Five-Year Comparative Outcomes Of Transepithelial Versus Epithelium-Off Accelerated Corneal Crosslinking
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR186 | Type: Free paper | DOI: 10.82333/3447-f984
Authors: Dr Gizem Taskin* 1 , A/Prof. Nilay Kandemir Besek 1 , A/Prof. Ahmet Kirgiz 1 , Dr Gulay Yalcinkaya Cakir 1 , A/Prof. Sibel Ahmet 1 , A/Prof. Burcu Kemer Atik 1
1Beyoglu Eye Training and Research Hospital,Istanbul,Türkiye
Purpose
To compare the long-term visual, refractive, and topographic outcomes of transepithelial (epithelium-on) accelerated (TE-CXL) and epithelium-off accelerated corneal crosslinking (ACXL) in patients with keratoconus.
Setting
A single-center retrospective study conducted at the University of Health Sciences, Beyoglu Eye Training and Research Hospital, including patients who underwent TE-CXL or ACXL between January 2017 and January 2020.
Methods
In this retrospective comparative study, medical records of patients with keratoconus who underwent corneal crosslinking between January 2017 and January 2020 were reviewed. Eyes were divided into two groups: TE-CXL and ACXL. Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), refraction, corneal higher-order aberrations (HOAs), and corneal topographic indices including K1, K2, mean keratometry (Kmean), maximum keratometry (Kmax), central corneal thickness (CCT), thinnest corneal thickness (TCT), as well as corneal biomechanical indices (SIf, SIb, Kvf, Kvb) were analyzed preoperatively and at the 5-year postoperative follow-up.
Results
Seventy-eight eyes (41 TE-CXL, 37 ACXL) were included. At 5 years, keratometric values, CCT, TCT, VA remained stable in the TE-CXL group, while ACXL showed flattening of K1, K2, Kmean and Kmax (p<0.05) with thinning of CCT and TCT (p=0.001) and improved UDVA (p=0.035). HOA, coma, and trefoil decreased similarly in both groups, whereas spherical aberration slightly increased after TE-CXL and decreased after ACXL,with no significance. Intergroup analysis revealed mild non-significant steepening in TE-CXL (ΔK1 +0.37D, ΔKmean +0.45D) and flattening in ACXL (–0.45D,–0.75D;p=0.006,p=0.008). TCT reduction was greater after ACXL (–18.1µm vs –6.3µm;p=0.038). No significant intergroup differences were observed in VA or Δaberrometry outcomes (p>0.05).
Conclusions