Clinical observation on transepithelial rapid cross-linking combined with RGPCL in the treatment of keratoconus

Abstract

AIM: To investigate the clinical effect of transepithelial rapid cross-linking combined with wearing rigid gas permeable contact lens(RGPCL)in keratoconus patients.METHODS: This was a retrospective study of patients with progressive keratoconus diagnosed in the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine in October 2014, and underwent transepithelial rapid keratoplasty. After surgery 16 patients(25 eyes)used RGPCL. Average age was 25.31±5.92 years old, maximum preoperative corneal curvature was 58.96±6.76D, thinnest corneal thickness was 439.52±53.24μm. Rapid cross-linking was performed using riboflavin and 45mW/cm2 ultraviolet light(UV)irradiation with a total energy of 7.2J/cm2. RGPCL was used after surgery. Follow up of 3-6a, average follow-up time was 52.44±11.39mo. The best corrected visual acuity [(BCVA), in RGPCL], corneal curvature of flat meridian(K1), corneal curvature of steep meridian(K2), maximum corneal curvature(Kmax), corneal refractive power(MPP), Baiocchi Calossi Versaci index of anterior and posterior surface(BCVf and BCVb)asymmetry index of anterior surface curvature(SIf), asymmetry index of posterior surface curvature(SIb), the highest point of anterior cone cornea(KVf), the highest point of posterior cone cornea(KVb), the change of corneal thickness(ThkMin), lens opacity, and corneal endothelial cell count were observed.RESULTS: All patients had a successful operation, and no intraoperative complications. On the first day after surgery, all cases felt slight tingling and slight photophobia tears. After 1d of operation, the corneal epithelium was removed in two eyes. While 3d after re-wearing the bandage, the epithelium healed. None of lens in the patients was opacified during follow-up, and there was no significant difference in corneal endothelial cell count compared with preoperative(P>0.05). The BCVA(wearing RGPCL)after operation is obviously improved compared with preoperative. All postoperative Kmax, SIf, KVf, BCVf, BCVb were lower than preoperative(P<0.05). CONCLUSION: Transepithelial rapid corneal cross-linking combined with RGPCL is safe and effective in controlling the progress of keratoconus. And the long-term effect is stable.

Keywords

• keratoconus
• corneal cross-linking
• rigid gas permeable contact lens
• riboflavin
• ultraviolet light