Abstract
P 026
Collagen crosslinking with riboflavin and UVA-light in endothelial-epithelial decompensation
Anne Hoyer, Frederik Raiskup-Wolf, Eberhard Spörl, Lutz E. Pillunat
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden
Objective
With photooxidative collagen crosslinking, additional covalent bindings between collagen molecules can be achieved which stabilizes the collagen scaffold and therewith might induce a mechanical barrier which inhibits aqueous influx.
Aim of our pilot study was to prove the effect of collagen crosslinking in patients with a symptomatic endothelial-epithelial decompensation.
Methods
10 patients were included in this ethics committee-approved study. The maximum follow-up time was 12 months. In all patients we examined besides slitlamp biomicroscopy, refraction, best corrected visual acuity, corneal topography, corneal thickness and endothelial cellcount. The crosslinking was done according to the standard developed for the treatment of keratoconus: after topical anesthesia and removal of the epithelial tissue 0.1% riboflavin solution was applied to the cornea for 20 minutes. Then the central cornea was irradiated with UVA light with a wavelength of 370 nm and an irradiance of 3 mW/cm2 for 30 minutes. During irradiation, drops of riboflavin solution again were applied to the cornea every 4 to 5 minutes to sustain the necessary concentration of the riboflavin and prevent desiccation of the cornea.
Results
The preoperative mean values recorded were for corneal thickness 792203µm, for best-corrected visual acuity 0.180.13 lines and for endothelial cellcount 1394147/mm2. Already one week after treatment patients reported on relief of their complaints. After one month a plain but not yet significant decrease of corneal thickness of 40µm was noticed. The vision remained stable (i.e. no line loss). The endothelial cellcount showed an increase by 300 cells/mm2. At month 12 we recorded a significant decline in corneal thickness by an average of 150µm (Wilcoxon-Test, p<0.05) and an improvement in vision by an average of one line. The densitiy of endothelial cells was equivalent to the preoperative value.
Conclusions
Our results indicate that collagen crosslinking might be an effective, worthwhile palliative therapeutical option for patients suffering from symptomatic endothelial-epithelial decompensation.
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