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Early findings in a randomised controlled trial on crosslinking protocols using isoosmolar and hypoosmolar riboflavin for the treatment of progressive keratoconus

Gustafsson, Ingemar LU ; Olafsdottir, Thorbjörg ; Neumann, Olof LU ; Johansson, Per E ; Bizios, Dimitrios LU orcid ; Ivarsen, Anders and Hjortdal, Jesper (2025) In Acta Ophthalmologica 103(1). p.23-32
Abstract
Purpose
To present baseline characteristics and to present the perioperative corneal thickness during corneal crosslinking (CXL) treatment for progressive keratoconus and to describe how the addition of sterile water (SW) efficaciously can maintain the corneal thickness. The treatment efficacy will be evaluated when the 1-year follow-up is complete.

Methods
A randomised clinical study using epithelium-off CXL with continuous UVA irradiation (9 mW/cm2) and two kinds of riboflavin solutions: (i) isoosmolar dextran-based riboflavin (n = 27) and (ii) hypoosmolar dextran-free riboflavin (n = 27). Inclusion criteria: progressive keratoconus with an increase in maximum keratometry value (Kmax) of 1.0 dioptre (12 months) or 0.5... (More)
Purpose
To present baseline characteristics and to present the perioperative corneal thickness during corneal crosslinking (CXL) treatment for progressive keratoconus and to describe how the addition of sterile water (SW) efficaciously can maintain the corneal thickness. The treatment efficacy will be evaluated when the 1-year follow-up is complete.

Methods
A randomised clinical study using epithelium-off CXL with continuous UVA irradiation (9 mW/cm2) and two kinds of riboflavin solutions: (i) isoosmolar dextran-based riboflavin (n = 27) and (ii) hypoosmolar dextran-free riboflavin (n = 27). Inclusion criteria: progressive keratoconus with an increase in maximum keratometry value (Kmax) of 1.0 dioptre (12 months) or 0.5 dioptres (6 months). Corneae thinner than 400 μm were also included. Outcome parameters: Perioperative corneal thickness and the effect of adding SW.

Results
Seventy-four per cent of the patients in the isoosmolar group and 15% in the hypoosmolar group required the addition of SW, which effectively maintained a corneal thickness of 400 μm in all cases during CXL. The addition of SW was primarily needed during the irradiation procedure and not the preoperative soaking period.

Conclusions
Especially during the CXL irradiation phase, isoosmolar riboflavin causes a significant dehydrating effect leading to corneal thinning during CXL. The customised addition of SW is efficacious in maintaining the corneal thickness during CXL and could increase the safety of the procedure. (Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Ophthalmologica
volume
103
issue
1
pages
23 - 32
publisher
Wiley-Blackwell
external identifiers
  • pmid:38970233
  • scopus:85197705621
ISSN
1755-3768
DOI
10.1111/aos.16736
language
English
LU publication?
yes
id
b8b0853e-9b3f-48a5-9529-eb4158c9c45e
date added to LUP
2024-07-07 07:33:37
date last changed
2025-04-04 14:19:18
@article{b8b0853e-9b3f-48a5-9529-eb4158c9c45e,
  abstract     = {{Purpose<br/>To present baseline characteristics and to present the perioperative corneal thickness during corneal crosslinking (CXL) treatment for progressive keratoconus and to describe how the addition of sterile water (SW) efficaciously can maintain the corneal thickness. The treatment efficacy will be evaluated when the 1-year follow-up is complete.<br/><br/>Methods<br/>A randomised clinical study using epithelium-off CXL with continuous UVA irradiation (9 mW/cm2) and two kinds of riboflavin solutions: (i) isoosmolar dextran-based riboflavin (n = 27) and (ii) hypoosmolar dextran-free riboflavin (n = 27). Inclusion criteria: progressive keratoconus with an increase in maximum keratometry value (Kmax) of 1.0 dioptre (12 months) or 0.5 dioptres (6 months). Corneae thinner than 400 μm were also included. Outcome parameters: Perioperative corneal thickness and the effect of adding SW.<br/><br/>Results<br/>Seventy-four per cent of the patients in the isoosmolar group and 15% in the hypoosmolar group required the addition of SW, which effectively maintained a corneal thickness of 400 μm in all cases during CXL. The addition of SW was primarily needed during the irradiation procedure and not the preoperative soaking period.<br/><br/>Conclusions<br/>Especially during the CXL irradiation phase, isoosmolar riboflavin causes a significant dehydrating effect leading to corneal thinning during CXL. The customised addition of SW is efficacious in maintaining the corneal thickness during CXL and could increase the safety of the procedure.}},
  author       = {{Gustafsson, Ingemar and Olafsdottir, Thorbjörg and Neumann, Olof and Johansson, Per E and Bizios, Dimitrios and Ivarsen, Anders and Hjortdal, Jesper}},
  issn         = {{1755-3768}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{23--32}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Ophthalmologica}},
  title        = {{Early findings in a randomised controlled trial on crosslinking protocols using isoosmolar and hypoosmolar riboflavin for the treatment of progressive keratoconus}},
  url          = {{http://dx.doi.org/10.1111/aos.16736}},
  doi          = {{10.1111/aos.16736}},
  volume       = {{103}},
  year         = {{2025}},
}