Related Experiment Video
Updated: Aug 10, 2025
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Customized corneal crosslinking with excimer laser-assisted epithelium removal for progressive keratoconus: 1-year
João Q Gil1, Andreia M Rosa, Esmeralda Costa
1From the Centro de Responsabilidade Integrado de Oftalmologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal (Gil, Rosa, Costa, Quadrado, Murta); Faculty of Medicine, University of Coimbra, Coimbra, Portugal (Gil, Rosa, Costa, Quadrado, Murta); Clinical Academic Center of Coimbra, Coimbra, Portugal (Gil, Rosa, Quadrado, Murta); Unidade de Oftalmologia de Coimbra, Coimbra, Portugal (Gil, Rosa, Quadrado, Murta).
Purpose:
To evaluate the 1-year visual and tomographic results of customized crosslinking using excimer laser-assisted epithelium removal and topography-guided irradiation in the treatment of progressive keratoconus.
Setting:
Coimbra Ophthalmology Unit, Private Practice, Coimbra, Portugal.
Design:
Prospective nonrandomized clinical trial.
Methods:
Eyes with documented progressive keratoconus were enrolled. After de-epithelialization with phototherapeutic keratectomy, customized UV irradiation was performed, designed as 3 concentric circular areas centered on the thinnest point (Mosaic System). Energy exposure was 5.4 J/cm 2 in the outer circle and then increased centripetally to 7.2 J/cm 2 and 10 J/cm 2 . Corrected distance visual acuity (CDVA), refractive outcomes, and Scheimpflug tomographies (Allegro Oculyzer) were assessed at baseline, and 6 months, and 12 months postoperatively.
Results:
37 eyes of 32 patients were enrolled in this prospective study. The mean diameter for treated areas was 6.17 ± 0.80 mm, 4.45 ± 0.47 mm, and 2.58 ± 0.14 mm for the outer, medium, and inner circle, respectively. At the 1-year follow-up, the mean CDVA improved significantly from 0.38 ± 0.19 to 0.20 ± 0.16 logMAR ( P < .01), with 34 (91.89%) of the 37 eyes retaining or improving CDVA. The mean preoperative minimum pachymetry decreased from 449.26 ± 41.62 to 443.26 ± 41.06 μm ( P = .02). The maximum keratometry decreased significantly from 58.50 ± 7.84 to 57.05 ± 7.27 diopters ( P < .01). After 1 year, 34 eyes (91.89%) showed no signs of progression.
Conclusions:
1 year postoperatively, patients showed a significant improvement in visual acuity while achieving stabilization of disease progression.
