VIDEO: Hypotonic riboflavin can improve safety of crosslinking for keratoconus
NEW ORLEANS — Using hypotonic riboflavin to induce swelling in the cornea can protect patients with keratoconus from endothelial toxicity during crosslinking, according to Julia Yu, at Academy ’23.
“Historically, crosslinking was reserved only for patients with a corneal thickness of greater than 400 microns due to concerns of endothelial toxicity,” Yu, a third-year medical student at Thomas Jefferson University, told Healio. “However, this excluded a lot of patients from receiving this beneficial treatment. Since then, hypotonic riboflavin has emerged as a potential solution by inducing corneal swelling.”
Yu and colleagues recruited 31 patients (mean age, 29.7 years) for a prospective study at Wills Eye Hospital in Philadelphia to examine corneal swelling dynamics. According to Yu, intraoperative baseline pachymetry for these patients was 338 microns, which improved to a mean average thickness of 412 microns after application of hypotonic riboflavin. In addition, patients with a baseline pachymetry of at least 350 microns experienced much faster corneal swelling.
“The main takeaway of our project is that patients with severe keratoconus and thinner corneas should not be excluded from receiving such a beneficial treatment, and they should still be considered for crosslinking with the help of hypotonic riboflavin,” Yu said. “It only takes 5.2 minutes on average to achieve a greater than 400-micron threshold.”
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