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Journal of Refractive Surgery, 2009;25(4):371–376
Published Online:https://doi.org/10.3928/1081597X-20090401-02Cited by:139

Abstract

Purpose:

To assess the progression of keratoconus in patients treated with collagen cross-linking with riboflavin and ultraviolet A (UVA) irradiation.

Methods:

Thirty-eight eyes of 19 patients with progressive keratoconus were enrolled in a prospective comparative study. Average follow-up was 9±2 months (range: 5 to 12 months). The worse eye was treated with collagen cross-linking, and the fellow eye served as the control. Corneal epithelium was mechanically removed. Riboflavin 0.1% solution in dextran T-500 20% solution was applied every 2 to 3 minutes for 30 minutes throughout the irradiation. Ultraviolet A irradiation (370 nm) was performed using a commercially available UVA lamp for 30 minutes.

Results:

The group treated with collagen cross-linking demonstrated a mean decrease (less myopic) in spherical equivalent refraction and cylinder of 1.03±2.22 diopters (D) (range: −5.25 to +3.75 D) and 1.04±1.44 D (range: −2.00 to +4.00 D), respectively (P<.01), and an increase in uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) of 0.06±0.05 (range: 0.00 to 0.20) and 0.10±0.14 (range: −0.10 to 0.34), respectively (P<.01). The maximal curvature decreased by 1.57±1.14 D (range: 0.00 to 3.90 D), and intraocular pressure increased by 2±2 mmHg (range: −1 to 6 mmHg), which was statistically significant. No statistical difference was noted regarding central corneal thickness (P=.06) and endothelial cell count (P=.07). The untreated group showed no statistical difference for any of the clinical parameters, apart from UCVA and BSCVA, which decreased by 0.08±0.12 (range: −0.40 to 0.10) and 0.06±0.09 (range: −0.20 to 0.10), respectively (P<.01).

Conclusions:

Riboflavin/UVA collagen cross-linking appears to be efficacious in inhibiting the progression of keratoconus by reducing the corneal curvature, spherical equivalent refraction, and refractive cylinder in eyes with progressive keratoconus at average 9-month follow-up. [J Refract Surg. 2009;25:371–376.]

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