Comparison of Epithelium-off and Transepithelial Corneal CXL for Treatment of Keratoconus
Narrative Responses:
Purpose
To compare efficiency and safety of epithelium-off corneal cross-linking (CXL) and transepithelial cross-linking (TE-CXL) in keratoconus patients.
Methods
Uncorrected and corrected visual acuity, simulated keratometry, corneal topography and pachymetry (Sirius , CSO Italy) data were evaluated at baseline and at 3,6, and 12 months in 15 keratocconus patients were treated with TE-CXL and 20 keratoconus patients were treated with conventional or epithelium-off CXL. All patients had a thinnest corneal thickness of ≥ 400 um.
Results
In the TE-CXL group (20 patients, 25 eyes), a significant improvement at month 12 was present for Kmax -1.29 D, Kmin -3.2 D, mean K -1.47 D, surface asymmetry index (-0.86 D), inferior-superior symmetry index or symmetry index front SIF (-0.56 D), and anterior elevation at the thinnest location (-2.82 D) and at the apex (-2.27 D).
In the TE-CXL group (15 patients, 18 eyes), a significant improvement at month 12 was present for Kmax (-1.01 D), Kmin (-2.04 D), mean K (-1.25 D), surface asymmetry index (-0.64 D), inferior-superior symmetry index or symmetry index front SIF (-0.55 D), and anterior elevation at the thinnest location (-2.96 D) and at the apex (-2.19 D).
Conclusion
TE-CXL was less painful with fewer complications but less effective than epithelium-off CXL at 12 months follow up. In short, conventional epithelium-off CXL is better than transepithelial CXL regarding efficacy and visual improvement.