Transepithelial CXL treatment appeared to halt keratoconus progression, with a statistically significant improvement in visual and topographic parameters. The treatment was safe and well tolerated. Its noninvasive nature makes it potentially useful in cases in which epithelial debridement is ideally avoided, such as pediatric cases, uncooperative patients, and thin corneas with thicknesses nearing 380 μm.

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Aims A blind, randomised, prospective, bilateral study to investigate the efficacy of riboflavin/ultraviolet A corneal collagen cross-linkage to halt the progression of keratoconus. Methods 24 patients with early/moderate bilateral keratoconus with recent progression were recruited. One eye was randomly assigned to undergo collagen cross-linkage following epithelial removal with riboflavin 0.1% and ultraviolet A (370 nm at 3 mW/cm 2 ). The other remained untreated as a control. The follow-up was 18 months in 22 patients. Results At 18 months, Orbscan II 3 mm, 5 mm keratometry and simulated astigmatism and cone apex power and wave-front measurements (Keraton Scout), including root mean square, coma and pentafoil showed significant reductions from baseline in treated compared with untreated eyes (p¼0.04). In treated eyes at 18 months, the best spectacle-corrected acuity improved (p¼0.01), and Orbscan II-simulated keratometry (p<0.001), 3 mm keratometry (p¼0.008), simulated astigmatism (p¼0.007), cone apex power (p¼0.002), root mean square, coma, spherical aberration, secondary astigmatism and pentafoil (p¼0.05) decreased from baseline. One treated eye experienced transient recurrent corneal erosions; otherwise there were no complications attributable to the treatment. Conclusions Corneal collagen cross-linkage appears to be an effective and safe modality to halt the progression of keratoconus. Improvements in visual and topographic parameters are seen in some eyes.

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METHODS:Riboflavin eyedrops were applied at 5-minute intervals for 35 minutes to the anterior corneal surface of 36 porcine eyes (12 with no epithelial trauma but treated with tetracaine eyedrops, 12 with superficial epithelial trauma but with an intact basal epithelium, and 12 with a fully removed epithelium). The corneal surface of 6 tetracaine-treated eyes, 6 eyes with superficial epithelial trauma, and 6 eyes with a fully removed epithelium was exposed to UVA light for 30 minutes during riboflavin administration. The light transmission spectra of the enucleated corneas were analyzed with a spectrophotometer and compared with those of 9 untreated porcine corneas.

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In myopic PRK, refractive stability achieved at 1 year was maintained up to 12 years with no evidence of hyperopic shift, diurnal fluctuation, or late regression in the long term. Corneal haze decreased with time, with complete recovery of BSCVA. Night halos remained a significant problem in a subset of patients due to the small ablation zone size.

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