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Epithelial disruption cross-linking for keratoconus: two year results

Session Details

Session Title: Cross-linking

Session Date/Time: Monday 07/10/2013 | 14:30-16:30

Paper Time: 15:52

Venue: Elicium 2 (First Floor)

First Author: : M.Rechichi ITALY

Co Author(s): :    S. Daya   V. Scorcia   A. Meduri         Dupps

Abstract Details


To evaluate medium-term efficacy of epithelial disruption collagen crosslinking (EDCXL) for progressive keratoconus using a corneal disruptor device to enhance corneal penetration of Riboflavin solution designed for a transepithelial technique.


University Eye Clinic, Magna Graecia University, Catanzaro, Italy


The most severely affected eye of 28 patients with bilateral progressive keratoconus was treated. Mean age was 28 years and follow-up was 24 months. A corneal disruptor device was used to create pockmarks in the epithelium to facilitate deeper penetration of the enhanced riboflavin solution normally used for transepithelial crosslinking. The primary goal was to maintain as much live epithelium while promoting riboflavin penetration. The fellow eye was considered a control. The corneal epithelium was punctured multiple times with the disruptor device followed by application of an enhanced riboflavin solution (Riboflavin 0.1%, dextran T500 with Trometamol [Tris-hydroxymethyl aminomethane] and EDTA [ethylenediaminetetraacetic] sodium salt) on the punctured corneal epithelium for 30 minutes. Irradiation with ultraviolet A (370 nm at 3 mW/cm2 ) for 30 minutes was then performed and on completion a bandage contact lens was applied. Three days postoperatively after contact lens removal patients were asked to assess the level of pain in each eye using an 11-point verbal numerical rating scale.


The treatment was well-tolerated by patients. At three days postoperatively, the pain score was 2.1 and 20 patients (71%) complained of a foreign-body sensation that resolved by day seven. Mean preoperative corneal thickness was 450 micron(?m). The mean depth of the demarcation line centrally was 250.41 microns (SD 21,89 range 209- 290 ). No complications were reported. Mean baseline UDVA and CDVA was 0.73±0.21 and 0.30±0.11; 12 months mean UDVA and CDVA was 0.48±0.15 and 0.25±0.1 that was statistically significative . Mean spherical equivalent refraction showed a significant decrease of 0,96 D. Mean baseline apical keratometry (AK), apical gradient curvature (AGC), average pupillary power, inferior-superior index and cone area were 59.21 D, 8.91 D, 47.9 D, 11.49 and 10.32 mm2 respectively. At 24 months these values were 56.18 D, 7.32 D, 41.34 D, 9.65 and 7,75 mm2 respectively, a difference that was significant for all indices. There were no significant changes in endothelial cell count (ECC) following the procedure. No adverse effects were observed.


Corneal epithelial disruption to facilitate penetration of Riboflavin prior to UV ablation is safe and effective in medium-term stabilization of keratoconus with observed improvement of topographic and refractive parameters. The procedure is well tolerated with rapid epithelialization and less patient discomfort.

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