Efficacy and safety of transepithelial corneal collagen crosslinking

摘要

We would like to comment on the efficacy of transepithelial corneal collagen crosslinking (CXL) as described by Filippello et al. and raise our concerns about the safety of this procedure. In the classic CXL procedure, removal of the corneal epithelium can increase the risk for corneal infections, ulcers, haze, scarring, and infiltrates, longer recovery time, and discomfort and postoperative pain experienced by patients. Therefore, slight modifications of CXL have been proposed and shown to be effective in arresting the progression of ectasia or kerato-conus. However, the effect of these techniques appears to be less pronounced than described in classic CXL. In their study, Filippello et al. observed that with the transepithelial CXL technique, the formation of crosslinks appears to take place in the upper third of the corneal stroma, 20 mum to 30 mum beneath Bowman membrane, which is in contrast to that occurring at a depth of approximately 250 mum in classic CXL with epithelial debridement.