ESCRS - FP19.10 - Comparison Of Two Different Procedures In Keratoconus Patients With Corneas Thinner Than 400 Μm: Transepithelial Accelerated Corneal Crosslinking Versus Epi-Off Accelerated Corneal Crosslinking With Hypotonic Riboflavin

Comparison Of Two Different Procedures In Keratoconus Patients With Corneas Thinner Than 400 Μm: Transepithelial Accelerated Corneal Crosslinking Versus Epi-Off Accelerated Corneal Crosslinking With Hypotonic Riboflavin

Published 2025 - 43rd Congress of the ESCRS

Reference: FP19.10 | Type: Free paper | DOI: 10.82333/ja8f-9b41

Authors: Apeksha Manaklal Kataria* 1 , Rohit Shetty 2 , Pooja Khamar 2 , Swaminathan Sethu 3 , Arkasubhra Ghosh 3

1Cornea Refractive,Narayana Nethralaya,Bangalore,India, 2Refractive,Narayana Nethralaya,Bangalore,India, 3Research,Narayana Nethralaya,Bangalore,India

Purpose

To compare the results of transepithelial accelerated corneal cross-linking (T-CXL) and hypotonic riboflavin accelerated epi-off corneal cross-linking (H-CXL) in keratoconus patients with corneal thickness less than 400 μm.

Setting

University of Health Sciences, Beyoglu Eye Training and Research Hospital

Methods

The medical records of patients who underwent T-CXL or H-CXL with a minimum follow-up of one year were retrospectively analyzed. Preoperative and 1-year uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), thinnest corneal thickness (CT), and maximum keratometry (Kmax) values, as measured by Sirius (CSO, Italy) topography, were compared in both groups. Additionally, the number of eyes exhibiting CDVA improvement and the incidence of complications in both CXL groups were recorded.

Results

Sixty eyes of 60 patients (29 T-CXL, 31 H-CXL) were analyzed. The mean age was 24.8±5.2 years in T-CXL and 24.4±6.7 years in H-CXL (p>0.05). No significant change in UDVA or CDVA was observed preoperatively and at 1 year in either group. CDVA improved by ≥1 line in 41.4% (12/29) of T-CXL and 38.7% (12/31) of H-CXL eyes. Preoperative and 1-year Kmax ​​were 66.18±10.1 D and 66.01±10.4 D in T-CXL, and 59.76±5.5 D and 59.81±6.2 D in H-CXL (p>0.05). Kmax decreased ≥1 D in 27.6% (8/29) of T-CXL and 22.6% (7/31) of H-CXL eyes. Preoperative and 1st year CT were 359.5±21.3 μm and 357.9±25.2 μm in T-CXL (p>0.05), and 371.4±18.6 μm and 359.7±26.0 μm in H-CXL, respectively (p=0.04). Haze occurred in 3.4% (1/29) of T-CXL and 6.5% (2/31) of H-CXL eyes.

Conclusions

Both T-CXL and H-CXL demonstrated stability in visual acuity and corneal parameters at the 1-year follow-up in keratoconus patients with corneal thickness less than 400 μm. No significant differences were observed between the two groups in terms of UDVA, CDVA, or Kmax changes. While a similar proportion of eyes in both groups exhibited a CDVA improvement of at least one line, a reduction in Kmax exceeding 1 D was observed in a minority of cases. Corneal thinning was significant only in the H-CXL group. The incidence of postoperative haze was low in both groups. These findings suggest that both techniques are effective and safe for managing keratoconus in thin corneas, with comparable clinical outcomes.