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Objective: To compare the safety and efficacy epithelium on versus epithelium off collagen cross linking with riboflavin and UVR in treatment of early keratoconus. Patients and Methods: The present study was a prospective, randomized study. 40 eyes from 25 patients with a mean age of 24 years (range: 15–35 years) were included. There were 15 males and 10 females, and all of them underwent corneal CXL using riboflavin and ultraviolet-A light at the Tipa Eye Hospital, Assuit. Results: Among the included samples, 20 eyes underwent epithelium-on corneal collagen CXL, and 20 eyes underwent epithelium-off corneal CXL. The incidence of postoperative pain was lowered by about 20% in the trans-epithelial group as compared with the epithelial-off group in the first postoperative week. In addition, the incidence of postoperative corneal haze was lowered by about 50% in the transepithelial group as compared with the epithelial-off group in the first postoperative week. It was also noticed that the CXL was formed in the upper-third of the corneal stroma, 20-30 μm beneath bowman membrane in the transepithelial CXL technique, while in the classic debridement technique; it was formed much deeper in the stoma. In group I, after 3 and 6 months, there was a non-statistically significant corneal thinning. In group II, none statistically significant corneal thinning was detected after 3 months, but after 6 months there was some regression in the form of corneal thinning by nearly 5-10 μm in 20% of cases. Conclusion: Both epithelium-off CXL and the epitheliumon CXL were effective in stabilizing the progression of keratoconus at least for 6 months; however, the epithelium-off CXL appeared to be much more effective in improving the refractive best-corrected visual acuity and topographic outcomes in keratoconic eyes compared with the epithelium-on CXL.

COMPARATIVE STUDY BETWEEN EPITHELIUM ON AND EPITHELIUM OFF COLLAGEN CROSS LINKING WITH RIBOFLAVIN AND UVR IN TREATMENT OF EARLY KERATOCONUS