title: Corneal collagen crosslinking for keratoconus or corneal ectasia without epithelial debridement.
abstract: OBJECTIVE
  Corneal collagen crosslinking (CXL) is a relatively new technique to reduce the progression of keratoconus. The technique can be performed with or without complete debridement of the corneal epithelium. We describe a novel intermediate technique involving mechanical disruption of the epithelium, and evaluate its safety and efficacy.
  
  
  METHODS
  The case notes of 128 eyes with progressive keratoconus or iatrogenic corneal ectasia who had undergone CXL using the epithelial disruption technique were retrospectively reviewed. Thin corneas were treated with hypotonic riboflavin. All others were treated with an isotonic solution. Note was made of preoperative and postoperative parameters, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, and corneal tomography. Occurrence of procedure-related complications was recorded. Statistical analyses were performed using the paired sample t-test and Wilcoxon signed-rank test, with a level of P<0.05 being accepted as statistically significant.
  
  
  RESULTS
  At 12 months, 41.8% of patients treated with isotonic riboflavin had improved UCVA and 29.7% had improved BSCVA. Only 13.4% lost lines of UCVA and 14.9% lost BSCVA. Of the patients treated with hypotonic riboflavin, at 12 months, 75% demonstrated stability of BSCVA and 25% had stable Kmax. In addition, 25% showed improved visual acuity at 12 months, and 58.3% showed regression of their Kmax. Our rate of short-term complications was comparable to studies using complete epithelial removal.
  
  
  CONCLUSIONS
  CXL with epithelial disruption is a safe and effective treatment for keratoconus or iatrogenic corneal ectasia, and may be better tolerated by patients than the epithelium-off technique.
authors: 1] The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK [2] Department of Ophthalmology, East Surrey Hospital, Surrey, UK.
authors: N
authors: N
authors: Hirji
authors: The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK.
authors: E
authors: E
authors: Sykakis
authors: 1] The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK [2] Ophthalmology Department, Worthing and St. Richards Hospital, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK.
authors: F C
authors: FC
authors: Lam
authors: 1] The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK [2] Department of Ophthalmology, East Surrey Hospital, Surrey, UK.
authors: R
authors: R
authors: Petrarca
authors: The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK.
authors: S
authors: S
authors: Hamada
authors: The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK.
authors: D
authors: D
authors: Lake
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism*; D003432:Cross-Linking Reagents; D003646:Debridement / Q000379:methods*; D004108:Dilatation, Pathologic / Q000188:drug therapy / Q000209:etiology; D019573:Epithelium, Corneal / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin