Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomedical Engineering

Background:

• Keratoconus is a progressive condition affecting corneal shape.
• Corneal cross-linking (CXL) is a standard treatment to halt progression.
• Epi-off CXL involves removing the corneal epithelium for enhanced riboflavin penetration.

Purpose of the Study:

• To assess the efficacy of accelerated epi-off corneal cross-linking (CXL) using a novel high-oxygen chamber.
• To evaluate the impact of elevated oxygen levels on patient-reported pain during CXL.

Main Methods:

• An interventional randomized clinical trial enrolled 48 eyes with progressive keratoconus.
• The high-oxygen group (n=24) received CXL in a novel chamber (∼60% oxygen).
• The control group (n=24) received CXL under ambient air (∼21% oxygen).
• Outcomes measured included visual acuity, refraction, keratometry, demarcation line depth, and pain scores.

Main Results:

• The high-oxygen group showed significantly deeper demarcation lines (307 ± 14 µm vs 279 ± 23 µm).
• Greater reductions in keratometry values were observed in the high-oxygen group at 12 months.
• Intraoperative pain scores were significantly lower in the high-oxygen group (2.4 ± 0.9 vs 3.4 ± 0.7).
• Endothelial cell density remained stable in both groups.

Conclusions:

• Using a high-oxygen environment during accelerated epi-off CXL improves stromal demarcation and keratometric outcomes.
• This method also significantly reduces intraoperative pain for patients.
• The novel oxygen chamber approach shows potential for enhanced clinical results and patient experience in CXL procedures.