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Updated: May 16, 2026
07:29
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Corneal epithelial mapping after accelerated corneal cross-linking: early remodeling patterns.
Suzan Amana Rattan1, Ayat Abdulkadhim Jawad2
1Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq. suzanamana@kmc.uobaghdad.edu.iq.
International Ophthalmology
|May 14, 2026
Summary
Accelerated epithelium-off corneal cross-linking (CXL) causes early, localized corneal epithelial thickness changes in keratoconus patients. These changes reflect surface remodeling, not permanent stromal stabilization, within three months post-surgery.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Biomedical Engineering
Background:
- Keratoconus is a progressive corneal ectasia leading to vision impairment.
- Corneal cross-linking (CXL) aims to halt keratoconus progression by strengthening corneal tissue.
- Accelerated epithelium-off CXL is a common treatment modality.
Purpose of the Study:
- To assess early regional corneal epithelial thickness changes after accelerated epithelium-off CXL in progressive keratoconus.
- To investigate the relationship between these epithelial changes and corneal curvature and refractive error.
Main Methods:
- Prospective case series involving 90 eyes of 75 patients with progressive keratoconus.
- Accelerated epithelium-off CXL performed at 9 mW/cm² for 10 minutes.
- Corneal epithelial thickness profiles measured using spectral-domain anterior segment optical coherence tomography (AS-OCT) preoperatively and at 1 and 3 months postoperatively.
Main Results:
- Central epithelial thickness showed minimal change at 1 month but increased significantly by 3 months (P < 0.001).
- Regional analysis revealed thinning in nasal/inferonasal sectors and thickening in temporal sectors (P < 0.05).
- No significant correlations were found between epithelial thickness changes, maximum keratometry (Kmax), or spherical equivalent.
Conclusions:
- Accelerated epithelium-off CXL induces early, region-specific corneal epithelial thickness alterations within 3 months.
- These findings suggest early surface remodeling rather than immediate stromal stabilization.
- Epithelial mapping may offer insights into early postoperative changes, but long-term outcome prediction requires further study.
