Posters

Mechanical epithelium removal vs transepithelial corneal cross-linking with riboflavin for keratoconus: a two-year retrospective analysis

Poster Details

First Author: D.Mathur INDIA

Co Author(s):    R. Shroff   R. Dutta   N. Shroff              

Abstract Details

Purpose:

To compare and evaluate 2 year outcomes of mechanical epithelium removal versus transepithelial technique for accelerated Corneal Crosslinking(CXL) with Riboflavin (0.1%) for keratoconus.

Setting:

Cornea and Refractive Surgery Service, Shroff Eye Centre, A-9 Kailash Colony, New Delhi – 110048, India.

Methods:

This study included 119 eyes of 85 consecutive keratoconus patients with a 2 year follow up. Group I comprised 46 patients who underwent mechanical epithelium removal with 20% alcohol. Group II comprised of 39 patients who underwent transepithelial CXL, performed, using topical anesthetic solution containing benzalkonium chloride to facilitate Riboflavin diffusion through the epithelium. The uncorrected (UDVA) and corrected (CDVA) distance visual acuity, spherical equivalent (SE), manifest astigmatism, corneal topographic and aberrometric parameters, and patient satisfaction were assessed at 3, 6, 12, and 24 months post-operatively.

Results:

At 2 years, both groups had significant improvement in UDVA (p=.026) and (p=.015) respectively. Both groups showed a significant decrease in maximum keratometry (K-Max) (p=.002) and (p=.035) and improvement of thinnest cornea (p=.046) and (p=.039). The improvement in K-Max, topographic astigmatism, and spherical aberration were significantly greater in Group I at 12 months (p=.038, p=.016, p=.042) respectively which continued until 12 months. One eye showed continued progression with worsening of CDVA in Group I. Transient corneal erosion/epitheliopathy were reported 4 eyes in Group II. Immediate improvement in post-operative visual acuity and higher patient satisfaction was seen in Group II.

Conclusions:

I At 2 years, both procedures for accelerated corneal crosslinking showed high safety and efficacy, significant improvement in visual acuity, significant keratometric flattening and high patient satisfaction. However, the mechanical removal group showed a significantly more heightened  reaction to the crosslinking. Patient satisfaction was higher in the transepithelial group in the immediate post-operative period comparable at 2 years.

Financial Disclosure:

None