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Evaluation of epithelial integrity with various transepithelial corneal cross-linking protocols for treatment of keratoconus

Poster Details

First Author: S.Taneri GERMANY

Co Author(s):    S. Oehler   B. Dick           

Abstract Details


Corneal collagen cross-linking (CXL) has been demonstrated to stiffen the cornea and halt the progression of ectasia. The original protocol requires debridement of the central corneal epithelium to facilitate diffusion of a riboflavin solution to the stroma. Recently, transepithelial CXL has been proposed to reduce the risk of complications associated with epithelial removal. We wanted to evaluate and compare the impact of various transepithelial riboflavin delivery protocols on the corneal epithelium in regards to pain and epithelial integrity in the early postoperative period.


Zentrum für Refraktive Chirurgie, Augenabteilung am St. Franziskus Hospital, Münster, Germany


One hundred and sixty six eyes of 104 subjects affected by progressive keratoconus underwent transepithelial CXL using 6 different riboflavin application protocols. Postoperatively, epithelial integrity was evaluated at the slitlamp and all patients were queried if they had experienced ocular pain of any level. Optical coherence tomography (OCT) was used to qualitatively assess riboflavin diffusion.


One eye had a corneal infection associated with an epithelial defect. No other adverse event including endothelial decompensation or endothelial damage was observed in any eye, except for epithelial damages. The incidence of epithelial defects varied according to the treatment protocol from 0 to 63%. The incidence of reported pain varied from 0 to 83%. Corneas treated with the least invasive protocol showed only limited hyper reflectivity in OCT.


Different transepithelial crosslinking protocols have varying impacts on epithelial integrity. At present, it seems impossible to have sufficient riboflavin penetration without any epithelial disruption. A compromise between efficacy and epithelial integrity has to be found. FINANCIAL INTEREST: NONE

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