To Evaluate And Compare The Effects Of High Fluence, Accelerated Transepithelial Collagen Cross Linking Performed Using Pulsed Uv-A Light With That Performed Using A Combination Of Pulsed Uv-A And Oxygen Supplementation.

To Evaluate and Compare the  Effects of High fluence, Accelerated TransEpithelial Collagen Cross Linking (TECXL) performed using Pulsed UV-A light with that performed using a combination of Pulsed UV-A and Oxygen Supplementation.

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The study was a prospective,interventional,randomized controlled study which included 34 patients of progressive keratoconus.All the patients were randomized into 3 groups ,group 1 underwent TECXL using  3mW/cm²  of  continuous UVA exposure  for 30min (total fluence 5.4J/cm²)  ,group 2 underwent TECXL using 9mW/cm2 of UVA irradiance for a duration of  13.3 min (total fluence 7.2J/cm² ) with 1:1 pulsing of UVA ,group 3 underwent TECXL using 9mW/cm2 of UVA irradiance for a duration of  13.3 min (total fluence 7.2J/cm² ) with 1:1 pulsing of UVA  combined with external oxygen supplementation. Demarcation line depth was assesed using Anterior Segment Ocular coherence Tomography (ASOCT ) using Spectralis(Heidelberg engineering GmbH) .

The study included 34 cases of progressive keratoconus with a mean age of 18.44  and a male to female ratio of  3.2:1. The mean properative pachymetry in three groups was 453.33.The mean depth of demarcation line was 239,247 and 300 in Group A ,Group B and Group C respectively.The percentage of depth of demarcation line was 52.9%,53% and 67.7% in Group A,Group B and Group C respectively.

Comparing depth of demarcation line as efficacy of cross linking, high fluence accelerated pulsed TECXL with oxygen supplementation is superior to without oxygen supplementation . Transepeithelial collagen cross linking is as efficacious as conventional Epithelium-off collagen crosslinking.