CXL with epithelial disruption safely and effectively treats ectasia

Corneal collagen crosslinking (CXL) with epithelial disruption appears to safely and effectively treat keratoconus or iatrogenic corneal ectasia, according to a study recently published in Eye. In fact, patients may tolerate the approach better than they tolerate the technique involving complete removal of the epithelium, say the authors, from the Corneoplastic Unit and Eye Bank of Queen Victoria Hospital in East Grinstead, UK.

The researchers retrospectively reviewed case notes of 128 eyes with progressive keratoconus or iatrogenic corneal ectasia; all had undergone CXL using the technique involving the mechanical disruption of the epithelium. Thin corneas had been treated with hypotonic riboflavin; all others were treated with isotonic riboflavin.

At the 12-month point, 41.8% of patients in whom isotonic riboflavin had been used saw improved uncorrected visual acuity (UCVA), and 29.7% experienced improved best spectacle-corrected visual acuity (BSCVA). Only 13.4% lost UCVA lines, and 14.9% lost BSCVA.

At that same time point, 75% of patients treated with hypotonic riboflavin had BSCVA stability, and 25% had stable Kmax. Also, 25% of them had improved VA, and 58.3% experienced Kmax regression.

The short-term complication rate was similar to that of studies using the epithelium-off technique.