title: A randomised, prospective study to investigate the efficacy of riboflavin/ultraviolet A (370 nm) corneal collagen cross-linkage to halt the progression of keratoconus.
abstract: OBJECTIVE
  A blind, randomised, prospective, bilateral study to investigate the efficacy of riboflavin/ultraviolet A corneal collagen cross-linkage to halt the progression of keratoconus.
  
  
  METHODS
  24 patients with early/moderate bilateral keratoconus with recent progression were recruited. One eye was randomly assigned to undergo collagen cross-linkage following epithelial removal with riboflavin 0.1% and ultraviolet A (370 nm at 3 mW/cm(2)). The other remained untreated as a control. The follow-up was 18 months in 22 patients.
  
  
  RESULTS
  At 18 months, Orbscan II 3 mm, 5 mm keratometry and simulated astigmatism and cone apex power and wave-front measurements (Keraton Scout), including root mean square, coma and pentafoil showed significant reductions from baseline in treated compared with untreated eyes (p=0.04). In treated eyes at 18 months, the best spectacle-corrected acuity improved (p=0.01), and Orbscan II-simulated keratometry (p<0.001), 3 mm keratometry (p=0.008), simulated astigmatism (p=0.007), cone apex power (p=0.002), root mean square, coma, spherical aberration, secondary astigmatism and pentafoil (p=0.05) decreased from baseline. One treated eye experienced transient recurrent corneal erosions; otherwise there were no complications attributable to the treatment.
  
  
  CONCLUSIONS
  Corneal collagen cross-linkage appears to be an effective and safe modality to halt the progression of keratoconus. Improvements in visual and topographic parameters are seen in some eyes.
authors.affiliation: Department of Ophthalmology, St Thomas' Hospital, London SE1 7EH, UK. davidobrart@aol.com
authors.forename: David P S
authors.initials: DP
authors.lastname: O'Brart
authors.forename: Elsie
authors.initials: E
authors.lastname: Chan
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Samaras
authors.forename: Parul
authors.initials: P
authors.lastname: Patel
authors.forename: Shaheen P
authors.initials: SP
authors.lastname: Shah
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003315:Cornea / Q000378:metabolism*; D019781:Corneal Topography / Q000379:methods; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012256:Riboflavin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D055815:Young Adult
chemical_list: D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin