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Corneal cross-linking with or without pocket for refractive correction

Poster Details

First Author: C.Kranemann CANADA

Co Author(s):                        

Abstract Details


The purpose was to determine whether or not the use of a pocket improved the outcomes of corneal crosslinking for refractive corrections vs. an epithelium on (EPI ON) or epithelium off (EPI OFF) approach.


Clearview Institute


Patients were prospectively enrolled and randomized to undergo corneal crosslinking/photo-induced crosslinking (PiXL) with either an EPI ON, an EPI OFF or pocket approach. All patients met inclusion criteria for laser vision correction and signed an informed consent form. They underwent a complete ocular examination/topography/anterior segment OCT/ocular wavefront and endothelial cell counts preoperatively and at month 1 and month 3 postoperatively. Treatment was performed with a standard protocol of Riboflavin soak for 12 minutes, followed by UV light exposure complemented with supplemental oxygen.


t10 patients were enrolled in each group. The mean reduction in spherical equivalent was 0.75 diopters in the EPI ON, 1.45 diopters in the EPI OFF(P<.03) and 1.35 diopters P<.03) in the pocket group at 3 months. There were no adverse effects in the EPI ON group, 1/10 with mild corneal haze (grade 1/4) at month 1 in the EPI OFF group and 2/10 with corneal haze (grade 1/4) in the pocket group at month 1. At month 3 the haze had resolved. Intraoperative anterior segment OCT showed greater Riboflavin penetration both with EPI OFF and pocket approaches..


The EPI OFF approach and pocket approach were equivalent in refractive correction and deeper riboflavin penetration. Both approaches demonstrated a low occurrence of corneal haze at month 1. The EPI ON approach was least effective though without even a transient side effect. At month 3 all haze had resolved. Larger prospective samples will be required to confirm these findings and to determine the role of supplemental oxygen to keep the corneal haze to a minimum and optimize the refractive outomes.

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