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Updated: Nov 11, 2025
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Selective transepithelial ablation with simultaneous accelerated corneal crosslinking for corneal regularization of
Miguel Rechichi1, Cosimo Mazzotta, Giovanni William Oliverio
1From the Centro Polispecialistico Mediterraneo, Sellia Marina, Italy (Rechichi, Ferrise); Siena Crosslinking Center, Siena University Hospital, Ophthalmology Unit, Siena, Italy (Mazzotta, Bagaglia); Departement of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy (Oliverio, Meduri); Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, United Kingdom (Romano); Department of Ophthalmology, Riga Stradins University, Riga, Latvia (Borroni); Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India (Jacob).
Purpose:
To evaluate the changes in refractive outcomes and corneal aberrations in central and paracentral keratoconus after selective transepithelial topography-guided photorefractive keratectomy combined with accelerated corneal crosslinking (STARE-X).
Settings:
Centro Polispecialistico Mediterraneo, Siena Crosslinking Center, and University of Messina, Italy.
Design:
Prospective, interventional, multicentric study.
Methods:
Patients were subdivided into 2 groups: Group 1 with cone located within the central 3 mm zone (50 eyes) and Group 2 (50 eyes) with cone located outside the central 3 mm zone. Follow-up was 2 years at least for all eyes. Outcome parameters included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Corneal tomography and corneal wavefront aberrations were assessed and compared before and 2 years after the treatment.
Results:
100 eyes of 100 patients underwent STARE-X protocol. At 2 years, UDVA and CDVA improved, and sphere, cylinder, and Kmax reduced after treatment in both groups (P < .001, respectively). Moreover, a statistically significant reduction was observed of total higher-order aberrations root main square (RMS), coma RMS, and spherical aberration RMS in both groups (P < .001, respectively). However, CDVA improved more in Group 1 than in Group 2 (P < .02).
Conclusions:
The STARE-X protocol demonstrated effective results in halting keratoconus progression and improving corneal regularity with a safe and effective profile. STARE-X improved both visual acuity and corneal aberration at 2 years. Longer follow-up studies are warranted to observe further long-term CXL flattening effect on the cone.
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