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How effective is transepithelial cross-linking? 1 year follow-up

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Session Details

Session Title: Cross-linking I

Session Date/Time: Monday 15/09/2014 | 14:30-16:30

Paper Time: 15:12

Venue: Capital Hall A

First Author: : S.Nanaiah INDIA

Co Author(s): :    R. Shetty   H. Nagaraj   A. Ajani        

Abstract Details


To evaluate the efficacy of trans epithelial cross linking on Asian eyes with progressive keratoconus


Tertiary eye care and research centre


Eyes with documented progressive keratoconus were recruited for the study after a detailed informed consent. Uncorrected and best corrected visual acuity were measured and refraction was done on all patients. Steep K, Flat K and thinnest pachymetry were studied on the Pentacam HR (Oculus, Inc., Wetzlar, Germany). Maximum and minimal epithelial thickness, epithelial thickness at the point of thinnest pachymetry and demarcation line were noted from the Optovue (Optovue RTVue-100, Optovue Inc., Fremont, CA). Biomechanics were studied on the CorVis ST (Oculus Inc., Wetzlar, Germany). The above mentioned tests were done preoperatively, at 3 months, 6 months and 1 year post operatively. Transepithelial crosslinking (TE-CXL)was performed in the operation room under sterile conditions. The procedure involved soaking the cornea with 0.25% Riboflavin (Medio-Cross TE solution, Peschke Meditrade GmbH, Hunenberg, Switzerland); applied every 2 minutes for 20 minutes and then exposing the cornea to 45mW UV light for two minutes and forty seconds. At the end of surgery, all patients were asked to grade their pain on the Wong-Baker pain scale.


40 eyes of 31 patients were included in the study. There were 20 males and 11 females. The mean age of the patients were 22.87 yrs (±9.14 years). At the end of 1 year, no patient showed progression of keratoconus. No statistically significant change was noticed in visual acuity, keratometry values, pachymetry or biomechanics operatively. Maximum epithelial thickness, minimal epithelial thickness and epithelium at thinnest pachy were analysed and did not show any statistically significant change from pre operatively to 1 day, 1 week, 1 month, 3 months, 6 months or 1 year post operatively. The demarcation line was patchy in most patients and the level was anterior as compared to regular crosslinking. 72.5% (31)patients scored 2 or lesser on the Wong Baker pain scale(no hurt or hurts a little bit).


Our study showed stabilization of progressive keratoconus after TE-CXL at the end of 1 year. TE-CXL did not cause any statistically significant changes in keratometry or corneal haze that has been reported to occur after conventional cross linking. Patients experienced lesser pain and faster recovery as compared to regular cross linking. Longer follow up will be needed to evaluate the long term efficacy of the procedure.

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