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A Journal on Ophthalmology
Minerva Oftalmologica 2010 June;52(2):65-76
Collagen crosslinking without corneal de-epithelialization
M. Filippello, E. Stagni
Casa di Cura Di Stefano Velona, Catania, Italy
Aim. The aim of this paper was to evaluate the effectiveness of transepithelial crosslinking (TE CXL) in patients with bilateral progressive keratoconus.
Methods. The study population was patients with a history of bilateral progressive keratoconus. The worse eye was treated; the untreated fellow eye served as control. TE CXL was performed stepwise in six steps of irradiation delivered by a laser source (CBM X-linker VEGA®) and application of Ricrolin TE® (0.1% riboflavin, dextrane T500, and enhancers to facilitate passage of the solution through the corneal epithelium) every 5 minutes, 2 hours before imbibtion with Ricrolin TE® in the worse eye.
Results. A gradual improvement in topographic and abberometric values, without postoperative corneal haze or other side effects, was noted in the TE-CXL-treated eyes; all indices deteriorated in the control eyes.
Conclusion. TE CXL treatment was found to be effective in slowing keratoconus progression, with a statistically significant improvement in parameters. Thanks to transepithelial treatment and absence of side effects, TE CXL permits treatment of keratoconus in cases of corneal thickness <400 micron; “complicated” patients <12 years of age (e.g., trisomy 21 syndrome); patients aged ≥35 years or with a mean K >55. Unlike conventional CXL, TE CXL, because it spares the epithelium, ensures better patient compliance, without postoperative pain or haze or deterioration of vision. TE CXL is an innovative treatment that acts on the anterior third of cornea, without side effects; as it is simple to perform, it can be used in conjunction with conventional CXL, which acts on the posterior third of cornea.