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Updated: May 10, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Transepithelial corneal collagen crosslinking for progressive keratoconus in a pediatric age group
1Ophthalmology Department, Ain Shams University, Cairo, Egypt. ab_gab@hotmail.com
Insights
Transepithelial corneal collagen crosslinking (CXL) significantly improved vision and reduced corneal steepness in children with keratoconus. This treatment showed no progression of the condition over 12 months in pediatric patients.
Area of Science:
- Ophthalmology
- Corneal Surgery
Background:
- Keratoconus is a progressive corneal ectasia affecting young individuals.
- Standard corneal collagen crosslinking (CXL) is effective but invasive.
- Transepithelial CXL offers a less invasive alternative for keratoconus treatment.
Purpose of the Study:
- To assess the efficacy and safety of transepithelial corneal collagen crosslinking (CXL) in pediatric keratoconus patients.
- To evaluate refractive and topographical changes following transepithelial CXL.
- To compare outcomes with a conservative management control group.
Main Methods:
- A prospective comparative case series included 22 children (<18 years) with bilateral keratoconus.
- Transepithelial CXL using transepithelial riboflavin was performed on one eye.
- The fellow eye served as a control, receiving conservative treatment; outcomes measured at 12 months.
Main Results:
- Transepithelial CXL significantly improved uncorrected (UDVA) and corrected (CDVA) distance visual acuity (P<.05).
- Mean simulated keratometry decreased by 2.03 D and apical flattening by 2.20 D (P<.05).
- The control group showed no visual acuity improvement and significant apical steepening (P<.05).
Conclusions:
- Transepithelial CXL demonstrated encouraging preliminary results in children with keratoconus.
- The procedure effectively halted keratoconus progression over a 12-month follow-up.
- No adverse effects on endothelial cell count were observed.
Purpose:
To evaluate the effectiveness and safety of transepithelial corneal collagen crosslinking (CXL) in children with keratoconus and the refractive changes induced by this treatment.
Setting:
Ophthalmology Department, Ain-Shams University Hospitals, Cairo, Egypt.
Design:
Prospective comparative case series.
Methods:
Patients younger than 18 years with bilateral keratoconus had transepithelial CXL with the use of transepithelial riboflavin. The other eye was used as a control and was treated conservatively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and corneal tomography at 12 months were the main outcome measures.
Results:
The mean age of the 22 patients (22 eyes) was 15.7 years ± 2.1 (SD). After transepithelial CXL, the improvement in the mean UDVA was statistically significant (from 0.95 ± 0.34 logMAR to 0.68 ± 0.45 logMAR) (P<.05). No eye lost lines of preoperative UDVA; 1 eye lost 1 line of preoperative CDVA. There was no improvement in the control group in UDVA or CDVA (P>.05). The mean simulated keratometry (K) decreased by a mean of 2.03 diopters (D), with mean flattening of the apical K by 2.20 D; both results were statistically significant (P<.05). In the control group, the simulated K increased by a mean of 0.59 D (P>.05), with mean steepening of the apical K by 2.9 D (P<.05). No significant changes occurred in the endothelial cell count in either group.
Conclusion:
Preliminary results of transepithelial CXL in children with keratoconus were encouraging, with no evidence of progression of keratoconus over 12 months.
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