Related Experiment Video
Updated: Jul 20, 2026
07:29
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
20.4K
Transepithelial corneal cross-linking: a review
Wen Zhou1, Sandeepani K Subasinghe2, Francesc March de Ribot3
1Department of Anatomy, University of Otago, 270 Great King Street, P.O. Box 913, Dunedin, 9054, New Zealand. zhowe294@student.otago.ac.nz.
International Ophthalmology
|January 10, 2026
Summary
Transepithelial corneal cross-linking (TE-CXL) offers a less invasive keratoconus treatment with improved comfort and faster recovery. However, its effectiveness is currently less than standard epithelium-off cross-linking (S-CXL), requiring further technological advancements.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Biomaterials Science
Background:
- Keratoconus (KC) is a progressive thinning disorder of the cornea.
- Standard epithelium-off cross-linking (S-CXL) is effective but invasive.
- Transepithelial corneal cross-linking (TE-CXL) aims to provide a less invasive alternative.
Purpose of the Study:
- To review the current understanding of TE-CXL for keratoconus treatment.
- To compare TE-CXL with S-CXL.
- To discuss recent advancements enhancing TE-CXL efficacy.
Main Methods:
- Systematic review of studies from PubMed and Google Scholar.
- Focus on novel riboflavin solutions, delivery methods, and UV-A settings.
- Inclusion of research on oxygen supply and emerging TE-CXL technologies.
Main Results:
- TE-CXL offers better patient comfort and fewer complications by preserving the corneal epithelium.
- Corneal stiffening is generally less than S-CXL due to limited riboflavin penetration.
- Emerging techniques like chemical enhancers, iontophoresis, optimized UV-A, nanotechnology, ultrasound, and theranostic-guided CXL show promise for improved biomechanical strengthening.
- Variability in outcomes persists due to differing protocols and parameters.
Conclusions:
- TE-CXL is a promising, less invasive option for KC with improved patient comfort and recovery.
- Long-term stability and biomechanical effects of TE-CXL are currently inferior to S-CXL.
- Future advancements require optimizing riboflavin/oxygen delivery, refining UV-A protocols, and validating new technologies like theranostic-guided CXL through clinical studies.
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