ESCRS - POCOR392 - Epithelium-On Vs Epithelium-Off Corneal Cross Linking In Pediatric And Young Patients With Keratoconus : A Comparative Study Of Clinical And Topographical Outcomes ,Conducted By A Young Ophthalmology Resident

Epithelium-On Vs Epithelium-Off Corneal Cross Linking In Pediatric And Young Patients With Keratoconus : A Comparative Study Of Clinical And Topographical Outcomes ,Conducted By A Young Ophthalmology Resident

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR392 | Type: Free paper | DOI: 10.82333/bedk-xf42

Authors: Dr Aguenaou Sarah* 1 , A/Prof. El hassan Abdallah 1 , A/Prof. ibrahimi fatema 2

1ophtalmologie b ,hsr,rabat,Morocco, 2ophtalmologie b,hsr,rabat,Morocco

Purpose

to compare the long -term clinical efficacy and safety of transepithelial (epi-on) versus standard epithelium-off( epi-off) corneal  cross-linking (cxl) for stabilizing progressive keratoconus in a young population (aged 12-21 years)

Setting

prospective study of 30 patients at the ophtalmology department of hopital des specialites de rabat 

Methods

a prospoective comparative study included 60 eyes of 30 patients with documented progressive keratoconus (from 12 years to 21 years old)

One eye receives Epi-On  ( group1) and the other Epi-Off  ( group2)to eliminate individual genetic bias.

 
 

-group 1: epi-off : standard Dresden protocol 3mW/cm2 for 30 min 

-group2(epi-on) : transepitgelial cxl using enhanced riboflavin penetration (riboflavine pre-enriched with 0,02% benzakonium chloride : BAC ) as a penetration enhancer to overcome the epithelial barrier 

main outcome measures included : corrected distance visual acuity , maximum keratometry (kmax), central corneal thickness,and endothelial cell density at baseline: 6,12,and 24months . Demarcation line depth was assessed by As-oct at 1 month

Results

both groups showed stabilization of kmax at 12 months ( mean change: groupe 1: -1,2+/- 0,8 ;  groupe2 : -0,6+/-0,9 ,  p>0,05).  at 24 months , group 1 (epi off) showed slightly superior flattening of kmax compared to group 2. corrected distance visual acuity remained stable or improved in both groups . the demarcation line was significantly deeper in the epi-off group (290+/-45 um) vs epi-on (210 +/-38. um). Post operative pain scores (VAS) were significantly lower in the Epi on group : The pain experienced, the return to school, and sport activities were immediate for the Epi-On group,  allowing a better quality of life for these patients. No significant endothelial loss  or permanent haze was observed in either group 

Conclusions

both epi off and epi on CXL effectively stabilize progressive keratoconus in young patients over 2 year period . while epi off cxl achieves a deeper corneal effect and slightly better flattening , epi on cxl offers a superior safety profile and faster visual recovery , making it a viable alternative for young patients with lower pain tolerance