Related Experiment Video
Updated: Feb 11, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Transepithelial corneal crosslinking for keratoconus
Peter S Hersh1, Michael J Lai1, John D Gelles1
1From the Cornea and Laser Eye Institute-Hersh Vision Group (Hersh), CLEI Center for Keratoconus (Hersh, Lai, Gelles), Teaneck, and the Department of Ophthalmology, Rutgers-New Jersey Medical School (Hersh, Lesniak), Newark, New Jersey, USA.
Purpose:
To evaluate outcomes of corneal crosslinking (CXL) using a transepithelial technique for the treatment of keratoconus.
Setting:
Cornea and refractive surgery subspecialty practice.
Design:
Prospective case series.
Methods:
Transepithelial CXL was performed in keratoconic eyes using riboflavin 0.1% and topical anesthetic containing benzalkonium chloride to facilitate riboflavin diffusion through the epithelium. Eyes were randomized to receive riboflavin administration either every 1 minute or every 2 minutes during ultraviolet-A exposure at 3mW/cm2. The principal outcome was change in maximum keratometry (K) and secondary outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, mean K, and comparison of randomized groups.
Results:
Eighty-two eyes of 56 patients were treated. At 1 year, maximum K decreased significantly by 0.45 diopters (D) ± 1.94 (SD); it improved by 2.0 D or more in 11 eyes (13%) and worsened by 2.0 D or more in 4 eyes (5%). The mean UDVA significantly improved by 0.7 lines, whereas the CDVA improved by 0.2 lines. Two eyes showed both continued progression with loss of CDVA. Only the 1-minute subgroup showed significant improvements in maximum K (-0.73 D) and UDVA. Transient corneal erosion and epitheliopathy were reported in 21% of eyes.
Conclusions:
Transepithelial CXL resulted in significant improvements in maximum K and UDVA over 1 year. There was a suggestion that increased riboflavin dosing might improve procedure outcomes. Further study is required to determine the relative advantages and disadvantages of different transepithelial approaches to the standard CXL protocol with epithelial removal.
