title: Transepithelial corneal collagen crosslinking for progressive keratoconus: 24-month clinical results.
abstract: OBJECTIVE
  To assess the clinical results of transepithelial collagen crosslinking (CXL) in patients 26 years and younger with progressive keratoconus suitable for epithelium-off (epi-off) CXL.
  
  
  METHODS
  Department of Ophthalmology, Siena University Hospital, Siena, Italy.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  The study included 26 eyes (26 patients) treated by transepithelial (epithelium-on) CXL. The mean age was 22 years (range 11 to 26 years) (10 younger than 18 years; 16 between 19 years and 26 years). Preoperative and postoperative examinations included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, simulated maximum keratometry (K), coma and spherical aberration, and corneal optical coherence tomography optical pachymetry. The solution for transepithelial CXL (Ricrolin TE) comprised riboflavin 0.1%, dextran 15.0%, trometamol (Tris), and ethylenediaminetetraacetic acid. Ultraviolet-A treatment was performed with the Caporossi Baiocchi Mazzotta X Linker Vega at 3 mW/cm(2).
  
  
  RESULTS
  After relative improvement in the first 3 to 6 months, the UDVA and CDVA gradually returned to baseline preoperative values. After 12 months of stability, the simulated maximum K value worsened at 24 months. Coma aberration showed no statistically significant change. Spherical aberration increased at 24 months. Pachymetry showed a progressive, statistically significant decrease at 24 months. Fifty percent of pediatric patients were retreated with epi-off CXL due to significant deterioration of all parameters after 12 months of follow-up.
  
  
  CONCLUSIONS
  Functional results after transepithelial CXL showed keratoconus instability, in particular in pediatric patients 18 years old and younger; there was also functional regression in patients between 19 years and 26 years old after 24 months of follow-up. mentioned.
authors.affiliation: Department of Ophthalmology, Siena University, Siena, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Caporossi
authors.forename: Cosimo
authors.initials: C
authors.lastname: Mazzotta
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Paradiso
authors.forename: Stefano
authors.initials: S
authors.lastname: Baiocchi
authors.forename: Davide
authors.initials: D
authors.lastname: Marigliani
authors.forename: Tomaso
authors.initials: T
authors.lastname: Caporossi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003094:Collagen / Q000378:metabolism*; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D019573:Epithelium, Corneal / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin