Epithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus

Kenneth A Beckman1,2 1Comprehensive EyeCare of Central Ohio, Westerville, OH, USA; 2The Ohio State University, Columbus, OH, USACorrespondence: Kenneth A BeckmanComprehensive EyeCare of Central Ohio, 450 Alkyre Run Dr #100, Westerville, OH, 43082, USATel +1 614 890-5692Email submissiondrbeckman@gmai...

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Autor principal:	Beckman KA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	epithelium-on cross-linking cxl dextran-free photrexa Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/a2c56b494c1446fab3129e8b756ff304
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spelling	oai:doaj.org-article:a2c56b494c1446fab3129e8b756ff3042021-12-02T18:34:17ZEpithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus1177-5483https://doaj.org/article/a2c56b494c1446fab3129e8b756ff3042021-07-01T00:00:00Zhttps://www.dovepress.com/epithelium-on-corneal-collagen-cross-linking-with-hypotonic-riboflavin-peer-reviewed-fulltext-article-OPTHhttps://doaj.org/toc/1177-5483Kenneth A Beckman1,2 1Comprehensive EyeCare of Central Ohio, Westerville, OH, USA; 2The Ohio State University, Columbus, OH, USACorrespondence: Kenneth A BeckmanComprehensive EyeCare of Central Ohio, 450 Alkyre Run Dr #100, Westerville, OH, 43082, USATel +1 614 890-5692Email submissiondrbeckman@gmail.comIntroduction: Epithelium-off cross-linking (epi-off CXL) has long been established as the gold standard treatment for progressive keratoconus. Several protocols for epithelium-on (epi-on) CXL have been proposed to help reduce post-operative pain and facilitate visual recovery, but there is no epi-on treatment approach that is currently approved in the United States. The hydrophilic and macromolecular characteristics of conventional epi-off riboflavin formulations may create clinical challenges for absorption through an intact epithelium. This study investigates the clinical efficacy of a dextran-free hypotonic riboflavin ophthalmic solution (Photrexa, Glaukos, Burlington, MA, USA), approved for epi-off CXL, in a novel epi-on CXL protocol.Methods: Twenty-five eyes of 17 patients were treated in this prospective, single-arm study using a hypotonic riboflavin formulation without dextran and low irradiance UVA (3mW/cm2) for epi-on CXL. Visual acuity, as well as refractive and keratometry outcomes, were observed over 12 months.Results: At 12 months, Kmax was stable with no clinically or statistically significant change from a mean pre-op of 55.4D to 55.9D (p=0.13). Uncorrected and best corrected logMAR visual acuity significantly improved from 0.77 to 0.62 and from 0.17 to 0.12, respectively. There were no significant adverse safety events.Conclusion: Patients who underwent epi-on CXL with dextran-free hypotonic riboflavin demonstrated improvements in uncorrected and best corrected visual acuity with stable keratometry at 12 months post-operatively. The efficacy is consistent with other epi-on studies to date but remains lower than standard epi-off CXL. New technologies, including supplemental oxygen and transepithelial riboflavin ophthalmic solutions, are currently under clinical evaluation and may offer a path forward for epi-on CXL in the USA.Keywords: epithelium-on, cross-linking, CXL, dextran-free, photrexaBeckman KADove Medical Pressarticleepithelium-oncross-linkingcxldextran-freephotrexaOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 2921-2932 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	epithelium-on cross-linking cxl dextran-free photrexa Ophthalmology RE1-994
spellingShingle	epithelium-on cross-linking cxl dextran-free photrexa Ophthalmology RE1-994 Beckman KA Epithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus
description	Kenneth A Beckman1,2 1Comprehensive EyeCare of Central Ohio, Westerville, OH, USA; 2The Ohio State University, Columbus, OH, USACorrespondence: Kenneth A BeckmanComprehensive EyeCare of Central Ohio, 450 Alkyre Run Dr #100, Westerville, OH, 43082, USATel +1 614 890-5692Email submissiondrbeckman@gmail.comIntroduction: Epithelium-off cross-linking (epi-off CXL) has long been established as the gold standard treatment for progressive keratoconus. Several protocols for epithelium-on (epi-on) CXL have been proposed to help reduce post-operative pain and facilitate visual recovery, but there is no epi-on treatment approach that is currently approved in the United States. The hydrophilic and macromolecular characteristics of conventional epi-off riboflavin formulations may create clinical challenges for absorption through an intact epithelium. This study investigates the clinical efficacy of a dextran-free hypotonic riboflavin ophthalmic solution (Photrexa, Glaukos, Burlington, MA, USA), approved for epi-off CXL, in a novel epi-on CXL protocol.Methods: Twenty-five eyes of 17 patients were treated in this prospective, single-arm study using a hypotonic riboflavin formulation without dextran and low irradiance UVA (3mW/cm2) for epi-on CXL. Visual acuity, as well as refractive and keratometry outcomes, were observed over 12 months.Results: At 12 months, Kmax was stable with no clinically or statistically significant change from a mean pre-op of 55.4D to 55.9D (p=0.13). Uncorrected and best corrected logMAR visual acuity significantly improved from 0.77 to 0.62 and from 0.17 to 0.12, respectively. There were no significant adverse safety events.Conclusion: Patients who underwent epi-on CXL with dextran-free hypotonic riboflavin demonstrated improvements in uncorrected and best corrected visual acuity with stable keratometry at 12 months post-operatively. The efficacy is consistent with other epi-on studies to date but remains lower than standard epi-off CXL. New technologies, including supplemental oxygen and transepithelial riboflavin ophthalmic solutions, are currently under clinical evaluation and may offer a path forward for epi-on CXL in the USA.Keywords: epithelium-on, cross-linking, CXL, dextran-free, photrexa
format	article
author	Beckman KA
author_facet	Beckman KA
author_sort	Beckman KA
title	Epithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus
title_short	Epithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus
title_full	Epithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus
title_fullStr	Epithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus
title_full_unstemmed	Epithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus
title_sort	epithelium-on corneal collagen cross-linking with hypotonic riboflavin solution in progressive keratoconus
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/a2c56b494c1446fab3129e8b756ff304
work_keys_str_mv	AT beckmanka epitheliumoncornealcollagencrosslinkingwithhypotonicriboflavinsolutioninprogressivekeratoconus
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Epithelium-on Corneal Collagen Cross-Linking with Hypotonic Riboflavin Solution in Progressive Keratoconus

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