Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Ophthalmology
Published in: International Ophthalmology 6/2019

01-06-2019 | Original Paper

Corneal stromal depth of the demarcation line in ‘accelerated corneal cross-linking’ with different concentrations of riboflavin solutions

Authors: Dilay Ozek, Ozlem Evren Kemer, Pinar Altiaylik Ozer

Published in: International Ophthalmology | Issue 6/2019

Login to get access

Abstract

Purpose

The aim of this study is to compare the effect of different riboflavin solutions (hypotonic and isotonic) used during accelerated corneal cross-linking (CXL) on the mean depth of the demarcation line (DDL) formed in corneal stroma.

Methods

This prospective, cross-sectional study included 38 eyes of 26 patients. All patients underwent accelerated CXL due to progressive keratoconus. When the corneal epithelium was removed, 17 eyes of 12 patients with corneal thickness < 400 µm were categorized as Group 1, and 21 eyes of 14 patients with corneal thickness > 400 µm as Group 2. Hypotonic riboflavin was applied to Group 1 patients, and isotonic riboflavin to Group 2 patients. Anterior segment optical coherence tomography was performed on all patients by two independent observers at the end of the first and third months.

Result

Group 1 included 5 male and 7 female patients with an average age of 25.1 ± 8.0 years, whereas Group 2 included 7 male and 7 female patients with an average age of 31.8 ± 10.12 years. At the end of the first month, the mean DDL in Group 1 and Group 2 was 180.32 ± 10.26 and 287.21 ± 15.01 µm, respectively. This difference was statistically significant (p < 0.05).

