Epithelium-on Corneal Cross-linking for Progressive Keratoconus: Two-year Outcomes

Abstract

Corneal cross-linking (CXL) has been established as a successful treatment tool for the treatment of progressive keratoconus in terms of slowing or halting progressive corneal steepening and thinning and even on some occasions, reversing the steepening. To date the Dresden epithelium-off protocol is regarded as the gold standard and the epithelium-on (epi-on) approaches have met with less success. Both doctors and patients would welcome an epi-on CXL procedure that provided good outcomes as the morbidity with epi-on CXL is so much less and the safety is enhanced. Patient comfort is greater with the epi-on techniques when compared to epi-off. This study looked at 82 eyes that had documented progression of keratoconus and then underwent epi-on CXL using the CXLO system. The results show that corneal steepening can be halted and even reversed over a 2-year follow-up period with no complications noted. Over the 24 months post treatment on average there was a decrease in all keratometry values, BAD and ISV when compared to before treatment with IHD being marginally increased.Further studies over a longer follow-up period are required but recent publications using the same approach are validating the findings seen in this study.

Preliminary Characterization of Predictive Factors of the Visual Change after Epi-On and Epi-Off Corneal Collagen Crosslinking Techniques

“…Besides these investigations, other CXL protocols have been evaluated that are based on the epi-on concept, such as the CXLO protocol that uses a new sodium iodide riboflavin formulation that theoretically allows a greater level of penetration [47][48][49][50][51]. ese investigations have shown that the use of the CXLO protocol can halt the progression of ectasia and result in better visual acuity without the risk associated to epi-off CXL [47][48][49][50][51].…”