Transepithelial Iontophoresis Versus Standard Corneal Collagen Cross-linking: 1-Year Results of a Prospective Clinical Study

PURPOSE: To compare 1-year transepithelial corneal collagen cross-linking with iontophoresis (I-CXL) outcomes with standard CXL (S-CXL) epithelium-off for progressive keratoconus. METHODS: Forty eyes of 40 patients with progressive keratoconus were included in this comparative, prospective clinical study. Corrected distance visual acuity (CDVA), spherical equivalent, cylinder refraction, corneal topography, Scheimpflug tomography, aberrometry, and endothelial cell count were assessed at baseline and at 1, 3, 6, and 12 months of follow-up. RESULTS: Patients received either I-CXL (20 eyes) or S-CXL (20 eyes). Functional parameters (visual acuity and aberrometry) showed a significant improvement ( P < .05) after 6 and 12 months of follow-up in both groups. In the I-CXL group, the CDVA showed a rapid recovery of vision after 3 months ( P = .01) compared to baseline. Morphological parameters showed a significant reduction of maximum keratometry in the S-CXL group by −1.05 ± 1.51 diopters (D) after 12 months, whereas the I-CXL group curvature was stable (−0.31 ± 1.87 D). Minimum pachymetry values were stable even after 12 months of follow-up in the I-CXL group, whereas a significant corneal thinning 12 months following treatment was recorded in the S-CXL group ( P < .001). None of the patients had continuous progression of keratoconus or had to repeat CXL procedures. Endothelial cell counts did not change significantly ( P > .05). CONCLUSIONS: The 1-year outcomes suggest that I-CXL might be comparable to S-CXL in stabilizing the progression of the degenerative ectatic disease. Additionally, quicker improvement of functional parameters was reported in the I-CXL group. [ J Refract Surg. 2016;32(10):672–678.]