2009, Journal of cataract and refractive surgery.

[3]  J. Males,et al.  Polymicrobial Keratitis After a Collagen Cross-Linking Procedure With Postoperative Use of a Contact Lens: A Case Report , 2009, Cornea.

[4]  M. Jankov,et al.  Contralateral eye study of corneal collagen cross-linking with riboflavin and UVA irradiation in patients with keratoconus. , 2009, Journal of refractive surgery.

[5]  P. Rama,et al.  Acanthamoeba keratitis with perforation after corneal crosslinking and bandage contact lens use. , 2009, Journal of cataract and refractive surgery.

[6]  C. Baudouin,et al.  Multiple endpoint analysis of the 3D-reconstituted corneal epithelium after treatment with benzalkonium chloride: early detection of toxic damage. , 2009, Investigative ophthalmology & visual science.

[7]  G. Wollensak,et al.  Biomechanical and histological changes after corneal crosslinking with and without epithelial debridement , 2009, Journal of cataract and refractive surgery.

[8]  C. Cursiefen,et al.  Bacterial keratitis early after corneal crosslinking with riboflavin and ultraviolet-A. , 2009, Journal of cataract and refractive surgery.

[9]  R. Vinciguerra,et al.  Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. , 2009, Ophthalmology.

[10]  Dilraj S. Grewal,et al.  Corneal collagen crosslinking using riboflavin and ultraviolet‐A light for keratoconus: One‐year analysis using Scheimpflug imaging , 2009, Journal of cataract and refractive surgery.

[11]  M. Arbelaez,et al.  Collagen cross-linking with riboflavin and ultraviolet-A light in keratoconus: One-year results , 2009, Oman journal of ophthalmology.

[12]  E. Spörl,et al.  Kollagenvernetzung mit Riboflavin und UVA-Licht bei Keratokonus – Dresdner Ergebnisse , 2009, Der Ophthalmologe.

[13]  Ecosse Lamoureux,et al.  A randomized controlled trial of corneal collagen cross-linking in progressive keratoconus: preliminary results. , 2008, Journal of refractive surgery.

[14]  A. Ertan,et al.  Intacs implantation with sequential collagen cross-linking treatment in postoperative LASIK ectasia. , 2008, Journal of refractive surgery.

[15]  E. Spoerl,et al.  Cigarette smoking is negatively associated with keratoconus. , 2008, Journal of refractive surgery.

[16]  M. Kohlhaas,et al.  Kollagen-Crosslinking mit Riboflavin und UVA-Licht beim Keratokonus , 2008, Der Ophthalmologe.

[17]  Eberhard Spoerl,et al.  Collagen crosslinking with riboflavin and ultraviolet‐A light in keratoconus: Long‐term results , 2008, Journal of cataract and refractive surgery.

[18]  J. Marshall,et al.  Effect of complete epithelial debridement before riboflavin–ultraviolet‐A corneal collagen crosslinking therapy , 2008, Journal of cataract and refractive surgery.

[19]  S. Majumdar,et al.  Effect of chitosan, benzalkonium chloride and ethylenediaminetetraacetic acid on permeation of acyclovir across isolated rabbit cornea. , 2008, International journal of pharmaceutics.

[20]  D. K. Majumdar,et al.  Effect of formulation factors on in vitro transcorneal permeation of gatifloxacin from aqueous drops , 2006, AAPS PharmSciTech.

[21]  T. Reinhard,et al.  [Corneal melting after cross-linking and deep lamellar keratoplasty in a keratoconus patient]. , 2008, Klinische Monatsblatter fur Augenheilkunde.

[22]  G. Duncker,et al.  Haze-Bildung nach Vernetzungstherapie bei Keratokonus , 2008, Der Ophthalmologe.

[23]  H. Sasaki,et al.  Electrophysiological characterization of tight junctional pathway of rabbit cornea treated with ophthalmic ingredients. , 2007, Biological & pharmaceutical bulletin.

