title: Transepithelial Corneal Cross-Linking With Vitamin E-Enhanced Riboflavin Solution and Abbreviated, Low-Dose UV-A: 24-Month Clinical Outcomes.
abstract: OBJECTIVE
  To report the clinical outcomes with 24-month follow-up of transepithelial cross-linking using a combination of a D-alpha-tocopheryl polyethylene-glycol 1000 succinate (vitamin E-TPGS)-enhanced riboflavin solution and abbreviated low fluence UV-A treatment.
  
  
  METHODS
  In a nonrandomized clinical trial, 25 corneas of 19 patients with topographically proven, progressive, mild to moderate keratoconus over the previous 6 months were cross-linked, and all patients were examined at 1, 3, 6, 12, and 24 months. The treatments were performed using a patented solution of riboflavin and vitamin E-TPGS, topically applied for 15 minutes, followed by two 5-minute UV-A treatments with separate doses both at fluence below 3 mW/cm(2) that were based on preoperative central pachymetry.
  
  
  RESULTS
  During the 6-month pretreatment observation, the average Kmax increased by +1.99 ± 0.29 D (diopter). Postoperatively, the average Kmax decreased, changing by -0.55 ± 0.94 D, by -0.88 ± 1.02 D and by -1.01 ± 1.22 D at 6, 12, and 24 months. Postoperatively, Kmax decreased in 19, 20, and 20 of the 25 eyes at 6 months, 12 months, and 24 months, respectively. Refractive cylinder was decreased by 3 months postoperatively and afterward, changing by -1.35 ± 0.69 D at 24 months. Best spectacle-corrected visual acuity (BSCVA) improved at 6, 12, and 24 months, including an improvement of -0.19 ± 0.13 logarithm of the minimum angle of resolution units at 24 months. There was no reduction in endothelial cell count. No corneal abrasions occurred, and no bandage contact lenses or prescription analgesics were used during postoperative recovery.
  
  
  CONCLUSIONS
  Transepithelial cross-linking using the riboflavin-vitamin E solution and brief, low-dose, pachymetry-dependent UV-A treatment safely stopped keratoconus progression.
authors.affiliation: *Corneal Transplant Center, Pellegrini Hospital, Naples, Italy; †Department of Pharmacy, University of Naples Federico II, Naples, Italy; ‡Mercy Center for Corrective Eye Surgery, McHenry, IL; §I.R.O.S. (Institute of Refractive and Ophthalmic Surgery), Naples, Italy; ¶Department of Ophthalmology, Salerno University Hospital, Salerno, Italy; and ‖Ophthalmic Center Med Laser Caserta, Caserta, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Caruso
authors.forename: Carmine
authors.initials: C
authors.lastname: Ostacolo
authors.forename: Robert L
authors.initials: RL
authors.lastname: Epstein
authors.forename: Gaetano
authors.initials: G
authors.lastname: Barbaro
authors.forename: Salvatore
authors.initials: S
authors.lastname: Troisi
authors.forename: Decio
authors.initials: D
authors.lastname: Capobianco
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism; D003319:Corneal Stroma / Q000378:metabolism; D003432:Cross-Linking Reagents; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D009883:Ophthalmic Solutions; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012256:Riboflavin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D014810:Vitamin E / Q000031:analogs & derivatives* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D004338:Drug Combinations; D009883:Ophthalmic Solutions; D017319:Photosensitizing Agents; D014810:Vitamin E; D011092:Polyethylene Glycols; D003094:Collagen; C014225:tocophersolan; D012256:Riboflavin