Penetration of riboflavin and postoperative pain in corneal collagen crosslinking: excimer laser superficial versus mechanical full-thickness epithelial removal.
OBJECTIVE
To compare the severity of postoperative pain and the rate of penetration of riboflavin between eyes treated by corneal crosslinking (CXL) using excimer laser superficial epithelial removal and mechanical full-thickness epithelial removal.


METHODS
Departments of Ophthalmology, Ullevål University Hospital, Oslo, and University Hospital of Northern Norway, Tromsø, Norway.


METHODS
Patients with corneal ectasia were treated with superficial corneal epithelial removal using the excimer laser programmed to 35 mum of phototherapeutic keratectomy (Group 1) or mechanical full-thickness epithelial removal with a brush (Group 2). Pain was evaluated postoperatively by the patients' subjective evaluation and need for analgesia. The duration of topical application of riboflavin to achieve stromal saturation was measured.


RESULTS
Thirty eyes of 30 patients, 15 in each group, were treated. Postoperative pain was severe in 40.0% of patients in Group 1 and in no patient in Group 2 (P = .009) and moderate in 53.3% and 33.3%, respectively (no significant difference). The mean time to riboflavin saturation was 43.7 minutes +/- 10.8 (SD) in Group 1 and 31.3 +/- 3.0 minutes in Group 2 (P = .001).


CONCLUSIONS
Superficial epithelial removal using the excimer laser resulted in more postoperative pain and the need for prolonged application of riboflavin to achieve corneal saturation.
Bakke
Espen F
EF
Department of Ophthalmology, Oslo University Hospital Ullevål, Oslo, Norway. espen.bakke@medisin.uio.no
Stojanovic
Aleksandar
A
Chen
Xiangjun
X
Drolsum
Liv
L
D000293:Adolescent; D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism*; D003646:Debridement / Q000379:methods; D004108:Dilatation, Pathologic / Q000188:drug therapy / Q000378:metabolism; D019573:Epithelium, Corneal / Q000601:surgery*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy / Q000378:metabolism; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D012256:Riboflavin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D014466:Ultraviolet Rays; D055815:Young Adult
D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin