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Updated: Jan 12, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Comparison of epithelium-on customized remodeled vision and epithelium-off accelerated crosslinking in keratoconus
Zuzana Halašová1, Pavel Stodůlka, Lucia Škrovinová
1From the Gemini Eye Clinic, Zlín, Czech Republic (Halašová, Stodůlka, Škrovinová, Rakušanová, Slovák, Randárová); The Ophthalmology Department, Third Faculty of Medicine, Charles University, Prague, Czech Republic (Halašová, Stodůlka, Škrovinová).
Purpose:
To evaluate the effectiveness and safety of epithelium-on (epi-on) customized remodeled vision (CuRV) crosslinking compared with epithelium-off (epi-off) accelerated corneal crosslinking (aCXL) in stabilizing keratoconus and improving visual outcomes.
Setting:
Gemini Eye Clinic, Zlín, Czech Republic.
Design:
Prospective, observational, nonrandomized 1-center study.
Methods:
The study included 179 eyes (135 patients) with progressive keratoconus (grades 1 to 3-4). Patients received either epi-on CuRV (n = 77 eyes) or epi-off aCXL (n = 102 eyes) and were followed for 24 months. Distance visual acuities, refraction, maximum keratometry (Kmax), corneal thickness, wavefront aberrations, endothelial cell count, and adverse events were assessed.
Results:
CuRV demonstrated greater and sustained reductions in Kmax (-2.46 ± 2.64 diopters [D] vs -1.38 ± 2.13 D, P = .0018) and mean keratometry (-0.93 ± 1.62 D vs -0.52 ± 1.02 D, P = .0367) compared with aCXL over 2 years. CuRV resulted in a lower rate of Kmax increase (>1 D) compared with aCXL (1% vs 9%). Higher-order aberrations improved significantly in both groups, with greater overall reduction in the CuRV group.
Conclusions:
The CuRV protocol, using topography-guided, pulsed UV-A exposure with oxygenation, effectively stabilizes keratoconus while improving corneal shape and reducing aberrations. Its noninvasive, epi-on approach offers potential advantages in safety, comfort, and recovery over standard aCXL.
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