Transepithelial corneal collagen cross-linking in keratoconus

Area of Science:

• Ophthalmology
• Corneal Science
• Vision Research

Background:

• Keratoconus is a progressive corneal ectasia leading to vision impairment.
• Traditional corneal cross-linking (CXL) requires epithelial removal, potentially increasing risks.
• Transepithelial CXL aims to achieve similar results with a less invasive approach.

Purpose of the Study:

• To assess the clinical outcomes of transepithelial corneal cross-linking (CXL) in patients with keratoconus.
• To evaluate the efficacy and safety of pre-treating the corneal epithelium to enhance permeability for CXL.

Main Methods:

• A prospective, single-masked, paired-eye study involving 51 keratoconus patients.
• One eye was treated with transepithelial CXL, while the fellow eye served as a control.
• The procedure involved epithelial permeability enhancement, riboflavin instillation, and ultraviolet A irradiation.

Main Results:

• Transepithelial CXL improved corrected distance visual acuity (0.036 logMAR) and reduced myopia (-0.35 D spherical equivalent).
• Corneal flattening was observed, with decreased simulated keratometry (-0.10 D) and increased apex curvature (0.51 D).
• The safety index was favorable (1.05) with no change in endothelial cell density.

Conclusions:

• Transepithelial CXL demonstrates a limited but favorable clinical effect in keratoconic eyes.
• The procedure was well-tolerated, showing no significant complications.
• The outcomes suggest a potentially safer, albeit less potent, alternative to conventional CXL.