RESUMO
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.
RESUMO
PURPOSE: To investigate the relationship among functional and morphological findings before and after macular pucker surgery. METHODS: Thirty-eight eyes with idiopathic macular pucker that underwent 25-gauge vitrectomy and infracyanine green-assisted internal limiting membrane peeling were prospectively enrolled. Main outcome measures were best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography findings and MP-1 microperimetry findings. RESULTS: Mean BCVA improvement was 0.34 logMAR (p < 0.0001). Mean central retinal thickness (CRT) reduction was 50 µm (p = 0.0041). Mean retinal sensitivity improvement was 0.9. Patients with a greater improvement of postoperative BCVA showed worse baseline BCVA (p < 0.001), shorter final inner/outer segment (IS/OS) interruption length (p = 0.039) and thinner final CRT (p = 0.035). Furthermore, final BCVA was correlated with baseline IS/OS interruption length (p = 0.001). CONCLUSION: Baseline BCVA, CRT and IS/OS integrity can be used to predict the functional outcomes after macular pucker surgery.
