Photo Credit: Sruilk

The following is a summary of “Early findings in a randomised controlled trial on crosslinking protocols using isoosmolar and hypoosmolar riboflavin for the treatment of progressive keratoconus,” published in the July 2024 issue of Ophthalmology by Gustafsson et al.

Researchers conducted a retrospective study investigating baseline characteristics, tracking corneal thickness during corneal crosslinking (CXL) for keratoconus, and evaluating sterile water’s (SW) effectiveness in maintaining thickness. Treatment success was assessed at the one-year follow-up.

They used epithelium-off CXL with continuous UVA irradiation at 9 mW/cm² was conducted using 2 types of riboflavin solutions, which are isoosmolar dextran-based riboflavin (n = 27) and hypoosmolar dextran-free riboflavin (n = 27). Inclusion criteria encompassed progressive keratoconus with a maximum keratometry value (Kmax) increased to 1.0 dioptres over 12 months or 0.5 dioptres over 6 months and corneas thinner than 400 μm. The outcome measured perioperative corneal thickness and the impact of adding SW.

The result showed that more patients (74%) in the isoosmolar group needed SW than those with hypoosmolar (15%) to maintain corneal thickness at 400 μm throughout the CXL procedure. The SW was mainly administered during irradiation rather than preoperative soaking.

Investigators concluded that isoosmolar riboflavin thins the cornea during CXL irradiation, but adding SW effectively maintains thickness and potentially improves safety.

Source: onlinelibrary.wiley.com/doi/10.1111/aos.16736