Epi-off corneal collagen crosslinking outperforms accelerate
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Researchers compared the 5-year efficacy and safety of accelerated transepithelial (epi-on) and standard (epi-off) corneal collagen crosslinking (CXL) in children with progressive keratoconus. Standard epithelial-off corneal collagen crosslinking appears to be safer and more effective in flattening keratometry and halting progression compared with accelerated transepithelial corneal collagen cross-linking in the pediatric population.

This single-center, prospective, cohort study included 78 eyes of pediatric patients who underwent epi-on corneal collagen crosslinking or epi-off corneal collagen crosslinking for progressive keratoconus. Thirty-two eyes underwent epi-on corneal collagen crosslinking (30 minutes of impregnation followed by 5 minutes of irradiation at 18 mW/cm2) and 46 underwent epi-off corneal collagen crosslinking (30 minutes of impregnation followed by 30 minutes of irradiation at 3 mW/cm2). Visual acuity, refraction, keratometry, and pachymetry were evaluated pre-and postoperatively at 1 and 5 years.

Both groups experienced a mean improvement in BCVA at 5 years, but 3 eyes that progressed in the epi-on corneal collagen crosslinking group lost lines of BCVA compared with no loss of BCVA in the standard epi-off corneal collagen crosslinking group. The cylinder in the epi-off corneal collagen crosslinking group significantly decreased by 0.66 D and 0.89 D at 1 and 5 years, respectively, while there was no change in a cylinder in the epi-on corneal collagen crosslinking group. By 5 years, there was significantly more flattening in mean keratometry in the epi-off group than in the epi-on group. Three of the 32 eyes (9.37%) in the epi-on group experienced Kmax progression greater than 1 D—all of which were noted by 1 year—whereas none of the eyes in the epi-off group experienced Kmax progression greater than 1 D at 5 years.

Source:https://www.aao.org/editors-choice/epi-off-cxl-outperforms-accelerated-epi-on-cxl-in-
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