title: Accelerated Corneal Cross-Linking With a Hypoosmolar Riboflavin Solution in Keratoconic Thin Corneas: Short-Term Results.
abstract: OBJECTIVE
  The aim of this study was to evaluate the early term topographic and aberration results of accelerated (9 mW/cm) corneal cross-linking (CXL) treatment in keratoconic thin corneas.
  
  
  METHODS
  Forty-nine eyes from 43 patients (mean age of 21.2 ± 7.1) with progressive keratoconic thin corneas (<400 μm without epithelium) who had accelerated corneal CXL with hypoosmolar riboflavin solution throughout the procedure were enrolled. We measured the uncorrected and corrected distance visual acuity, refraction, slit-lamp examination, topographic values, and corneal higher-order aberrations (Pentacam HR, Oculus Optikgeräte GmbH) preoperatively and 1, 3, and 6 months after surgery.
  
  
  RESULTS
  Before surgery, the corneal thickness was 404 ± 18 μm, and the thickness was reduced to 360 ± 24 μm after removing the epithelium. After the application of hypoosmolar riboflavin solution, the thickness increased to 432 ± 44 μm. At month 6, there was a significant increase in uncorrected distance visual acuity (P = 0.043) and corrected distance visual acuity (P = 0.024), a decrease in spherical refraction (P = 0.041), maximum keratometry (Kmax, P = 0.003), anterior elevation values (P = 0.008), corneal thickness (P < 0.001), coma (P = 0.022), spherical aberration (P = 0.001), higher-order root mean square (P = 0.004), and total root mean square (P < 0.001), whereas the cylindrical refraction (P = 0.627), anterior (P = 0.665) and posterior astigmatism (P = 0.165) of the cornea, posterior elevation (P = 0.198), and trefoil (P = 0.141) remained unchanged. No patients showed any complications or scar formation during follow-up.
  
  
  CONCLUSIONS
  Accelerated corneal CXL with hypoosmolar riboflavin solution throughout the procedure is effective in thin corneas.
authors.affiliation: *Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey; †Department of Ophthalmology, University of Kafkas, Kars, Turkey; and ‡Department of Ophthalmology, Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Koç
authors.forename: Mehmet Murat
authors.initials: MM
authors.lastname: Uzel
authors.forename: Yaran
authors.initials: Y
authors.lastname: Koban
authors.forename: Kemal
authors.initials: K
authors.lastname: Tekin
authors.forename: Ayşe Güzin
authors.initials: AG
authors.lastname: Taşlpnar
authors.forename: Pelin
authors.initials: P
authors.lastname: Ylmazbaş
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003315:Cornea / Q000378:metabolism / Q000473:pathology; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007038:Hypotonic Solutions / Q000627:therapeutic use*; D007640:Keratoconus / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012256:Riboflavin / Q000627:therapeutic use*; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D007038:Hypotonic Solutions; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin