Transepithelial Corneal CXL for Progressive Keratoconus: 6–24 Month Clinical Results
Purpose
To evaluate the clinical results of transepithelial corneal crosslinking (CXL) in patients with progressive keratoconus.
Methods
The study included 15 eyes of 10 patients treated by transepithelial (epithelium-on) CXL. The mean age was 24 years (range 18 to 35 years). Preoperative and postoperative examinations included uncorrected distance visual acuities (UDVA), corrected distance visual acuities (CDVA), average keratometry(AveK), maximam karametry(Kmax), corneal optical coherence tomography optical pachymetry, specular microscopy, intraocular pressure(IOP) and fundus examination. The solution for transepithelial CXL (ParaCell) comprised riboflavin 0.25%, benzalkonuim chloride,EDTA, trometamol, hydroxypropylmethylcellulose and phosphate buffered saline solution. Ultraviolet-A treatment was performed with the Avedro KXL at 30 mW/cm(2) for 3 minutes without corneal epithelial debridement. Patients were followed up to 6 to 24 months postoperatively. Patients were also asked to report any pain or discomfort during the procedure.
Results
It showed small-scale improvement in CDVA anddeteriorationin UDVA during the period. The AveK and Kmax values decreased significantly at 12 months and kept stable at 24 months. Pachymetry showed a gradual reduction over the first 6 months after transepithelial CXL and almost returned to baseline values by 24 months. There were no postoperative corneal haze, sterile infiltrates, infection and significant endothelial damage. The IOP and fundus showed no significant change.Pain following transepithelial CXL appeared especially in the first 3 days, but no more than 1 week in almost cases.
Conclusion
In patients with progressive keratoconus, transepithelial CXL showed improvement of CDVA, AveK and Kmax, reduced postoperative pain, fewer complications than epithelium-off CXL at 6 to 24-month follow-up.