title: Transepithelial Iontophoresis Versus Standard Corneal Collagen Cross-linking: 1-Year Results of a Prospective Clinical Study.
abstract: OBJECTIVE
  To compare 1-year transepithelial corneal collagen cross-linking with iontophoresis (I-CXL) outcomes with standard CXL (S-CXL) epithelium-off for progressive keratoconus.
  
  
  METHODS
  Forty eyes of 40 patients with progressive keratoconus were included in this comparative, prospective clinical study. Corrected distance visual acuity (CDVA), spherical equivalent, cylinder refraction, corneal topography, Scheimpflug tomography, aberrometry, and endothelial cell count were assessed at baseline and at 1, 3, 6, and 12 months of follow-up.
  
  
  RESULTS
  Patients received either I-CXL (20 eyes) or S-CXL (20 eyes). Functional parameters (visual acuity and aberrometry) showed a significant improvement (P < .05) after 6 and 12 months of follow-up in both groups. In the I-CXL group, the CDVA showed a rapid recovery of vision after 3 months (P = .01) compared to baseline. Morphological parameters showed a significant reduction of maximum keratometry in the S-CXL group by -1.05 ± 1.51 diopters (D) after 12 months, whereas the I-CXL group curvature was stable (-0.31 ± 1.87 D). Minimum pachymetry values were stable even after 12 months of follow-up in the I-CXL group, whereas a significant corneal thinning 12 months following treatment was recorded in the S-CXL group (P < .001). None of the patients had continuous progression of keratoconus or had to repeat CXL procedures. Endothelial cell counts did not change significantly (P > .05).
  
  
  CONCLUSIONS
  The 1-year outcomes suggest that I-CXL might be comparable to S-CXL in stabilizing the progression of the degenerative ectatic disease. Additionally, quicker improvement of functional parameters was reported in the I-CXL group. [J Refract Surg. 2016;32(10):672-678.].
authors.forename: Paolo
authors.initials: P
authors.lastname: Vinciguerra
authors.forename: Vito
authors.initials: V
authors.lastname: Romano
authors.forename: Pietro
authors.initials: P
authors.lastname: Rosetta
authors.forename: Emanuela F
authors.initials: EF
authors.lastname: Legrottaglie
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piscopo
authors.forename: Claudia
authors.initials: C
authors.lastname: Fabiani
authors.forename: Claudio
authors.initials: C
authors.lastname: Azzolini
authors.forename: Riccardo
authors.initials: R
authors.lastname: Vinciguerra
mesh_terms: D057128:Aberrometry; D000328:Adult; D003094:Collagen / Q000378:metabolism*; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism*; D019781:Corneal Topography; D003432:Cross-Linking Reagents; D019573:Epithelium, Corneal; D005260:Female; D006801:Humans; D007478:Iontophoresis / Q000379:methods*; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D010778:Photochemotherapy / Q000379:methods*; 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
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin