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Bilateral epi-off corneal cross-linking for keratoconus in adult patients

Poster Details

First Author: F.Hafezi SWITZERLAND

Co Author(s):    L. Kollros   E. Torres-Netto   F. Gilardoni   R. Abrishamchi   H. Abdshahzadeh   N Hafezi     

Abstract Details


Corneal cross-linking for keratoconus is a well-established procedure to halt the progression of corneal ectasias. Since the introduction of CXL into clinical ophthalmology in 2002, the procedure was usually been performed unilaterally. This approach was mainly a precautionary measure because little was known at the time regarding the long-term effect of UV-A irradiation on the cornea, the risk of postoperative infection, and the overall complication rate and safety profile. Today, CXL is a well-studied and established method with a low risk profile. Here, we investigated whether epithelium-off CXL may also be performed bilaterally.


The study was conducted at the ELZA Institute AG, Dietikon, Switzerland.


Bilateral CXL was performed as follows: following abrasio of the first eye, the 20-minute riboflavin instillation was started and abrasio of the second eye was commenced immediately. After abrasio of the second eye, riboflavin instillation was commenced, with a delay of approximately 6 minutes to the first eye. UV-A irradiation was performed using 9 mW/cm2 for 10 minutes. At the same time, riboflavin soaking of the second eye was continued for another 10 minutes, followed by UV-A irradiation. Following irradiation, moxifloxacin and dexamethasone eyedrops were applied and a bandage contact lens was placed onto the cornea.


We performed bilateral epi-off CXL in 20 eyes of 10 patients. Age ranged from 24 to 56 years (mean age 42.7 years). Nine patients were male and 1 patient was female. Twelve eyes had keratoconus, 4 eyes had PMD and 4 eyes had ectasia after LASIK. The postoperative period was uneventful in all cases. Specifically, no cases of infection were observed.


Bilateral epithelium-off CXL in adult patients seems to be well-tolerated and substantially reduces time to recovery and overall costs related to the technique.

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