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Updated: Apr 21, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Transepithelial iontophoresis corneal collagen cross-linking for progressive keratoconus: initial clinical outcomes
Purpose:
To report initial clinical results of transepithelial corneal collagen cross-linking with iontophoresis (I-CXL).
Methods:
Twenty eyes of 20 patients diagnosed as having progressive keratoconus who underwent I-CXL were included in this prospective non-randomized clinical study. Corrected distance visual acuity (CDVA), spherical equivalent and cylinder refraction, various corneal topography and Scheimpflug tomography parameters, aberrometry, anterior segment optical coherence tomography, and endothelial cell count were assessed at baseline and at 1, 3, 6, and 12 months postoperatively.
Results:
CDVA improved significantly at 3, 6, and 12 months postoperatively (logMAR difference of -0.07 ± 0.01, -0.09 ± 0.03, and -0.12 ± 0.06, respectively; P < .05). Aberrometry remained stable during follow-up and a trend toward improvement was noted. All topographic parameters (including maximum keratometry) were stable during the follow-up, but exhibited a positive non-significant trend toward improvement. Minimum corneal thickness values were stable for up to 12 months postoperatively. None of the patients showed a progression of keratoconus. Endothelial cell counts did not change significantly (P > .05).
Conclusions:
Preliminary results up to 1 year postoperatively indicate the efficacy of I-CXL in stabilizing the progression of this degenerative disease combined with significant improvement of CDVA. I-CXL, which spares the corneal epithelium, has the potential to become a valid alternative for halting the progression of keratoconus while reducing postoperative patient pain, risk of infection, and treatment time in select patients; however, the relative efficacy of this technique compared to standard epithelium-off techniques remains to be determined.
Insights
Transepithelial corneal collagen cross-linking with iontophoresis (I-CXL) shows promise for halting progressive keratoconus. This method improved visual acuity and stabilized corneal structure in patients after one year.
Area of Science:
- Ophthalmology
- Corneal Science
- Regenerative Medicine
Background:
- Keratoconus is a progressive corneal disease leading to vision impairment.
- Standard corneal collagen cross-linking (CXL) requires epithelium removal, causing patient discomfort and increasing infection risk.
- Novel CXL techniques aim to improve patient outcomes and reduce treatment invasiveness.
Purpose of the Study:
- To evaluate the initial clinical outcomes of transepithelial corneal collagen cross-linking with iontophoresis (I-CXL).
- To assess the safety and efficacy of I-CXL in patients with progressive keratoconus.
Main Methods:
- A prospective, non-randomized study included 20 eyes of 20 patients with progressive keratoconus.
- I-CXL was performed, and outcomes were assessed at 1, 3, 6, and 12 months postoperatively.
- Evaluated parameters included visual acuity, refraction, corneal topography, tomography, aberrometry, and endothelial cell count.
Main Results:
- Significant improvement in corrected distance visual acuity (CDVA) was observed at 3, 6, and 12 months.
- Corneal topography and maximum keratometry remained stable, with a trend toward improvement.
- No progression of keratoconus was noted, and endothelial cell counts remained stable.
Conclusions:
- I-CXL demonstrates efficacy in stabilizing progressive keratoconus and improving CDVA up to one year post-treatment.
- This epithelium-sparing technique offers potential benefits including reduced pain, infection risk, and treatment time.
- Further research is needed to compare I-CXL directly with standard epithelium-off CXL methods.
