A New Surgical Technique to Deliver Riboflavin Beneath Corneal Epithelium: The Corneal Cross-Linking Epi-Pocket

Asia Pac J Ophthalmol (Phila). 2021 Sep 14;10(5):495-498. doi: 10.1097/APO.0000000000000420.

Abstract

Purpose: To describe a new technique to deliver riboflavin into the corneal stroma during Corneal Cross-Linking (CXL) without the removal of corneal epithelium.

Methods: Keratoconus patients underwent CXL for progressive keratoconus. Riboflavin was delivered by manually creating an epithelial pocket (CXL Epi-Pocket). Verbal rating scale was recorded postoperatively. Best-corrected visual acuity, keratometric indices, corneal thickness and corneal densitometry were recorded at baseline and at 12-month follow-up.

Results: Eighteen eyes of 18 patients were included in the study. At a 12-month follow-up, best-corrected visual acuity, K1, K2 and densitometry values were stable. Maximum keratometry (Kmax) reduced from 55.31 ± 6.21 (SD) to 52.34d ± 4.12d (SD) (P value = 0.032). the thinnest point went from 441 ± 21.18 (SD) to 425.4 ± 19.02 (SD) um (P value = 0.041). The verbal rating scale at 1, 2 and 3 days postoperatively were 1.76 ± 0.19 (SD), 1.02 ± 0.51 (SD) and 0.28 ± 0.14 (SD).

Conclusions: CXL Epi-Pocket is able to deliver riboflavin to halt the progression of keratoconus at a 12-month follow-up.

MeSH terms

  • Collagen / therapeutic use
  • Corneal Topography
  • Cross-Linking Reagents / therapeutic use
  • Epithelium, Corneal*
  • Follow-Up Studies
  • Humans
  • Keratoconus* / drug therapy
  • Photochemotherapy*
  • Photosensitizing Agents / therapeutic use
  • Riboflavin / therapeutic use
  • Ultraviolet Rays
  • Visual Acuity

Substances

  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Collagen
  • Riboflavin