Epithelial Flap Corneal Cross-Linking

Published 2022 - 40th Congress of the ESCRS

Reference: FPS10.09 | Type: Free paper | DOI: 10.82333/gsze-kt61

Authors: Davide Borroni* ¹ , Chiara Bonzano ² , Maria Garcia Lorente ³ , Fernando Godin ⁴ , Jose'-Maria Sánchez-González ⁵ , Marina Rodríguez-Calvo-de-Mora ³ , Rahul Rachwani-Anil ⁶ , Francisco Zamorano-Martin ⁷ , Jorge Pereza-Nieves ⁸ , Marco Di Maita ⁹ , Carlos Rocha de Lossada ¹⁰

¹Ophthalmology,VISIA CLINIC,MILAN,Italy, ²Ophthalmology,DiNOGMI, University of Genoa and IRCCS San Martino Polyclinic Hospital,Genoa,Italy, ³Department of Ophthalmology,Hospital Regional Universitario Málaga,Malaga,Spain, ⁴Department of Ophthalmology,Universidad el Bosque ,Bogota',Colombia, ⁵Department of Physics of Condensed Matter,University of Seville,Seville,Spain, ⁶Department of Ophthalmology,Hospital of Antequera,Malaga,Spain, ⁷Deparment of Ophthalmology ,Hospital Clinic of Barcelona,Barcelona,Spain, ⁸Department of Ophthalmology ,Hospital Regional Universitario Málaga,Malaga,Spain, ⁹ADVALIA ,MILANO,Italy, ¹⁰Department of Ophthalmology ,University Hospital Virgen,Granada,Spain

Purpose

To compare standard epithelium-off corneal cross-linking (standard Epi-Off CXL) to corneal cross-linking

with an epithelial flap (Epi-Flap CXL).

Setting

1 Department of Doctoral Studies, Riga Stradins University, Riga, Latvia;

2 DiNOGMI, University of Genoa and IRCCS San Martino Polyclinic Hospital, Genoa, Italy

3 Department of Physics of Condensed Matter. University of Seville, Seville, Spain.

4 Hospital of Antequera, Malaga, Spain

5 Hospital Clinic of Barcelona, Barcelona, Spain

6 Hospital Regional Universitario Málaga, Málaga, Spain

Methods

Patients who had undergone sequential bilateral CXL for progressive keratoconus were included in this com

parative interventional case series. One eye was treated with the Epi-Off CXL technique and the fellow eye with the Epi-Flap CXL technique. Postoperative pain was measured using the Verbal Rating Scale and corneal densitometry using a Scheimpflug camera. Sex, age, corrected distance visual acuity, keratometry, and corneal thickness were also recorded.

Results

24 eyes of 12 patients with keratoconus with a mean age of 27.15 ± 5.15 years were included. The Verbal Rating Scale scores were significantly lower in patients who had Epi-Flap CXL on the first (1.00 [interquartile range (IQR): 0.00 to 1.00] vs 3.00 [IQR: 3.00 to 3.75], P = .01) and third (0.00 [IQR: 0.00 to 1.00] vs 1.00 [IQR:0.00 to 1.00], P =.01) postoperative day compared to the Epi-Off CXL group. No pain was observed in both groups after the third day. After 12 months, the Epi-Flap CXL group showed significantly less anterior corneal haze (measured as corneal densitometry) compared to the patients treated with Epi-Off CXL (P = .01).Both groups demonstrated stability of keratometry and corneal thickness at 12 months after CXL (P < .01)

Conclusions

Epi-Flap CXL is associated with less postop erative pain and anterior stromal haze in patients undergoing

CXL for progressive keratoconus with no loss of efficacy.