Transepithelial Versus Epithelium-Off Corneal Collagen Cross-Linking for Progressive Keratoconus: A Prospective Randomized Controlled Trial.
OBJECTIVE
To compare the safety and efficacy of transepithelial with epithelium-off corneal cross-linking for progressive keratoconus.


METHODS
In a prospective clinical trial, 70 patients with progressive keratoconus were randomized to undergo corneal cross-linking with intact epithelium (n = 34) or after deepithelialization (n = 36). The main outcome measure was a change in the maximum K reading (K(max)).


RESULTS
With 3-year follow-up, K(max) decreased in the epithelium-off group with a mean of 2.4 D and no patient showed evidence of progression. In the transepithelial group, K(max) increased by a mean of 1.1 D, and 20 patients (55%) showed progression of keratoconus.


CONCLUSIONS
In this study, epithelium-off was significantly more effective than transepithelial corneal cross-linking in halting the progression of keratoconus (P < 0.0001).
*Department of Ophthalmology, King Abdul Aziz University Medical School; †The Eye and Laser Centre; and ‡The Eye Hospital, Jeddah, Saudi Arabia.
Mashhoor F
MF
Al Fayez
Salman
S
Alfayez
Yasmin
Y
Alfayez
D000328:Adult; D003094:Collagen / Q000378:metabolism*; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism*; D003432:Cross-Linking Reagents; D018450:Disease Progression; D019573:Epithelium, Corneal / Q000187:drug effects / Q000502:physiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use*; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin