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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

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Accelerated Epi-On Versus Standard Epi-Off Corneal Collagen Cross-Linking for Progressive Keratoconus in Pediatric

Maria A Henriquez1, Gustavo Hernandez-Sahagun, Jorge Camargo

  • 1Research Department, Oftalmosalud Institute of Eyes, San Isidro, Lima, Perú.

Cornea
|August 16, 2020
PubMed

Insights

Standard corneal collagen cross-linking (CXL) was safer and more effective than accelerated transepithelial CXL in halting progressive keratoconus in children over 5 years. Both methods stopped disease progression, but epi-off CXL showed superior results.

Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Biomaterials Science

Background:

  • Keratoconus (KC) is a progressive corneal ectasia often diagnosed in children and young adults.
  • Corneal collagen cross-linking (CXL) is a standard treatment to halt KC progression.
  • Newer accelerated transepithelial (A-epi-on) CXL techniques aim for improved patient comfort and shorter procedure times.

Purpose of the Study:

  • To compare the 5-year efficacy and safety of accelerated transepithelial (A-epi-on) corneal collagen cross-linking (CXL) versus standard (epi-off) CXL in pediatric patients with progressive KC.
  • To evaluate visual acuity, refractive outcomes, and corneal topography changes over a 5-year period.

Main Methods:

  • A prospective cohort study involving 78 eyes of patients aged 18 or younger with progressive KC.
  • Patients underwent either A-epi-on CXL (32 eyes) or standard epi-off CXL (46 eyes).
  • Evaluations included best corrected visual acuity, refraction, and Scheimpflug imaging parameters at baseline, 1 year, and 5 years postoperatively.

Main Results:

  • Both A-epi-on and epi-off CXL halted KC progression at 5 years.
  • Epi-off CXL demonstrated a statistically significant improvement in mean keratometry flattening (3.18 D, P < 0.001) compared to A-epi-on CXL (0.09 D, P = 0.33).
  • The KC progression rate was 9.37% in the A-epi-on group, with no progression observed in the epi-off group.

Conclusions:

  • Both accelerated transepithelial (A-epi-on) and standard (epi-off) corneal collagen cross-linking (CXL) effectively halt keratoconus progression in children over a 5-year period.
  • Standard epi-off CXL proved to be safer and more effective than A-epi-on CXL in this pediatric cohort.
  • Further research may explore optimized A-epi-on protocols to enhance its efficacy while maintaining patient comfort.
Abstract

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