Transepithelial Versus Epithelium-Off Corneal Collagen Cross-Linking for Progressive Keratoconus: A Prospective Randomized Controlled Trial

Purpose: To compare the safety and efficacy of transepithelial with epithelium-off corneal cross-linking for progressive keratoconus. Methods: In a prospective clinical trial, 70 patients with progressive keratoconus were randomized to undergo corneal cross-linking with intact epithelium (n = 34) or after deepithelialization (n = 36). The main outcome measure was a change in the maximum K reading (K-max). Results: With 3-year follow-up, K-max decreased in the epithelium-off group with a mean of 2.4 D and no patient showed evidence of progression. In the transepithelial group, K-max increased by a mean of 1.1 D, and 20 patients (55%) showed progression of keratoconus. Conclusions: In this study, epithelium-off was significantly more effective than transepithelial corneal cross-linking in halting the progression of keratoconus (P < 0.0001).