A study comparing standard and transepithelial collagen cross-linking riboflavin solutions: epithelial findings and pain scores.
OBJECTIVE
To evaluate epithelial signs and pain after epithelial-on corneal collagen cross-linking (Epi-on CCL) with new transepithelial riboflavin formulation and epithelial-off corneal collagen cross-linking (Epi-off CCL) with standard riboflavin formulation and to compare pain and duration of epithelial healing between both techniques.


METHODS
Thirty-nine eyes of 39 patients undergoing Epi-on CCL and 39 eyes of 39 patients undergoing Epi-off CCL were evaluated. Corneal epithelial signs and durations of corneal epithelial healing and subjective pain scores after the procedures were recorded and compared between 2 groups.


RESULTS
Total epithelialization was observed after 2.7 ± 0.7 days in Epi-on CCL and 2.3 ± 0.4 days in Epi-off CCL (P = 0.006). The mean pain score on the first day was 3.1 ± 0.6 in Epi-on CCL and 2.3 ± 0.4 in Epi-off CCL with a significant difference (P = 0.0001).


CONCLUSIONS
The epithelial damage was observed in both procedures; also, the epithelial healing time was longer in Epi-on CCL and it is of great importance that the patients should have therapeutic contact lenses until the epithelium heals in both procedures. The Epi-off CCL group had less pain scores than the Epi-on CCL group and more pain problems after Epi-on CCL still remains. The patient should be informed about pain, even if the Epi-on CCL procedure was performed.
Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey.
Erdem
E
Yuksel
Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey.
Shahin
S
Novruzlu
Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey.
Mehmet C
MC
Ozmen
Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey.
Kamil
K
Bilgihan
D000293:Adolescent; D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D003432:Cross-Linking Reagents / Q000008:administration & dosage* / Q000009:adverse effects; D019573:Epithelium, Corneal / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D008297:Male; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D017319:Photosensitizing Agents / Q000008:administration & dosage / Q000009:adverse effects; D012256:Riboflavin / Q000008:administration & dosage* / Q000009:adverse effects; D014945:Wound Healing / Q000187:drug effects; D055815:Young Adult
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin