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Simultaneous transepithelial intratunnel cross-linking with ICRS implantation vs simultaneous epi-off cross-linking with ICRS implantation for keratoconus management

Poster Details

First Author: M.Nour EGYPT

Co Author(s):    M. Hosny   S. Azzam   M. Salem   E. Elmayah           

Abstract Details


To compare the efficacy of the intra tunnel cross linking combined with ICRS versus combined epi-off cross linking and ICRS for management of Keratoconus.


Dar Eloyoun Eye Hospital, Egypt


Prospective, randomized, interventional comparative clinical cohort study, included 20 eyes of 12 patients . Inclusion criteria keratoconus grade II to III , contact lens intolerance ,corneal thickness at the thinnest point >400 um , clear cornea. Patients randomly divided into 2 groups . Group (A) underwent simultaneous ICRS with intra tunnel cross linking, Group (B) underwent simultaneous ICRS with epithelial–off cross linking . The following examinations were performed before surgery and 6 months postoperatively: (UCVA), (CDVA), manifest refraction, slit lamp bio-microscopy, indirect ophthalmoscopy, (IOP) by tonometry. Scheimpflug imaging with Pentacam, corneal hysteresis by ORA


comparison between the results of epi off CXL and intra tunnel CXL and their significance Mean difference between 2 groups P value Km 1.39 0.312 Kmax 0.412 0.857 Apex 6.3 0.620 Thinnest 3.8 0.780 UCVA 0.03 0.798 CDVA -0.14 0.126 Sphere 2.07 0.111 Cylinder 0.25 0.773 CH 0.11 0.633 CRF 0.31 0.313


Improvement in the UCVA, CDVA, manifest refraction , keratometric values in our study suggest that simultaneous treatment might have better results than sequential treatment but larger sample sizes and longer follow-up are needed. The non-significant difference between both groups widen the horizon of use of intratunnel CXL as a substitute of epi-off CXL when rapid visual recovery is needed or fear of epithelial defect is present. When we combined ICRS with Intratunnel riboflavin injection, we obtained direct riboflavin penetration into the stroma without removing epithelium. To our mind this is the first randomized study to compare both techniques.

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