Evaluation of Intrastromal Riboflavin Concentration in Human Corneas after Three Corneal Cross-Linking Imbibition Procedures: A Pilot Study

Abstract EN

Purpose.

To compare stromal riboflavin concentration after three corneal cross-linking (CXL) imbibition procedures: standard (EpiOff), transepithelial corneal (EpiOn), and iontophoresis-assisted technique (Ionto) using 0.1% hypotonic riboflavin phosphate.

Methods.

Randomized open-label pilot clinical study.

Twelve corneas/12 patients with advanced keratoconus were randomly divided into 4 groups for CXL ( n = 3 ).

The corneas underwent imbibition with standard riboflavin EpiOff and with enhanced riboflavin solution (RICROLIN+) EpiOff, EpiOn, and iontophoresis techniques.

Thereafter, deep anterior lamellar keratectomy procedure was performed and the obtained debrided corneal tissues were frozen.

The maximal intrastromal riboflavin concentration was measured by high-performance liquid chromatography/mass spectrometry (mcg/dg).

Results.

The mean stromal concentration of riboflavin was 2.02 ± 0.72 mcg/dg in EpiOff group, 4.33 ± 0.12 mcg/g in EpiOff-RICROLIN+ group, 0.63 ± 0.21 mcg/dg in EpiOn-RICROLIN+ group, and 1.15 ± 0.27 mcg/dg in iontophoresis RICROLIN+ group.

A 7-fold decrease in intrastromal riboflavin concentration was observed comparing EpiOn-RICROLIN+ and EpiOff-RICROLIN+ groups.

Conclusion.

The present pilot study indicates that both transepithelial CXL techniques in combination with hypotonic enhanced riboflavin formulation (RICROLIN+) were still inferior to the standard CXL technique; however, larger clinical studies to further validate the results are needed and in progress.