Progressive Keratoconus Clinical Trial
Official title:
Non-inferiority Trial of Iontophoretic Corneal Collagen Crosslinking (CXL) Compared to Standard Corneal Collagen Crosslinking in Progressive Keratoconus.
The primary purpose of the protocol is to compare the current standard CXL with iontophoretic
CXL to provide evidence in relation to the efficacy and safety in progressive keratoconus.
Corneal collagen crosslinking (CXL) is the first surgical procedure that appears to halt the
progression of keratoconus. In the current standard CXL, the central corneal epithelium must
be debrided to efficiently permeate the corneal stroma with riboflavin. The epithelium
debridement can cause severe pain, infection and stromal haze. The study hypothesis is that
iontophorese CXL is as effective as standard CXL to stabilize a progressive keratoconus.
Keratoconus is a common bilateral progressive corneal ecstatic disease causing visual
impairment by inducing irregular astigmatism and corneal opacities. This disorder typically
begins during teenage years, progresses until the age of 30 to 40 years and, in severe forms,
may need a corneal transplantation. CXL has changed the natural evolution of keratoconus. It
creates links between collagen fibrils in order to rigidify the corneal stroma and slow down
the progression of keratoconus. The corneal stroma is soaked with a riboflavin solution
before being exposed to ultraviolet-A radiation.
In the current standard CXL, the central corneal epithelium must be debrided to allow the
penetration of riboflavin into the cornea with a risk of side effects, such as pain for the
first two post-operative days, temporary loss of visual acuity during the first three months,
and serious complications such as infection and stromal opacity due to corneal scarring.
Iontophoresis is a non invasive technique in which a weak electric current is used to enhance
the penetration of riboflavin into the cornea. The iontophoresis technique could allow
intrastromal riboflavin diffusion, while keeping the corneal epithelium on, combining the
efficiency of the standard procedure without the side effects of epithelial debridement.
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