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Related Experiment Video

Updated: May 27, 2026

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
07:29

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

Published on: November 12, 2015

Transepithelial corneal collagen crosslinking: bilateral study.

Massimo Filippello1, Edoardo Stagni, David O'Brart

  • 1Casa Di Cura Di Stefano-Velona, Catania, Italy. m.filippello@gmail.com

Journal of Cataract and Refractive Surgery
|November 23, 2011
PubMed
Summary

Transepithelial collagen crosslinking (CXL) effectively halted progressive keratoconus, improving visual acuity and corneal topography. This noninvasive treatment demonstrated safety and tolerability, offering a promising option for various patient groups.

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Vision Science

Background:

  • Keratoconus is a progressive corneal ectasia leading to vision impairment.
  • Traditional collagen crosslinking (CXL) requires epithelial debridement, which can be associated with complications.
  • Transepithelial CXL offers a less invasive alternative for keratoconus management.

Purpose of the Study:

  • To assess the efficacy of transepithelial collagen crosslinking (CXL) in halting the progression of bilateral progressive keratoconus.
  • To compare the outcomes of transepithelial CXL in treated eyes versus untreated fellow eyes.

Main Methods:

  • A cohort study involving patients with bilateral progressive keratoconus.
  • One eye was treated with transepithelial CXL using riboflavin and ultraviolet A irradiation.
  • The fellow eye served as an untreated control, with an 18-month follow-up period.

Main Results:

  • Transepithelial CXL showed statistically significant improvements in visual acuity and topographic parameters (keratometry, cone apex power, higher-order aberrations) in treated eyes (P<.05).
  • Untreated control eyes exhibited a trend toward worsening of these parameters.
  • The treatment was well-tolerated, with transient hyperemia and foreign-body sensation in 40% of treated eyes, resolving within 24 hours. No complications were reported.

Conclusions:

  • Transepithelial CXL effectively halted keratoconus progression and improved visual and topographic outcomes.
  • The procedure is safe, well-tolerated, and noninvasive.
  • This technique is particularly suitable for patients where epithelial debridement is contraindicated, such as pediatric cases, uncooperative patients, or those with thin corneas.