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Cornea haziness and outcome after collagen cross-linking (CXL) for keratoconus: a comparison between total epithelium off and partial epithelial removal methods

Session Details

Session Title: Cross-linking

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

Paper Time: 15:58

Venue: Elicium 2 (First Floor)

First Author: : A.Peyman IRAN

Co Author(s): :    B. Rahimi   H. Razmjoo   M. Peyman        

Abstract Details


To determine effect of epithelium removal method on visual, refractive, and corneal haziness (quantitative optical density) after CXL with total epithelium removal and partial epithelium removal methods.


Isfahan Ophthalmology Research Center, Isfahan University of Medical Sciences


44 keratoconic eyes of 22 patients enrolled in this randomized prospective study. In the first group we totally removed the corneal epithelium with a diameter of 9mm, in the second group the central 3mm of epithelium kept undamaged and partial removal was performed by removing a 3-mm width ring and leaving the central 3 mm of the cornea. After impregnation of cornea with riboflavin, UV irradiation of 3mW/cm2 for 30 minutes employed for crosslinking in both groups. A comprehensive ophthalmologic examination was performed on all patients before and 6 months after the surgery. The examinations included best corrected visual acuity, quantitative measurement of cornea haziness and keratoconus indices by Pentacam Scheimpflug imagery, and refraction.


The difference between two groups was not statistically significant regarding post-op corneal haziness, refraction, and visual acuity (p>0.05). However, comparison of pre- and post-operative parameters within each group revealed that total removal of the cornea has resulted in significant improvement of K-max (p-value: 0.01), and Q-value (p-value: 0.009); while eyes in partial removal group had better improvement of corrected vision (p-value: 0.006). Both methods had significant and similar increase in optical corneal density (p-value<0.0001).


In our study keeping central corneal epithelium intact was not beneficial for decreasing corneal haziness but this method caused better improvement in corrected vision. Total epithelium off technique resulted in better improvement of Kmax and Q value.

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