Randomized Controlled Trial Comparing Transepithelial Corneal Cross-linking Using Iontophoresis with the Dresden Protocol in Progressive Keratoconus
Transepithelial Corneal Cross-linking using iontophoresis is safe and efficacious and leads to significant visual and refractive improvements in progressive keratoconus at 12 months follow-up.
In a recent study by Lombardo et al, published in Ophthalmology 2017; 124:804-812 Q 2017 Published by Elsevier Inc., transepithelial corneal cross-linking using iontophoresis (T-ionto CL) was compared with standard corneal cross-linking (standard CL) in progressive keratoconus. It was a prospective randomized controlled trial, conducted in thirty-four eyes of 25 participants, which were randomized into T-ionto CL (22 eyes) or standard CL (12 eyes). T-ionto CL was performed using an iontophoresis device with dextran-free 0.1% riboflavin- 5-phosphate solution with enhancers and by irradiating the cornea with a 10mW/cm2 ultraviolet-A device for 9 minutes. Standard CL was performed according to the Dresden protocol.
The study showed that 12 months after T-ionto CL and standard CL, Kmax on average flattened by 0.52`1.30 D (P 1⁄4 0.06) and 0.82`1.20 D (P 1⁄4 0.04), respectively. The mean change in CDVA was 0.10`0.12 logMAR (P 1⁄4 0.003) and 0.03`0.06 logMAR (P 1⁄4 0.10) after T-ionto CL and standard CL, respectively. The CCT and ECD measures did not change significantly in any group at 12 months. Thus, it concluded that significant visual and refractive improvements were found 12 months after T-ionto CL.