Corneal iontophoresis and cross linking: a preliminary report of our experience.

PURPOSE: To evaluate the effect induced by UVA radiation with corneal iontophoresis and cross-linking.

MATERIALS AND METHODS: From February 2013 to August 2014 we saw 15 eyes of 15 patients, age range 19-38 years (10 women and 5 men) keratoconus stage 1-2. Vision evaluation was carried out with ETDRS scale and Topography and Pachymetry. To evaluate line of demarcation with the confocal microscope and corneal optical coherence tomography (OCT) and the pain with the Faces Pain Scale.

RESULTS: At 6 months there was a stabilization of vision and topography, with a slight improvement at 1 year of vision of 1 line and of the Km of 0.5 diopters. The in vivo microscopic examination with the confocal microscope showed that the line of demarcation was not particularly evident, it was irregular and when present was more evident at 150-200 µ depth, there was a keratinocyte activation in the anterior stroma with slight oedema. There were also superficial epithelial alterations present and only slight involvement of the subepithelial nervous plexus, there were no alterations of the endothelium. The Faces Pain Scale the pain score was 2±1. We have to stress the usefulness of Corneal optical coherence tomography (OCT) also pre and post iontophoretic treatment.

CONCLUSIONS: Further, larger studies and longer follow-ups are needed, recent studies have shown the absorption of riboflavin with iontophoresis is 50% with respect to the classic technique, the percentage of riboflavin in the anterior 2/3 of the corneal stroma would be, however, efficacious to provide good results.