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Safety of Corneal Collagen Cross-linking With UV-A and Riboflavin in Progressive Keratoconus

Goldich, Yakov MD; Marcovich, Arie L MD; Barkana, Yaniv MD; Avni, Isaac MD; Zadok, David MD

doi: 10.1097/ICO.0b013e3181bd9f8c
Clinical Science

Purpose: To assess the possible damage to ocular tissues during treatment of keratoconus with UV-A-riboflavin corneal collagen cross-linking (CXL).

Design: Single center, prospective, interventional study.

Methods: Fourteen eyes of 14 patients aged 28.2 ± 5.9 (mean ± SD) years with progressive keratoconus were treated with UV-A-riboflavin CXL. Corneal endothelium was assessed with the endothelial specular microscope. Central retina was assessed with biomicroscopy fundus examination and with optical coherence tomography using macular thickness protocol. Patients were assessed preoperatively, at week 1, month 1, 3, 6, 9, and 12 after treatment.

Results: Comparative preoperative and postoperative results showed stable endothelial cell density (2730 cells/mm2, 2793 cells/mm2, and 2640 cells/mm2, preoperatively, at month 6, and at month 12, respectively) and stable foveal thickness (203, 202, and 205 μm, preoperatively, at month 6, and at month 12, respectively). No morphological abnormalities were noted.

Conclusions: UV-A-riboflavin CXL seems to be a safe procedure that does not cause damage to the corneal endothelium and central retina.

From the *Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel; and †Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.

Received for publication July 9, 2009; revision received August 9, 2009; accepted August 21, 2009.

No author has a financial or proprietary interest in any material or method mentioned.

Reprints: Yakov Goldich, MD, Department of Ophthalmology, Assaf Harofeh Medical Center, Beer Yaakov, Zerifin 70300, Israel (e-mail:

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