RESUMEN
PURPOSE: To evaluate the efficacy of epithelial-disruption collagen crosslinking (CXL) for progressive keratoconus using a corneal disruptor device and a riboflavin solution designed for a transepithelial technique. SETTING: Magna Graecia University Eye Clinic, Catanzaro, Italy. DESIGN: Prospective comparative case series. METHODS: The most severely affected eye of patients with bilateral progressive keratoconus was treated. The fellow eye served as a control. Follow-up was 12 months. A corneal disruptor device was used to create pockmarks in the epithelium. Riboflavin solution was applied for 30 minutes and irradiation for 30 minutes. Three days postoperatively, patients were asked to assess the level of pain. RESULTS: The study comprised 28 patients (mean age 28 years). The mean postoperative pain score was 4.3, 2.6, and 2.1 at 1 day, 2 days, and 3 days. The mean preoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities improved from 0.73 logMAR ± 0.21 (SD) and 0.30 ± 0.11 logMAR to 0.48 ± 0.15 logMAR and 0.25 ± 0.1 logMAR, respectively, at 12 months (P=.02). The mean spherical equivalent refraction decreased 0.96 diopter (D). The mean baseline apical keratometry, apical gradient curvature, average pupillary power, inferior-superior index, and cone area were 59.21 D, 8.91 D, 47.9 D, 11.49 mm(2), and 10.32 mm(2), respectively. At 12 months, these values were 56.18 D, 7.32 D, 41.34 D, 9.65 mm(2), and 7.75 mm(2), respectively. No adverse effects were observed. CONCLUSIONS: Corneal epithelial-disruption CXL was safe and effective in medium-term stabilization of keratoconus with an improvement in topographic and refractive parameters and less patient discomfort.
