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Custom-fast Cross-linking procedure in Thinner Corneas (<400 µm): an In-vitro study

Poster Details

First Author: C.Caruso ITALY

Co Author(s):    C. Caruso   L. Pacente   S. Troisi   S. Bartoliino   C. Costagliola        

Abstract Details


To assess the thickness variations in corneas thinner than 400µ, affected by progressive keratoconus, after a custom fast EPI-ON cross-linking treatment and to evaluate the ultra-structural effects of this procedure with scanning electron microscopy


Pellegrini Hospital ASL NA 1 and Institutional Review Board (IRB)/Ethics Committee approval was obtained (authorization n. 1269)


We used 20 corneal buttons obtained from penetrating keratoplasty; we used samples with homogeneous thickness (mean SD: 3.55µ). The buttons were mounted on a Franz Cell, and standard measure points were identified and marked on the surface. Corneal thickness was measured at every point. After soaking with riboflavin solution, the left half of the corneal surface was covered, leaving the right side exposed to UV-A radiation (average intensity of 1.8 ± 0.9 mW / cm2 for 10 ± 1.5 min). After the irradiation step, we measured again the thickness at every point


UV-A exposed areas showed a significant reduction in thickness compared with both pre-treatment areas (average -20.47µ, P=0.006) and contralateral covered areas (average – 19.58µ, P=0.009). The UV-A unexposed areas showed a minimal reduction in thickness compared to the same pre-treatment areas (average -1.42µ). No significant differences in thickness reduction were noticed between upper and lower exposed areas (P=0.17) Scanning electron microscopy examination showed stromal fibers compacting in the exposed areas, with a higher organized appearance of the collagen fibers compared to non-exposed areas. After the procedure, the endothelium showed a normal structure and no cellular loss


The custom-fast epi-on procedure seems to be an effective protocol for cross-linking in corneas thinner than 400µ; it appears to be a safe procedure for the corneal endothelium, with the advantages of keeping an intact epithelium while reducing treatment time

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