Comparison between standard and transepithelial corneal crosslinking using a theranostic UV-A device
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CORNEA
Comparison between standard and transepithelial corneal crosslinking using a theranostic UV-A device Giuseppe Lombardo 1,2
&
Sebastiano Serrao 3 & Marco Lombardo 1,3
Received: 29 August 2019 / Revised: 20 December 2019 / Accepted: 27 December 2019 / Published online: 3 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess corneal concentration of riboflavin in two different corneal crosslinking protocols performed by a novel image-guided therapeutic (or “theranostic”) UV-A device. Methods Ten human eye bank donor tissues were used in this work. The tissues underwent corneal cross-linking according to the conventional treatment protocol (n = 5; 30 min of stromal soaking followed by 30 min of 3 mW/cm2 UV-A irradiance) and the iontophoresis-assisted transepithelial protocol (n = 5; soaking for 5 min at 1 mA/min and 9 min of 10 mW/cm2 UV-A irradiance) using a theranostic UV-A device (Vision Engineering Italy srl, Italy). The device provided real time assessment of riboflavin concentration by hyperspectral image analysis of the cornea. A 0.1% riboflavin hypotonic solution (Ricrolin+, Sooft Italia Spa, Italy) was used in all cases. Results Manual application of hypotonic riboflavin for 30 min into the stroma achieved greater corneal riboflavin concentration (425 ± 77 μg/cm3) than transepithelial delivery of riboflavin by corneal iontophoresis (195 ± 35 μg/cm3; P = 0.001). In both UVA irradiation protocols, corneal riboflavin concentration decreased exponentially with a constant energy rate of 2.3 ± 0.5 J/cm2 and 1.8 ± 0.3 J/cm2 respectively. At the end of treatment, the average corneal concentration of riboflavin decreased by ≥ 85%, with values of 54 ± 29 μg/cm3 and 31 ± 9 μg/cm3 (P = 0.11), respectively. Conclusion Manual application of riboflavin onto the stroma achieved almost 50% greater concentration of riboflavin than transepithelial delivery by corneal iontophoresis. The theranostic UV-A device provided a novel approach to estimate corneal concentration of riboflavin non-invasively during treatment. Keywords Corneal crosslinking . Riboflavin . Theranostics . Keratoconus . Iontophoresis
Introduction Novel objective optical methodologies for measuring the riboflavin concentration in the cornea are widening our understanding on the different stromal diffusion of ophthalmic riboflavin solutions in various treatment protocols [1–5]. Theranostics is an emerging therapeutic paradigm that enables image-guided therapy in clinic; theranostic devices make use of real-time non-invasive molecular analysis to achieve
* Marco Lombardo [email protected] 1
Vision Engineering Italy srl, Via Livenza 3, 00198 Rome, Italy
2
CNR-IPCF, Istituto per i Processi Chimico-Fisici, Viale F. Stagno D’Alcontres 37, 98158 Messina, Italy
3
Studio Italiano di Oftalmologia, Via Livenza 3, 00198 Rome, Italy
optimal treatment outcomes in the management of disease. In previous studies [4, 5], we have shown the reliability of a theranostic UV-A device for image-guided corneal crosslink
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