Riboflavin-UVA treatment in the management of edema and nonhealing ulcers of the cornea.
OBJECTIVE
Riboflavin-ultraviolet A (UVA) treatment induces cross-linking and stiffens the corneal stroma. A parallel reduction in stromal swelling and increased resistance to microbial and enzymatic degradation has been suggested. The purpose of this study was to evaluate the potential of riboflavin-UVA treatment in the management of corneal disorders, in particular edema due to endothelial decompensation and non-healing ulcers.


METHODS
Two clinical series are reported, 11 eyes with endothelial decompensation and 14 eyes with non-healing ulcers. Treatment comprised a) abrasion of epithelium (if present), b) instillation of 0.1% riboflavin in saline, and c) irradiation at 365 nm UVA light over approximately 30 minutes (3 mW/cm(2)). Four eyes in the first group were treated twice. Postoperatively, all eyes were followed for at least 3 months.


RESULTS
Reduction in corneal thickness was observed in 10 of 11 eyes with stromal edema and the majority also experienced improvement in vision. The effect occurred over weeks and lasted for months. Fourteen patients with non-healing ulceration were similarly treated; 6 healed, 8 showed no clear effect.


CONCLUSIONS
In addition to the stiffening of keratoconic and ectatic cornea, riboflavin-UVA treatment is effective in reducing corneal edema and has the potential to heal corneal ulcers.
Ehlers
Niels
N
Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.
Hjortdal
Jesper
J
Nielsen
Kim
K
Søndergaard
Anders
A
D000368:Aged; D000369:Aged, 80 and over; D003094:Collagen / Q000378:metabolism; D015715:Corneal Edema / Q000188:drug therapy* / Q000473:pathology; D003319:Corneal Stroma / Q000378:metabolism / Q000473:pathology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012256:Riboflavin / Q000627:therapeutic use*; D014466:Ultraviolet Rays
D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin