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Transepithelial iontophoresis collagen cross-linking vs iontophoresis CXL with epithelial debridement vs standard CXL: one year clinical results of a prospective clinical study

Poster Details

First Author: P.Rosetta ITALY

Co Author(s):    R. Vinciguerra   E. Legrottaglie   V. Romano   R. Piscopo   E. Morenghi   P. Vinciguerra     

Abstract Details


To compare one year transepithelial corneal collagen cross-linking with Iontophoresis (I-CXL epi-on) outcomes with Iontophoresis CXL with Epithelial Debridement (I-CXL epi-off) and with standard CXL epithelium-off (S-CXL) for progressive keratoconus.


Humanitas Clinical and Research Center, Rozzano, Milan, Italy


Sixty eyes of sixty patients with progressive keratoconus were included in this comparative prospective clinical study. Best spectacle corrected visual acuity (BSCVA), spherical equivalent, cylinder refraction, corneal topography, Scheimpflug tomography, aberrometry and endothelial cell count were assessed at baseline and 12 months of follow up. The parameters considered to establish keratoconus progression were always proved with differential maps as change in curvature in the cone area of at least 1 diopters obtained with an instantaneous map.


Visual acuity showed significant improvement (p<0.05) in all groups. The comparative analysis showed a reduction of Kmax in S-CXL (-1.05 �ï�‚�± 1.51D, p=0.017), while I-CXL epi-on (-0.38 �ï�‚�± 1.92D, p=0.650) and I-CXL epi-off (-0.34 �ï�‚�± 2.93D, p=0.391) did not change significantly compared to baseline. Minimum pachymetry was stable in I-CXL epi-on group (0.8 �ï�‚�± 7.20 p=0.819), while in S-CXL (-41.1 �ï�‚�± 35.3 p<0.001) and I-CXL epi-off (-17.6 �ï�‚�± 25.6 p=0.004) decreased significantly. None of the patients had continuous progression of keratoconus or had to repeat crosslinking procedures. Endothelial cell counts did not change significantly (p>0.05).


The one-year outcomes suggest that the I-CXL epi-on and I-CXL epi-off might be comparable to S-CXL, stabilizing the progression of the degenerative ectatic disease.

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