Transepithelial cross-linking in keratoconus patients: confocal analysis

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomaterials Science

Background:

• Keratoconus is a progressive thinning disorder of the cornea.
• Conventional corneal cross-linking (CXL) requires epithelium removal, which can be uncomfortable and limit treatment options.
• Transepithelial corneal cross-linking (TE-CXL) aims to improve patient comfort and expand treatment indications.

Purpose of the Study:

• To evaluate the corneal layer modifications following transepithelial corneal cross-linking (TE-CXL).
• To assess the safety and efficacy of TE-CXL in patients with progressive keratoconus.

Main Methods:

• Twenty eyes of 20 patients with progressive keratoconus underwent TE-CXL without epithelial debridement.
• Corneal changes were analyzed using confocal microscopy (Nidek Confoscan 4) up to 18 months post-procedure.

Main Results:

• The corneal epithelium initially disorganized but normalized within 2 weeks.
• Stromal keratocytes and nerve fibers decreased by ~25% but recovered density by 6 months.
• A distinct demarcation line at ~60 μm confirmed effective cross-linking; endothelium remained unaffected.

Conclusions:

• TE-CXL demonstrates safety and efficacy for keratoconus treatment up to 18 months.
• The epithelium-sparing approach enhances patient comfort and enables treatment of thinner corneas (360-400 μm).
• TE-CXL is a viable alternative for patients unsuitable for conventional CXL.