Transepithelial Customized Cross-linking

Epithelium-on Customized Cross-linking for Keratoconus

Customized remodeled vision (CuRV) is a new corneal cross-linking protocol for keratoconus, combining a transepithelial approach with customized energy application. Our aim is to follow-up our patients and establish the short-and long-term results of CuRV.

Customized remodeled vision is a protocol for oxygen-boosted, tranespithelial cross-linking, customized to apply higher energy at the apex of the cone, relatively lower to the cone area and none to healthy cornea. Thus CuRV promises to halt keratoconus progression, simultaneously offering potential for relatively good visual rehabilitation.Our primary outcomes involve spectacle-corrected distance visual acuity and changes in corneal topography/tomography and OCT parameters. These parameters include Kmax, thinnest corneal pachymetry, maximal anterior and posterior elevation, the Fourier analysis-derived irregularity index, and demarcation line depth.

Inclusion Criteria:

• Topographic evidence of keratoconus:
• maximum corneal curvature (Kmax) ≥47.00 D,
• localized steepening on topographic maps,
• localized elevation in the anterior and posterior corneal surfaces.

Exclusion Criteria:

• Hypersensitivity to riboflavin
• Thinnest corneal pachymetry < 380 μm
• History of corneal surgery, including previous cross-linking
• Corneal scarring
• Aphakia
• Pseudophakia
• Any visually significant ocular condition