Official ESCRS | European Society of Cataract & Refractive Surgeons


Delayed re-epithelialization after epithelium-off cross-linking: predictors and impact on keratoconus progression

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Session Details

Session Title: Presented Poster Session: Corneal Cross-Linking

Venue: Poster Village: Pod 3

First Author: : C.Bonzano ITALY

Co Author(s): :    C. Cutolo   D. Musetti   C. Traverso                 

Abstract Details


Corneal collagen crosslinking (CXL) is a safe procedure for the treatment of progressive keratoconus (KC). Delayed re-epithelialization (DRE) is a possible complication of epithelium-off CXL (epi-off CXL). This study aims to investigate the demographic and corneal factors associated with DRE.


Clinica Oculistica, University of Genoa.


A retrospective chart review was performed to identify patients treated with epi-off CXL at Clinica Oculistica, University of Genova, Italy. A bandage contact lens was always fitted for 3-5 days after CXL to reduce discomfort and to promote epithelial healing. DRE was defined as a corneal epithelial defect, detected by fluorescein staining, that persisted more than 10 days. Slit-lamp examination, anterior segment optical coherence tomography (AS-OCT), corneal topography and, corneal in-vivo confocal microscopy (IVCM) were always performed preoperatively and at each follow-up visit (1, 3, 6, 12 months). Logistic regression was used to assess the baseline factors associated with DRE.


Data from 153 eyes were included. The mean patients’ age was 24.9±8.5 years, and 47 (30.7%) were females. The average re-epithelization time was 4.7 ± 1.8 days. Six eyes (3.9%) experienced DRE. In the multivariate logistic model, both the patient’s age (OR=1.30, 95% CI 1.1 to 1.6; p=0.019) and the corneal steepest meridian readings (OR=0.44, 95% CI 0.19 to 0.99, p=0.046) were associated with DRE. Male gender was associated with a slower early nerve regrowth (1 to 6 months) (p=0.048) but not with the occurrence of DRE (p=0.271). Preoperative central corneal thickness was not related with DRE (p=0.066).


The association between DRE and age may reflect the age-related decrease in the corneal healing response. Gender seems to affect re-innervation measured by IVCM but not the re-epithelization time. DRE does not seem to affect the efficacy of epi-off CXL treatment.

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