Conclusion

Application of different riboflavin solutions was observed to have an effect on measured corneal thickness after saturation and the depth of the demarcation line. The use of hypotonic riboflavin results in swelling of the cornea and more superficial localization of the stromal demarcation line after CXL.
Literature
1.
Ziaei M, Barsam A, Shamie N et al (2015) Cornea clinical committee reshaping procedures for the surgical management of corneal ectasia. J Cataract Refract Surg 41:842–872CrossRefPubMed
2.
Seiler T, Hafezi F (2006) Corneal cross-linking-induced stromal demarcation line. Cornea 25:1057–1059CrossRefPubMed
3.
Dupps WJ Jr, Netto MV, Herekar S, Krueger RR (2007) Surface wave elastometry of the cornea in porcine and human donor eyes. J Cataract Refract Surg 23:66–75CrossRef
4.
Spoerl E, Wollensak G, Seiler T (2004) Increased resistance of crosslinked cornea against enzymatic digestion. Curr Eye Res 29:35–40CrossRefPubMed
5.
Park J, Gritz DC (2013) Evolution in the use of intrastromal corneal ring segments for corneal ectasia. Curr Opin Ophthalmol 24:296–301CrossRefPubMed
6.
Wollensak G, Spoerl E, Seiler T (2003) Riboflavin/ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 135:620–627CrossRefPubMed
7.
Wollensak G, Spoerl E, Reber F, Seiler T (2004) Keratocyte cytotoxicity of riboflavin/UVA treatment in vitro. Eye 18:718–722CrossRefPubMed
8.
Wollensak G, Spoerl E, Wilsch M, Seiler T (2003) Endothelial cell damage after riboflavin-ultraviolet: a treatment in the rabbit. J Cataract Refract Surg 29:1786–1790CrossRefPubMed
9.
10.
Schmidinger G, Pachala M, Prager F (2013) Pachymetry changes during corneal crosslinking: effect of closed eyelids and hypotonic riboflavin solution. J Cataract Refract Surg 39:1179–1183CrossRefPubMed
11.
Hafezi F, Mrochen M, Iseli HP, Seiler T (2009) Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas. J Cataract Refract Surg 35:621–624CrossRefPubMed
12.
Raiskup F, Spoerl E (2011) Corneal cross-linking with hypo-osmolar riboflavin solution in thin keratoconic corneas. Am J Ophthalmol 152:28–32CrossRefPubMed
13.
Ozgurhan EB, Sezgin Akcay BI, Yildirim Y, Karatas G, Kurt T, Demirok A (2014) Evaluation of corneal stromal demarcation line after two different protocols of accelerated corneal collagen cross-linking procedures using anterior segment optical coherence tomography and confocal microscopy. J Ophthalmol 2014:981893CrossRefPubMedPubMedCentral
14.
Raiskup F, Spoerl E (2013) Corneal crosslinking with riboflavin and ultraviolet A. I. Principles. Ocul Surf 11:65–74CrossRefPubMed
15.
Richoz O, Hammer A, Tabibian D, Gatzioufas Z, Hafezi F (2013) The biomechanical effect of corneal collagen cross-linking (CXL) with riboflavin and UV-A is oxygen dependent. Transl Vis Sci Technol 2:6–8CrossRefPubMedPubMedCentral
16.
Kymionis GD, Tsoulnaras KI, Grentzelos MA et al (2014) Corneal stroma demarcation line after standard and high-intensity collagen crosslinking determined with anterior segment optical coherence tomography. J Cataract Refract Surg 40:736–740CrossRefPubMed
17.
Yam JC, Chan CW, Cheng AC (2012) Corneal collagen cross-linking demarcation line depth assessed by Visante OCT after CXL for keratoconus and corneal ectasia. J Refract Surg 28:475–481CrossRefPubMed
18.
Moramarco A, Iovieno A, Sartori A, Fontana L (2015) Corneal stromal demarcation line after accelerated crosslinking using continuous and pulsed light. J Cataract Refract Surg 41:2546–2551CrossRefPubMed
19.
Doors M, Tahzib NG, Eggink FA, Berendschot TT, Webers CA, Nuijts RM (2009) Use of anterior segment optical coherence tomography to study corneal changes after collagen cross-linking. Am J Ophthalmol 148:844–851CrossRefPubMed
20.
Gatzioufas Z, Balidis M, Kozeis N (2016) Is the corneal stromal demarcation line depth a true indicator of corneal collagen crosslinking efficacy. J Cataract Refract Surg 42:804CrossRefPubMed
21.
Tomita M, Mita M, Huseynova T (2014) Accelerated versus conventional corneal collagen crosslinking. J Cataract Refract Surg 40:1013–1020CrossRefPubMed
22.
Wernli J, Schumacher S, Spoerl E, Mrochen M (2013) The efficacy of corneal cross-linking shows a sudden decrease with very high intensity UV light and short treatment time. Invest Ophthalmol Vis Sci 54:1176–1180CrossRefPubMed
23.
Doors M, Tahzib NG, Eggink FA, Berendschot TTJM, Webers CAB, Nuijts RMMA (2009) Use of anterior segment optical coherence tomography to study corneal changes after collagen cross-linking. Am J Ophthalmol 148:844–851CrossRefPubMed
24.
Mazzotta C, Traversi C, Paradiso AL, Latronico ME, Rechichi M (2014) Pulsed light accelerated crosslinking versus continuous light accelerated crosslinking: one-year results. J Ophthalmol 2014:604731CrossRefPubMedPubMedCentral
Metadata
Title
Corneal stromal depth of the demarcation line in ‘accelerated corneal cross-linking’ with different concentrations of riboflavin solutions
Authors
Dilay Ozek
Ozlem Evren Kemer
Pinar Altiaylik Ozer
Publication date
01-06-2019
Publisher
Springer Netherlands
Published in
International Ophthalmology / Issue 6/2019
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-018-0951-x

Other articles of this Issue 6/2019

International Ophthalmology 6/2019 Go to the issue

Letter to the Editor

Ocular surface squamous neoplasia in a setting of fungal keratitis: a rare co-occurrence

Original Paper

Nd:YAG laser for epithelial ingrowth after laser in situ keratomileusis

Case Report

Macula halo syndrome

Original Paper

A study of changes in levator muscle in congenital ptosis

Original Paper

Microstructural retinal regeneration after internal limiting membrane flap surgery for repair of large macular holes: a 1-year follow-up study

Original Paper

Changes in ocular surface status after phacoemulsification in patients with senile cataract