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Eye (Lond). 2015 Jun;29(6):764-8. doi: 10.1038/eye.2015.23. Epub 2015 Mar 20.

Corneal collagen crosslinking for keratoconus or corneal ectasia without epithelial debridement.

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1] The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK [2] Department of Ophthalmology, East Surrey Hospital, Surrey, UK.
The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK.
1] The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East Grinstead, UK [2] Ophthalmology Department, Worthing and St. Richards Hospital, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK.



Corneal collagen crosslinking (CXL) is a relatively new technique to reduce the progression of keratoconus. The technique can be performed with or without complete debridement of the corneal epithelium. We describe a novel intermediate technique involving mechanical disruption of the epithelium, and evaluate its safety and efficacy.


The case notes of 128 eyes with progressive keratoconus or iatrogenic corneal ectasia who had undergone CXL using the epithelial disruption technique were retrospectively reviewed. Thin corneas were treated with hypotonic riboflavin. All others were treated with an isotonic solution. Note was made of preoperative and postoperative parameters, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, and corneal tomography. Occurrence of procedure-related complications was recorded. Statistical analyses were performed using the paired sample t-test and Wilcoxon signed-rank test, with a level of P<0.05 being accepted as statistically significant.


At 12 months, 41.8% of patients treated with isotonic riboflavin had improved UCVA and 29.7% had improved BSCVA. Only 13.4% lost lines of UCVA and 14.9% lost BSCVA. Of the patients treated with hypotonic riboflavin, at 12 months, 75% demonstrated stability of BSCVA and 25% had stable Kmax. In addition, 25% showed improved visual acuity at 12 months, and 58.3% showed regression of their Kmax. Our rate of short-term complications was comparable to studies using complete epithelial removal.


CXL with epithelial disruption is a safe and effective treatment for keratoconus or iatrogenic corneal ectasia, and may be better tolerated by patients than the epithelium-off technique.

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