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Journal of Ophthalmology
Volume 2012, Article ID 498435, 8 pages
Research Article

Safety and Efficacy of Epithelium-On Corneal Collagen Cross-Linking Using a Multifactorial Approach to Achieve Proper Stromal Riboflavin Saturation

1Department of Ophthalmology, University Hospital of North Norway, Fløyvn. 32, Tromsdalen, 9020 Tromsø, Norway
2SynsLaser Kirurgi, 9008 Tromsø and 0159 Oslo, Norway
3School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical College, Zhejiang, Wenzhou 325003, China
4University of Tromsø, 9037 Tromsø, Norway
5Department of Ophthalmology, Stavanger University Hospital, 4011 Stavanger, Norway
6Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
7Department of Medical Biochemistry, Oslo University Hospital, 0424 Oslo, Norway

Received 3 February 2012; Accepted 10 June 2012

Academic Editor: Andrew G. Lee

Copyright © 2012 Aleksandar Stojanovic et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. To evaluate the efficacy and safety of epithelium-on corneal collagen cross-linking (CXL) using a multifactorial approach to achieve proper stromal riboflavin saturation. Methods. This non-randomized retrospective study comprised 61 eyes with progressive keratoconus treated with epithelium-on CXL. Chemical epithelial penetration enhancement (benzalkonium chloride-containing local medication and hypotonic riboflavin solution), mechanical disruption of the superficial epithelium, and prolongation of the riboflavin-induction time until verification of stromal saturation were used before the UVA irradiation. Uncorrected and corrected distance visual acuity (UDVA, CDVA), refraction, corneal topography, and aberrometry were evaluated at baseline and at 1, 3, 6, and 12 months postoperative. Results. At 12-month, UDVA and CDVA improved significantly. None of the eyes lost lines of CDVA, while 27.4% of the eyes gained 2 or more lines. Mean spherical equivalent decreased by 0.74 D, and mean cylindrical reduction was 1.15 D. Irregularity index and asymmetry from Scheimpflug-based topography and Max-K at the location of cone from Placido-based topography showed a significant decrease. Higher-order-aberration data demonstrated a slight reduction in odd-order aberrations S 3, 5,7 ( 𝑃 = 0 . 0 4 ). Postoperative pain without other complications was recorded. Conclusion. Epithelium-on CXL with our novel protocol appeared to be safe and effective in the treatment of progressive keratoconus.