1. Lorelei L. Vicente, M.D. Brian S. Boxer Wachler, M.D.
One Year Safety Analysis of Endothelial Cell Counts of Trans-Epithelial Corneal Crosslinking for Keratoconus
Lorelei L. Vicente, M.D.
Brian S. Boxer Wachler, M.D.
BEVERLY HILLS , CA

2. Disclosure
Financial declaration/conflict of interest: Dr. Boxer Wachler is consultant to Addition Technology and Staar Surgical. Dr. Vicente has no financial interest in the subject matter of this paper.

3. Purpose
To assess change in endothelial cell count (ECC) of patients with keratoconus after trans-epithelial corneal collagen crosslinking with riboflavin-carboxymethylcellulose (RF-CMC).

4. Methods Trans-Epithelial Crosslinking using
66 eyes of 45 patients (39 +/- 14 y.o.)
Trans-Epithelial Crosslinking using
0.1 % riboflavin with 0.5% carboxymethylcellulose
(RF-CMC) and Tetracaine
keratoconus – 56 eyes (86%)
keratectasia – 10 eyes (14%)
post LASIK - 8 eyes
post RK - 2 eyes
26 eyes (39%) - Trans-Epithelial Crosslinking only
40 eyes (61%) - Intacs and Trans-Epithelial Crosslinking

5. Methods Specular microscopy IConan Noncon ROBO SP-9900 Dot method
Konan Medical Inc., Hyogo, Japan
Dot method
70 contiguous cells are
marked to estimate
endothelial cell density

6. Trans-Epithelial Crosslinking
Pretreatment with Tetracaine and RF-CMC
Instilled one drop after another every 5 minutes for 15 minutes
Trans-Epithelial Crosslinking Protocol
RF-CMC (q 3 min.) & Tetracaine (q 10 min.) for 30 mins.
Applied via soppy, wet surgical
sponges
(Merocel eye spears, Medtronic, Jacksonville, FL)
Ultraviolet-A light
(3.0 mW/cm2 at 370 nm)

7. Results

8. Conclusion (RF-CMC) is Safe to the Endothelium
Trans-Epithelial Crosslinking using 0.1% riboflavin w/ 0.5% CMC
(RF-CMC)
is Safe to the Endothelium