Clinical results of transepithelial corneal collagen cross-linking for pediatric keratoconus

Authors: Zhang Jia,  Chen Shihao,  Li Yini,  Ding Ping,  Wang Qinmei

DOI: 10.3760/cma.j.issn.2095-0160.2017.02.009
Published 2017-02-10
Cite as Chin J Exp Ophthalmol, 2017,35(2): 135-138.

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Keratoconus is a progressive corneal thinning and protrusion disease that develop in the age of puberty, resulting in a certain extent impairment of visual function.Corneal collagen cross-linking (CXL) increases the stiffness of the cornea through the photooxidation of ultraviolet A (UVA) and riboflavin, with the aim to postpone and prevent the progression of keratoectasia.


This study was to evaluate the safety and efficacy of transepithelial CXL in the treatment of pediatric keratoconus.


Ten eyes of 9 pediatric patients with keratoconus undergoing transepithelial CXL were enrolled from February 2010 to March 2013 in Affiliated Eye Hospital of Wenzhou Medical University, with the mean age was (15±1) years (range from 13 years to 17 years). After topical anesthesia (0.1% tetracaine) for 15 minutes, 0.5% riboflavin was applied until it was saturated in the anterior chamber, then UVA with the intensity of 3 mW/cm2 was performed on the cornea for 30 minutes.The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, topography, corneal thinnest thickness were measured 7 days, 1 month, 3 months, 6 months and 1 year after operation.Endothelium cell density (ECD) was measured 7 days after operative.


The mean corneal reepithelization time was (1.4±0.8) days.The UDVA and CDVA were significantly improved from preoperative 1.02±0.16 and 0.34±0.20 to postoperative 0.77±0.18 and 0.25±0.15, respectively (t=4.251, 3.750; both at P<0.05). The refractive sphere and spherical equivalent significantly changed from preoperative (-7.15±3.00)D and (-9.26±3.23)D to postoperative (-5.28±2.05)D and (-7.05±2.08)D 1 year, respectively (t=-2.515, -2.597; both at P<0.05). Maximum K-value (Kmax) was significantly decreased from preoperative (64.1±11.9)D to postoperative (61.8±10.4)D (t=2.304, P<0.05). The refractive cylinder, corneal thinnest thickness and ECD showed no significant differences between preoperation and postoperation (t=-1.331, 0.328, 1.205; all at P>0.05). Stromal opacity was observed in 2 eyes 3 months and 6 months after operation, respectively.


Transepithelial CXL is safe and effective in prolonging or halting progression in adolescent keratoconus.

Key words:

Keratoconus; Transepithelial; Corneal collagen cross-linking; Adolescent; Ocular/Treatment outcome

Contributor Information

Zhang Jia
The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou 325027, China
Chen Shihao
Li Yini
Ding Ping
Wang Qinmei
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Updated: February 20, 2023 — 8:36 am