Epi-on CuRV and Epi-off aCXL Protocols in the Management of Keratoconus

Comparison of Epithelium-on CuRV and Epithelium-off aCXL Protocols in the Management of Keratoconus

This study investigates the effectiveness and safety of two different corneal cross-linking (CXL) protocols for the management of progressive keratoconus: the accelerated epithelium-off technique (aCXL) and the topography-guided epithelium-on Customized Remodeled Vision (CuRV) protocol. These methods differ in their mode of ultraviolet-A (UVA) energy delivery and their approach to corneal surface preservation, with potential implications for both structural stabilization and patient comfort. The primary aim was to evaluate changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax) over a 24-month follow-up period, allowing for a direct comparison of visual and topographic outcomes between the two approaches.

By assessing these endpoints, the study seeks to address whether epithelium-on, customized cross-linking can achieve similar or improved results compared with conventional accelerated epithelium-off treatment. The findings are intended to provide insights into the relative benefits of standardized versus individualized cross-linking techniques, with the broader goal of optimizing treatment strategies for patients with keratoconus.

Inclusion Criteria:

• adult eyes
• progressive keratoconus (grades 1 to 3-4, Krumeich-Amsler classification)
• corneal thickness ≥400 μm
• endothelial cell density ≥1500 cells/mm²

Exclusion Criteria:

• prior corneal surgeries
• corneal scars
• dystrophies
• marginal pellucid degeneration
• systemic connective tissue disorders
• uncontrolled diabetes
• pregnancy, or breastfeeding.