Epi-keratoplasty Versus Collagen Cross-Linking in Progressive Keratoconus

Keratoconus is a bilateral corneal ecstatic disease which is not uncommon and always behaves progressively and results in visual impairment by inducing irregular astigmatism and corneal opacities.

Collagen Cross-Linking (CXL) is widely used in progressive keratoconus. The cornea is soaked with a riboflavin solution and then being exposed to ultraviolet-A radiation. The performance creates links between collagen fibrils in order to rigidify the corneal stroma and slow down the progression of keratoconus. However, the effectiveness is not satisfied and accompanied with risks of side effects and serious complications, such as pain for the first two post-operative days, temporary loss of visual acuity during the first three months, infection and stromal opacity due to corneal scarring.

Epi-keratoplasty is a reversible technique in which a corneal graft is transplanted on the recipients' eye with only removal of the epithelium of the receptor cornea. The procedure was assisted by femtosecond laser which allows precisely and neatly cutting. The graft strengths the whole host corneal rigidity and roughness and therefore renders the progression of keratoconus.

Inclusion Criteria:

• diagnosis of Keratoconus
• Age ≥ 18 years old
• Corneal thickness ≥ 400 µm
• Progressive stage 1 to 3 keratoconus (Krumeich classification)

Exclusion Criteria:

• Corneal thickness < 400µm
• Concomitant corneal disease
• History of corneal surgery

undecided