Abstract
BackgroundCorneal collagen crosslinking (CXL) is a widely used treatment for halting the progression of keratoconus. Although initial studies of CXL were performed with a riboflavin solution containing dextran, recent protocols for CXL have indicated the use of a riboflavin solution containing isotonic hydroxypropyl methylcellulose (HPMC). This study was performed to investigate differences in visual outcomes and Scheimpflug (Pentacam) analysis in patients who have undergone epithelium-off CXL with riboflavin solution containing either 20% dextran versus 1.1% HPMC.MethodsAll patients in this non-randomized, non-masked, retrospective cohort analysis were treated at Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA. Thirty-seven eyes of 33 patients were crosslinked with a dextran solution and 19 eyes of 19 patients crosslinked with an isotonic HPMC solution, both using an epithelium-off 30-min, 3 mW/cm2 protocol. All patients had a diagnosis of keratoconus or post-refractive surgery ectasia. Best spectacle corrected visual acuity (BSCVA) and Pentacam parameters were compared at all follow up visits (1, 6, 12, and 24 months). Differences between groups treated with HPMC and dextran were compared using student’s t-test. Differences between treated eye and fellow eye were calculated and compared between HPMC and dextran groups using paired t-test.ResultsPatients treated with a dextran solution had significantly greater improvement in BSCVA at 1, 6, and 24 months (p < 0.05) compared to the isotonic HPMC-treated group. Kmax increased in both groups at 1 month; however, HPMC-treated patients had a greater increase compared to dextran-treated patients (p = 0.01). Kmax decreased in both groups at 6 and 12 months, although this finding was only significant in the HPMC-treated group at 12 months.ConclusionsOur data suggest that crosslinking with the dextran solution may result in significantly better visual outcomes (demonstrated by visual acuity) compared to the isotonic HPMC riboflavin solution. Dextran solutions may have other potential advantages intrinsic to its biochemical properties facilitating more efficient crosslinking. Further research and long-term evidence regarding the use of dextran versus HPMC riboflavin solutions in collagen crosslinking is necessary.
Highlights
Corneal collagen crosslinking (CXL) is a widely used treatment for halting the progression of keratoconus
CXL to stop the progression of KCN and post-refractive surgery ectasia has recently been approved by the United States Food and Drug Administration (FDA) using a 0.154% riboflavin in 20% dextran solution
Thirty-seven eyes of 33 patients were treated with a dextran-based riboflavin solution, and 19 eyes of 19 patients were treated with an hydroxypropyl methylcellulose (HPMC)-based riboflavin solution
Summary
Corneal collagen crosslinking (CXL) is a widely used treatment for halting the progression of keratoconus. Corneal collagen crosslinking (CXL) is an evolving therapy shown to be effective in halting the progression of keratoconus and post-refractive surgery ectasia [1,2,3,4,5,6,7]. CXL to stop the progression of KCN and post-refractive surgery ectasia has recently been approved by the United States Food and Drug Administration (FDA) using a 0.154% riboflavin in 20% dextran solution. One obstacle in evaluating the potential efficacy of CXL is the variation in composition of the riboflavin solutions that are in use Both HPMC- and dextran-based riboflavin solutions are widely used with a recent preference being shown for HPMC solutions, possibly because they do not cause thinning of the corneal stroma [8]. There are proposed benefits of CXL with HPMC, there is a dearth of published data providing justification for the switch in common use from dextran to HPMC
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