title: Morphological modification of the cornea after standard and transepithelial corneal cross-linking as imaged by anterior segment optical coherence tomography and laser scanning in vivo confocal microscopy.
abstract: OBJECTIVE
  In vivo analysis of corneal modifications after traditional and transepithelial corneal cross-linking (CXL).
  
  
  METHODS
  Forty eyes of 35 patients underwent traditional or transepithelial CXL; there was randomization of 20 eyes to each group. By means of in vivo confocal microscopy and anterior segment ocular coherence tomography, we evaluated corneal alterations at 1 week, 1 month, and 3, 6, and 12 months after the treatment.
  
  
  RESULTS
  During follow-up, in vivo confocal microscopy showed a significant decrease in anterior keratocyte density (P = 0.001) and more evident stromal edema and keratocyte activation (P = 0.001) in the traditional group, whereas in the transepithelial group, no significant changes were observed (P > 0.05). Anterior segment ocular coherence tomography indicated the presence of hyperreflective stromal line significantly deeper and more persistent in the traditional group (P < 0.001).
  
  
  CONCLUSIONS
  The preliminary results suggest that traditional CXL induced marked corneal modifications, which were poorly evident in the transepithelial group.
authors.affiliation: Department of Medicine and Ageing Sciences, Ophthalmology Clinic, University G. D'Annunzio of Chieti and Pescara, Pescara, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
authors.forename: Mario
authors.initials: M
authors.lastname: Nubile
authors.forename: Manuela
authors.initials: M
authors.lastname: Lanzini
authors.forename: Roberta
authors.initials: R
authors.lastname: Calienno
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Mastropasqua
authors.forename: Luca
authors.initials: L
authors.lastname: Agnifili
authors.forename: Lisa
authors.initials: L
authors.lastname: Toto
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003094:Collagen / Q000378:metabolism; D015715:Corneal Edema / Q000175:diagnosis*; D060527:Corneal Keratocytes / Q000473:pathology*; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D018613:Microscopy, Confocal; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use; D041623:Tomography, Optical Coherence; D014466:Ultraviolet Rays; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin