Effect of Oral Riboflavin and Direct-sun UV-A on Tumor Necrosis Factor Alpha (TNF-• ) Concentrations in Tears of Mild-Moderate Keratoconus Patients

Purpose: To investigate Tumor necrosis factor alpha (TNF-α) levels in tears of mild-moderate keratoconus patients after high-dose oral riboflavin and direct sun UV-A exposure. Study Design: Quasi-experimental study. Place and Duration of Study: Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, and Dr. Sardjito General Hospital, Yogyakarta, Indonesia, from December 2022 until April 2023. Methods: The TNF-α from tear of 8 patients (10 eyes) was evaluated before and after therapy. All patients received a high dose of oral riboflavin (800 mg/day) and direct UV-A exposure (≥15 minutes/day) for a total of three months of follow-up. The TNF-α expression in tears, visual acuity and the risk factors were examined at baseline until three months follow-up. Results: TNF-α levels in tears decreased significantly from baseline (6.74±1.39 pg/ml) to1st month (5.98±0.69 pg/ml; p=0.048). However, in the following months, the levels of TNF-α elevated in the 2nd month (6.29±0.84; p=0.390) and the 3rd month (6.20±0.95; p=0.177). Although re-elevated after two months, TNF-α concentration still decreased from the beginning of the study (6.74±1.39 to 6.20±0.95 pg/ml). The Uncorrected visual acuity and best corrected visual acuity were significantly improved from baseline to the last follow up (p = 0.02 and p = 0.026 respectively). Conclusion: There was a significant decrease of TNF-α levels in tears of mild-moderate keratoconus patients 1st month after therapy but no significant decrease in the subsequent follow-up. Furthermore, UCVA and BCVA values were improved. © 2024, Ophthalmological Society of Pakistan. All rights reserved.