title: Mechanical epithelial removal followed by corneal collagen crosslinking in progressive keratoconus: short-term complications.
abstract: OBJECTIVE
  To compare the complications occurring within the first 3 months of corneal collagen crosslinking (CXL) performed with mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal in keratoconus patients.
  
  
  METHODS
  Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey.
  
  
  METHODS
  Nonrandomized retrospective clinical study.
  
  
  METHODS
  Eyes of consecutive progressive keratoconus patients who had PTK or mechanical epithelial removal followed by CXL were included. All patients were examined regularly until epithelial healing. Detailed ophthalmologic examinations were performed preoperatively and 1 and 3 months postoperatively.
  
  
  RESULTS
  The study comprised 499 eyes (302 patients) that had transepithelial PTK (Group 1, 153 eyes) or mechanical epithelial removal (Group 2, 256 eyes) followed by CXL. Delayed epithelial healing occurred in 15.0% of eyes in Group 1 and 3.5% of eyes in Group 2 (P = .001). Epithelial hypertrophy occurred in 24.8% of eyes and 3.5% of eyes, respectively (P = .001). Salzmann-like epithelial nodules (2.6%), epithelial herpetic keratitis (1.9%), anterior uveitis (1.9%), and elevated intraocular pressure (1.9%) occurred in Group 1 only and infective keratitis (0.8%) in Group 2 only. Marked stromal edema and peripheral sterile infiltrates occurred at similar rates in both groups (P = .567 and P = .479, respectively). Grade 1+ corneal haze was significantly high in Group 2. Grade 2+ and 3+ haze was significantly high in Group 1 (P = .001).
  
  
  CONCLUSIONS
  Ocular surface healing disorders were the most common early complications of CXL. Short-term complications were higher with the transepithelial PTK epithelial removal technique than with mechanical epithelial removal.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Nurullah
authors.initials: N
authors.lastname: Cagil
authors.affiliation: From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey. Electronic address: drozgesarac@gmail.com.
authors.forename: Ozge
authors.initials: O
authors.lastname: Sarac
authors.affiliation: From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Hasan Basri
authors.initials: HB
authors.lastname: Cakmak
authors.affiliation: From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Gamze
authors.initials: G
authors.lastname: Can
authors.affiliation: From the Department of Ophthalmology, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Erol
authors.initials: E
authors.lastname: Can
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism*; D019781:Corneal Topography; D003432:Cross-Linking Reagents; D003646:Debridement / Q000379:methods*; D019573:Epithelium, Corneal / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011183:Postoperative Complications; D012189:Retrospective Studies; 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