[24]  G. Kymionis,et al.  Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus. , 2007, Journal of cataract and refractive surgery.

[25]  Hitoshi Sasaki,et al.  Acute Corneal Epithelial Change after Instillation of Benzalkonium Chloride Evaluated Using a Newly Developed in vivo Corneal Transepithelial Electric Resistance Measurement Method , 2007, Ophthalmic Research.

[26]  H. Edelhauser,et al.  In vivo corneal epithelial permeability following treatment with prostaglandin analogs [correction of analoges] with or without benzalkonium chloride. , 2007, Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics.

[27]  C. Mazzotta,et al.  Stromal haze after combined riboflavin‐UVA corneal collagen cross‐linking in keratoconus: in vivo confocal microscopic evaluation , 2007, Clinical & experimental ophthalmology.

[28]  Hermann Herbst,et al.  Wound Healing in the Rabbit Cornea After Corneal Collagen Cross-Linking With Riboflavin and UVA , 2007, Cornea.

[29]  Munish Sharma,et al.  Effect of inferior‐segment Intacs with and without C3‐R on keratoconus , 2007, Journal of cataract and refractive surgery.

[30]  Farhad Hafezi,et al.  Corneal Cross-Linking-Induced Stromal Demarcation Line , 2006, Cornea.

[31]  G. Wollensak,et al.  Crosslinking treatment of progressive keratoconus: new hope , 2006, Current opinion in ophthalmology.

[32]  Claudio Traversi,et al.  Parasurgical therapy for keratoconus by riboflavin–ultraviolet type A rays induced cross‐linking of corneal collagen: Preliminary refractive results in an Italian study , 2006, Journal of cataract and refractive surgery.

[33]  H. Sasaki,et al.  Mechanism of permeability-enhancing effect of EDTA and boric acid on the corneal penetration of 4-[1-hydroxy-1-methylethyl]-2-propyl-1-[4-[2-[tetrazole-5-yl]phenyl]phenyl] methylimidazole-5-carboxylic acid monohydrate (CS-088). , 2005, International journal of pharmaceutics.

[34]  C. Kim,et al.  Corneal epithelial cellular dysfunction from benzalkonium chloride (BAC) in vitro , 2004, Clinical & experimental ophthalmology.

[35]  A. Leccisotti,et al.  Angle‐supported phakic intraocular lenses in eyes with keratoconus and myopia , 2003, Journal of cataract and refractive surgery.

[36]  T. Seiler,et al.  Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. , 2003, American journal of ophthalmology.

[37]  G. Wollensak,et al.  Behandlung von Keratokonus durch Kollagenvernetzung , 2003, Der Ophthalmologe.

[38]  H. Sasaki,et al.  Modification of ocular permeability of peptide drugs by absorption promoters. , 2000, Biological & pharmaceutical bulletin.

[39]  K P Xu,et al.  Corneal organ culture model for assessing epithelial responses to surfactants. , 2000, Toxicological sciences : an official journal of the Society of Toxicology.

[40]  M. Su,et al.  Benzalkonium chloride and gentamicin cause a leak in corneal epithelial cell membrane. , 2000, Experimental Eye Research.

[41]  G. Mazzanti,et al.  Evaluation of ocular permeation enhancers: In vitro effects on corneal transport of four β-blockers, and in vitro/in vivo toxic activity , 1996 .

[42]  H. Sasaki,et al.  Ophthalmic Preservatives as Absorption Promoters for Ocular Drug Delivery , 1995, The Journal of pharmacy and pharmacology.

[43]  R. Pfister,et al.  The effects of ophthalmic drugs, vehicles, and preservatives on corneal epithelium: a scanning electron microscope study. , 1976, Investigative ophthalmology.

[44]  A. Tønjum.  Effects of benzalkonium chloride upon the corneal epithelium studied with scanning electron microscopy. , 2009, Acta ophthalmologica.