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ORIGINAL ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 4  |  Page : 228-236

Standard versus transepithelial collagen cross-linking in the management of keratoconus


1 Department of Ophthalmology, Al Azhar faculty of Medicin, Al Zagazig University, Cairo, Egypt
2 Professor of ophthalmology, ophthalmology department, Al Azhar faculty of Medicin, Al Zagazig University, Cairo, Egypt

Correspondence Address:
Abd El-Magid M Tag El-Din
Flat 602, Building 13, Omar Zaafan Street, First District, Nasr City, Cairo 11765
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DJO.DJO_32_18

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Objective The aim of this study was to compare corneal collagen cross-linking (CXL) using either standard or transepithelial CXL. Patients and methods The study included 30 eyes of 18 patients with a mean age of 27.08 years. They were seven women and 11 men. Eyes were divided into two groups. Group I: included 15 eyes that underwent standard CXL after removal of the epithelium. Group II: included 15 eyes that underwent CXL with the epithelium intact. The patients were followed up postoperatively at 1 week, 1 month, 3 months, and 6 months for their uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), pentacam, ocular response analyzer, and specular microscopy. Results The preoperative mean keratometry (K) max was 47.9 diopters (D). Preoperative mean astigmatism was −3.75 D and mean pachymetry of the corneal center was 467.1 µm. The mean preoperative UCVA for group I was 0.118±0.05 and the mean postoperative UCVA at the 6-month visit was 0.26±0.18. In group II the mean preoperative UCVA was 0.278±0.14 and the postoperative UCVA at 6 months was 0.408±0.3. The mean preoperative BSCVA for group I was 0.218±0.204, while the mean postoperative BSCVA at the 6-month visit was 0.48±0.18. The mean preoperative BSCVA for group II was 0.6±0.305 while the mean postoperative BSCVA at 6 months was 0.745±0.21, There was a statistically significant difference between the two groups regarding UCVA improvement. However, there was a statistically nonsignificant difference between the two groups regarding BSCVA improvement. Comparing the change in mean spherical equivalent between the two groups, it was found statistically significant (P=0.04). On the other hand, comparing that of corneal astigmatism, it was statistically nonsignificant. Pentacam revealed a mean preoperative Kmax of 48.06±5.05 D. The mean postoperative Kmax at 1 month was 47.1±5.6 D. The mean postoperative Kmax at 3 months was 45.75±5.1 D and at 6 months was 45.725±4.49 D. There was a statistically significant difference between mean preoperative and mean postoperative Kmax. A nonsignificant corneal thinning with a mean pachymetry of 433.78±46.71 µm was observed. Conclusion There was significant difference between standard and transepithelial cross-linking with better results with the standard cross-linking, but with satisfactory results of both methods.


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