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Epithelial on or epithelial off corneal collagen cross-linking: bilateral comparison study

Poster Details

First Author: E.Yuksel TURKEY

Co Author(s):    M. Cubuk   G. Yalcin   M. Ozmen   B. Aydin   K. Bilgihan  

Abstract Details


To compare the epithelial on corneal collagen cross-linking (epi on-CCL) and epithelial off corneal collagen cross-linking (epi-off CCL) in terms of clinical and confocal microscopy results




18 eyes of 9 patients with progressive keratoconus and simultaneously undergoing epi-on CCL in one eye and epi-off CCL in other eye were evaluated. Durations of corneal epithelial healing and subjective pain scores immadiately after the procedure were evaluated. Uncorrected visual acuity (UCVA) and best corrected visual acuity with spectacle (BCVA) in logMAR and topographic findings (central corneal thickness (CCT), mean keratometry (Kmean), maximum keratometry (Kmax)) were recorded at 1., 3., 6. and 12. months. Also, anterior-segment OCT (AS-OCT) and confocal microscopy (CM) was performed in for corneal stromal demarcation line and subepithelial nerve presence respectively at 1. month.


Total epithelialization was 2.7±0.4 days in Epi-on eyes, 4.2±0.6 days in Epi-off eyes (p=0.001). The mean pain score was 3.0±0.57 in Epi-on and 3.7±0.95 in Epi-off eyes on the first day (p=0.182). UCVA, BCVA, Kmean, Kmax were less than base line at 12. months for both techniques (p>0.05). Stromal demarcation line for epi-on CCL is 276.4±58.9, while 148.3±24.8 for epi-off CCL. Also, subepithelial nerve was observed in any eye in epi-off CCL, however, in epi-on CCL, subepithelial nerve was observed in 7 eye (77.8%).


Although according to the results of AS-OCT and CM showed that epi-off CCL affected more deeply and aggressively, both techniques were able to stop progression at the end of 1 year. The epithelial damage were observed in both groups, however epithelial healing time was later in epi-on CCL than epi-off CCL. The pain was felt more in epi-on CCL than epi-off CCL at first day.

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