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Journal of Ophthalmology
Volume 2016, Article ID 1471807, 4 pages
Clinical Study

Intraoperative Corneal Thickness Changes during Pulsed Accelerated Corneal Cross-Linking Using Isotonic Riboflavin with HPMC

1Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11519, Egypt
2Vardinoyiannion Eye Institute of Crete (VEIC), Faculty of Medicine, University of Crete, Heraklion, 71003 Crete, Greece
3Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA

Received 3 July 2015; Accepted 16 September 2015

Academic Editor: Neil Lagali

Copyright © 2016 Ahmed M. Sherif et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. To evaluate corneal thickness changes during pulsed accelerated corneal cross-linking (CXL) for keratoconus using a new isotonic riboflavin formula. Methods. In this prospective, interventional, clinical study patients with grades 1-2 keratoconus (Amsler-Krumeich classification) underwent pulsed accelerated (30 mW/cm2) CXL after application of an isotonic riboflavin solution (0.1%) with HPMC for 10 minutes. Central corneal thickness (CCT) measurements were taken using ultrasound pachymetry before and after epithelial removal, after riboflavin soaking, and immediately after completion of UVA treatment. Results. Twenty eyes of 11 patients (4 males, 7 females) were enrolled. Mean patient age was (range from 18 to 30 years). No intraoperative or postoperative complications were observed in any of the patients. Mean CCT was μm (range: 559–459 μm) before and μm (range: 535–420 μm) after epithelial removal (). After 10 minutes of riboflavin instillation, there was a statistically significant decrease of CCT by 6.2% from μm (range: 535–420 μm) to μm (range: 508–400) (). There was no other statistically significant change of CCT during UVA irradiation. Conclusions. A significant decrease of corneal thickness was demonstrated during the isotonic riboflavin with HPMC application while there was no significant change during the pulsed accelerated UVA irradiation.