Official ESCRS | European Society of Cataract & Refractive Surgeons


Central cornea regularisation and collagen cross-linking in keratoconus treatment

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Session Details

Session Title: Presented Poster Session: Corneal Cross-Linking

Venue: Poster Village: Pod 3

First Author: : F.Cifariello ITALY

Co Author(s): :    E. Tonti   R. Dell'Omo   C. Costagliola                 

Abstract Details


To evaluate safety and efficacy of a customized trans-epithelial no-touch (c-TEN) corneal regularization (CCR), planned with a minimal invasiveness, together with a simultaneous accelerated corneal collagen crosslinking (A-CXL) , to treat corneal ectasia. CCR by means of the c-TEN trans-epithelial customized corneal regularization improves the quality of vision and the simultaneous CXL procedure increases the corneal stiffness and ameliorate at same time the quality of vision achieved by means of the custom treatment.


University of Molise, Campobasso, Italy.


In our retrospective, comparative observational case series 39 patients underwent combined c-TEN central cornea regularization and A-CXL from March 2016 to May 2017. Inclusion criteria were stable keratoconus in patients characterized by deterioration of visual acuity and contact lens intolerance. All patients underwent  ophthalmologic evaluation, corrected distance visual acuity (CDVA), Scheimpflug- corneal tomography. Ablation was performed using  flying spot laser (iRES, iVIS Technology) in trans-epithelial mode (c-TEN). Subsequently, the stroma was saturated topically,  0.17% riboflavin-5-phosphate as one drop every 3 minutes and A-CXL 9mw/cm2 for 10 minutes was performed. A p value of 0.05 or less was considered statistically significant.


46 eyes of 39 keratoconus patients were submitted to combined c-TEN and A-CXL protocol. Patients were analyzed before, at 1, 3 and 6 months after surgery. At first follow-up, after 1 month from treatment, the mean CDVA increased from 0.19 ± 0.24 to 0.12 ± 0.19 (p< 0.05), the difference remained unchanged in the subsequent follow-up. Medium keratometry value (Kmed) decreased 3 months after treatment from 49.14 ± 2.2 to 47.69 ± 2.1 and the difference was statistically significant. Total corneal  higher order aberrations (HOAs) decreased significantly from 47.8 ± 28.4 to 30.4 ± 24.1 postoperatively (p < 0.01).


This report confirms that CCR combined technique of a c-TEN together with a simultaneous A-CXL seems to be safe and effective in arresting keratectasia progression and in increasing corneal optic regularity in keratoconus. This findings show a significant improvement in CDVA, keratometry values and corneal HOAs after the CCR combined treatment.

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