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Cross-linking transepithelial par Iontophorèse : une cohorte rétrospective de 49 kératocônes

Collagen Cross-Linking (CXL) epi-off is now a common treatment for progressive keratoconus, but this treatment may include some risks including  pain and infection. Additionaly, thin corneas can not be treated. Iontophoresis (I-CXL) can be a good alternative. The main purpose of this study is to assess tolerance and efficacy of I-CXL.

This is a multicenter, retrospective, non-randomized study. 49 progressive keratoconus eyes were included in Fondation ophtalmologique A. de Rothschild in Paris and Gabriel-Montpied Hospital in Clermont-Ferrand, France. Corrected distance visual acuity (CDVA), corneal topography, anterior segment optical coherence tomography and endothelial cell count were performed during 1 year.

During the follow-up 79% of patients kept a stable keratometry or better (less than 1.5D increase) and even 32% had a Kmax decrease of 1.5D or more. After 1 year, the mean Kmax in the 3 mm central cornea was 58.4 D (57,5 D before surgery (p=0,64)). The mean endothelial cell count didn’t change significantly. 

The efficiency of this technique is similar to others studies and we can observe that I-CXL is slightly less effective on the stabilization than the conventional epi-off one (C-CXL).    Preserved epithelium probably reduces Ultraviolet rays penetration in the corneal stroma and consequently Riboflavin activation.

With this 1 year follow up, I-CXL seems to stabilize most of progressive keratoconus in our cohort. The benefits of not removing epithelium include less pain and infection risks. This technique can be a good alternative for thinner corneas. More studies are needed to compare conventional and I-CXL.