Official ESCRS | European Society of Cataract & Refractive Surgeons


The ‘epi-pocket’: a new technique for corneal cross-linking

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Session Details

Session Title: Corneal Cross-Linking

Session Date/Time: Monday 16/09/2019 | 16:00-18:00

Paper Time: 17:00

Venue: South 5

First Author: : D.Borroni ITALY

Co Author(s): :    N. Menassa   K. Iselin   S. Kaye   C. De Lossada   G. Coco   V. Romano              

Abstract Details


To describe a novel surgical technique for corneal collagen crosslinking (CXL) and analyse preliminary clinical outcomes. We aimed at developing and evaluating a technique that can preserve the corneal epithelium without compromising the permeability of riboflavin into the corneal stroma.


St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom


The Epithelial-pocket is prepared by applying 18% Ethanol solution on epithelial surface followed by manual detachment of corneal epithelium with a blunt cannula through the sub-epithelial zone. Riboflavin is injected directly in the subepithelial pocket followed by UVA irradiation. Patients requiring simultaneous bilateral CXL underwent treatment with the Epi-Pocket approach in one eye and Epi-Off in the fellow eye. We compared changes from baseline at 1 month follow up in UDVA (Uncorrected Distance Visual Acuity), BCVA (Best Corrected Visual Acuity), Kmax, thinnest point in the pachymetry analysis and corneal densitometry between the two eyes using the Wilcoxon rank sum test.


Six patients were included in the analysis. At 1-month there was a positive change in the UDVA improved by 0.0± 0.19 LogMAR in EpiPocket and a negative change of 0.18±0.4LogMAR in EpiOff (p=0.384).BCVA decreased by 0.08 ± 0.15LogMAR and 0.12 ± 0.14LogMAR in the EpiPocket and EpiOff groups respectively (p = 0.623). Kmax decreased by 0.56±2.05D and 0.18±0.68D (p = 0.75). Thinnest Pentacam-Pachymetry decreased by 23.2±17.38um and 30.6±38.45um (p=0.92). Total Corneal densitometry increased by 1.425±1.05 and 0.94±1.23 in the EpiPocket and EpiOff groups respectively(p=0.46). VRS-Pain score was higher in EpiOff (8±1.56) than EpiPocket group (4±1.12).


The EpiPocket is a promising technique that allows riboflavin penetration without compromising the corneal epithelium, thus offering faster recovery and less postoperative pain for patients. More long-term studies involving larger patient cohorts are required to assess the long-term safety and efficacy of the EpiPocket CXL technique.

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