Corneal crosslinking without epithelial removal.

Area of Science:

• Ophthalmology
• Corneal Ectasia Treatment
• Riboflavin-Ultraviolet A Corneal Crosslinking

Background:

• Ectatic corneal diseases, including keratoconus and post-LASIK ectasia, pose significant challenges to vision.
• Traditional corneal crosslinking (CXL) involves epithelial removal, which can lead to pain and delayed visual recovery.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel epithelium-on riboflavin-ultraviolet A corneal crosslinking (CXL) protocol for treating ectatic corneal diseases.
• To assess visual acuity, corneal curvature, higher-order aberrations, and progression rates post-treatment.

Main Methods:

• A prospective observational study involving 308 patients with keratoconus and 55 with post-LASIK ectasia.
• Treatment utilized a new riboflavin formulation with UV-A light exposure (365 nm, 4 mW/cm²) for 30 minutes, without epithelial removal.
• Visual acuity, Kmax, HOAs, and coma were measured at multiple postoperative intervals up to 24 months.

Main Results:

• No progression of ectatic corneal disease was observed in any treated eyes over 24 months.
• Significant improvements in uncorrected and corrected distance visual acuity were noted (1-1.5 lines, P < .0001).
• Mean Kmax decreased by 0.48 D (P = .0002), and total HOAs and coma reduced by 36% and 37% respectively (P < .0001).

Conclusions:

• Epithelium-on CXL using the described protocol effectively halts the progression of keratoconus and post-LASIK ectasia.
• This method offers a safer alternative to epithelium-off CXL, with faster visual recovery and the potential for simultaneous bilateral treatments.
• The study demonstrates the clinical viability of epithelium-on CXL for managing ectatic corneal conditions.