Riboflavin 0.1% (VibeX) for the treatment of keratoconus

Introduction: Keratoconus is an ectatic disease of the cornea characterized by biomechanical instability of stromal collagen leading to reduction of corneal thickness, variation in posterior and anterior corneal curvatures with associated progressive deterioration of visual acuity mainly due to a secondary irregular astigmatism. Corneal collagen crosslinking (CXL) is a new approach to increase the mechanical strength and biochemical stability of the corneal stromal tissue affected from primary or secondary ectasia. A novel pharmacological series of riboflavin formulations from Avedro, Inc. (Waltham, Massachusetts, MA, USA), were recently granted orphan drug designation by the Food and Drug Administration for the treatment of keratoconus and secondary corneal ectasia. Areas covered: This report reviews the basic concepts concerning the role of riboflavin in crosslinking treatment in order to understand the potentiality of the new VibeX™ and VibeX Rapid™ solutions for riboflavin UVA-induced CXL. The treatment should be offered to those patients with documented progressive keratoconus and secondary corneal ectasia in order to halt or delay its progression preventing the necessity of donor corneal graft. Expert opinion: VibeX solution complies well with other standard riboflavin solutions currently available on the market for epithelium-off CXL therapy. Compared with VibeX riboflavin 0.1%-dextran 20% formula, the VibeX Rapid has been proposed for a faster and homogeneous corneal soaking, avoiding the intraoperative corneal thinning often occurring with the standard riboflavin solutions containing high molecular weight dextran as excipient. © Informa UK, Ltd.