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Customized epithelial debridement for thin ectatic corneas undergoing corneal cross-linking: epithelial island cross-linking technique

Authors Mazzotta C, Ramovecchi V

Received 17 April 2014

Accepted for publication 20 May 2014

Published 17 July 2014 Volume 2014:8 Pages 1337—1343

DOI https://doi.org/10.2147/OPTH.S66372

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Cosimo Mazzotta,1 Vincenzo Ramovecchi2

1Unità Operativa Complessa di Oculistica, Siena University Hospital, Siena, Italy; 2Unità Operativa Complessa di Oculistica, San Severino Marche Hospital, San Severino Marche, Italy

Abstract: Thin corneas with a minimum corneal thickness less than 400 µm after epithelial removal represent a contraindication to standard epithelium-off cross-linking (CXL) treatment due to a significant endothelial cell density decrease and potentiality of permanent haze development. Preoperative swelling of the cornea with hypoosmolar riboflavin solutions broadens the spectrum of CXL indications to thin corneas. However the iatrogenic swelling effect might not be durable throughout the CXL procedure increasing the risk of postoperative complications. The transepithelial CXL technique proposed for thin corneas demonstrated poor clinical results and mid- to long-term keratoconus instability. The epithelial island CXL technique with customized pachymetry-guided epithelial debridement was evaluated by means of in vivo laser scanning confocal microscopy, corneal topography, and clinical examination in a 1-year follow-up, in order to assess if it may be considered an alternative surgical option for keratoconic patients with thin corneas undergoing corneal collagen CXL. According to our clinical and in-vivo micro-morphological results the technique results safe, and efficacious in stabilizing progressive keratoconus and may be considered a valid option in the treatment of thin ectatic corneas alone or in combination with hypoosmolar or dextran-free riboflavin solutions.

Keywords: cross-linking, keratoconus, thin corneas, epithelial island, surgical technique

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