International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 5 , ISSUE 3 ( September-December, 2016 ) > List of Articles


Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking

Rafael J Pérez-Cambrodí, Pedro Ruiz-Fortes, Alberto Artola

Citation Information : Pérez-Cambrodí RJ, Ruiz-Fortes P, Artola A. Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking. Int J Kerat Ect Cor Dis 2016; 5 (3):93-98.

DOI: 10.5005/jp-journals-10025-1128

Published Online: 01-12-2011

Copyright Statement:  Copyright © 2016; The Author(s).



To assess the clinical outcomes in ectatic corneas following accelerated transepithelial cross-linking (CXL) over 1 year of follow-up.

Materials and methods

Twenty-one eyes diagnosed with progressive corneal ectasia (19 keratoconus, 2 post-laser in situ keratomileusis ectasias) in 14 patients aged between 26 and 69 years were enrolled. All cases were treated with accelerated transepithelial CXL using the Avedro KXL® system (Waltham, MA, United States). Changes at visual, refractive, corneal topographic, and corneal aberrometric level were evaluated over a 12-month follow-up period. The demarcation was also determined using optical coherence tomography (OCT).


The mean depth of the demarcation line measured by OCT was 202.72 µm, varying between 153 and 230 µm. One month postsurgery, a change was noted at the limit of statistical significance in sphere (p = 0.05) and in spherical equivalent (p = 0.05). Likewise, a statistically significant difference was observed in corrected distance visual acuity (CDVA) (p = 0.01). There were no significant changes in either visual acuity or refraction between 1 and 6 months (p ≥ 0.35). Although changes in trend were observed in corneal topographic and aberrometric parameters after surgery, none reached statistical significance (p ≥ 0.08). A significant change was observed only in astigmatism of the posterior surface between 1 and 12 months (p = 0.02).


Accelerated transepithelial CXL may be a useful technique for the management of progressive corneal ectasia, as it is able to maintain the topographic and aberrometric profile of the cornea with no significant changes. Longer-term studies are required to confirm this finding

How to cite this article

Piñero DP, Artola A, Ruiz-Fortes P, Soto-Negro R, Pérez-Cambrodi RJ. Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking. Int J Kerat Ect Cor Dis 2016;5(3):93-98.

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  1. Corneal collagen cross-linking: a review. J Optom 2014 Jul;7(3):113-124.
  2. Topographic, corneal wavefront, and refractive outcomes 2 years after collagen crosslinking for progressive keratoconus. Cornea 2014 Jan;33(1):43-48.
  3. Effective corneal collagen crosslinking in advanced cases of progressive keratoconus. J Cataract Refract Surg 2013 Aug;39(8):1141-1145.
  4. Visual recovery after corneal crosslinking for keratoconus: a 1-year follow-up study. Graefes Arch Clin Exp Ophthalmol 2013 Mar;251(3):803-807.
  5. Corneal collagen crosslinking in progressive keratoconus: multicenter results from the French National Reference Center for Keratoconus. J Cataract Refract Surg 2011 Dec;37(12):2137-2143.
  6. Vectorial astigmatic changes after corneal collagen crosslinking in keratoconic corneas previously treated with intracorneal ring segments: a preliminary study. Eur J Ophthalmol 2012;22(Suppl 7):S69-S80.
  7. Corneal topography indices after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 2011 Jul;37(7):1282-1290.
  8. Br J Ophthalmol 2011 Apr;95(4):493-497.
  9. Contralateral eye study of corneal collagen cross-linking with riboflavin and UVA irradiation in patients with keratoconus. J Refract Surg 2009 Apr;25(4):371-376.
  10. A randomized controlled trial of corneal collagen cross-linking in progressive keratoconus: preliminary results. J Refract Surg 2008 Sep;24(7):S720-S725.
  11. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cataract Refract Surg 2008 May;34(5):796-801.
  12. Corneal collagen crosslinking with riboflavin and ultraviolet A to treat induced keratectasia after laser in situ keratomileusis. J Cataract Refract Surg 2007 Dec;33(12):2035-2040.
  13. Riboflavin/ultraviolet-a- induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 2003 May;135(5):620-627.
  14. Transepithelial corneal collagen crosslinking for keratoconus: qualitative investigation by in vivo HRT II confocal analysis. Eur J Ophthalmol 2012;22(Suppl 7):S81-S88.
  15. Biomechanical and histological changes after corneal crosslinking with and without epithelial debridement. J Cataract Refract Surg 2009 Mar;35(3):540-546.
  16. Corneal crosslinking: riboflavin concentration in corneal stroma exposed with and without epithelium. J Cataract Refract Surg 2009 May;35(5):893-899.
  17. Cross-linking in progressive keratoconus using an epithelial debridement or intrastromal pocket technique after previous corneal ring segment implantation. J Refract Surg 2011 Oct;27(10):737-743.
  18. Corneal crosslinking and visual rehabilitation in keratoconus in one session without epithelial debridement: new technique. Cornea 2010 Oct;29(10):1176-1179.
  19. Accelerated versus standard corneal collagen crosslinking combined with same day phototherapeutic keratectomy and single intrastromal ring segment implantation for keratoconus. Br J Ophthalmol 2015 Feb;99(2):155-159.
  20. Biomechanical changes in the human cornea after transepithelial corneal crosslinking using iontophoresis. J Cataract Refract Surg 2014 Oct;40(10):1706-1715.
  21. Transepithelial corneal collagen crosslinking for progressive keratoconus: 24-month clinical results. J Cataract Refract Surg 2013 Aug;39(8):1157-1163.
  22. Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas. Clin Ophthalmol 2012;6:1785-1792.
  23. Transepithelial corneal collagen crosslinking: bilateral study. J Cataract Refract Surg 2012 Feb;38(2):283-291.
  24. Transepithelial corneal collagen crosslinking for keratoconus: six-month results. J Cataract Refract Surg 2014 Dec;40(12):1971-1979.
  25. Pulsed vs continuous light accelerated corneal collagen crosslinking: in vivo qualitative investigation by confocal microscopy and corneal OCT. Eye (Lond) 2014 Oct;28(10):1179-1183.
  26. Advanced corneal cross-linking system with fluorescence dosimetry. J Ophthalmol 2012;2012:303459.
  27. Refractive and topographic results of benzalkonium chloride- assisted transepithelial crosslinking. J Cataract Refract Surg 2012 Jun;38(6):1000-1005.
  28. Keratoconus. Surv Ophthalmol 1998 Jan-Feb;42(4):297-319.
  29. Clinical characterization of corneal ectasia after myopic laser in situ keratomileusis based on anterior corneal aberrations and internal astigmatism. J Cataract Refract Surg 2011 Jul;37(7):1291-1299.
  30. BAC-EDTA transepithelial riboflavin-UVA crosslinking has greater biomechanical stiffening effect than standard epithelium-off in rabbit corneas. Exp Eye Res 2014 Aug;125:114-117.
  31. Transepithelial versus conventional corneal collagen crosslinking: a randomized trial in keratoconus. Oman J Ophthalmol 2015 Jan-Apr;8(1):9-13.
  32. Optical coherence tomography and confocal microscopy following three different protocols of corneal collagen-crosslinking in keratoconus. Invest Ophthalmol Vis Sci 2014 Oct;55(11):7601-7609.
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