OBJECTIVES

To compare the clinical efficacy of epithelium-off and transepithelial accelerated corneal collagen crosslinking (ACXL) in adolescent keratoconus.

METHODS

In this prospective observational study with a 1-year follow-up, 60 patients aged 16-26 years (60 eyes) with keratoconus were assigned to two groups: the epithelium-off ACXL group (30 patients, 30 eyes) and the transepithelial ACXL group (30 patients, 30 eyes). Patients were evaluated preoperatively and at 7 days, 1 month, 3 months, 6 months, and 12 months post-treatment. The measurements included visual acuity, corneal parameters, and corneal endothelium parameters. Baseline data and treatment effect were compared using the t-test or Wilcoxon rank-sum test for continuous variables and the chi-square test for categorical variables. Within-group comparisons used paired t-tests or paired rank-sum tests.

RESULTS

At 12 months postoperatively, the treatment groups showed statistically significant differences in central corneal thickness (IOLMaster), thinnest point corneal thickness (topography), thickness (topography), central corneal thickness, corneal thickness on optical coherence tomography, deformation amplitude (DA), first applanation time, first applanation velocity, second applanation time, second applanation velocity, peak distance (PD), high-contrast acuity, stiffness parameter at the first applanation, and comprehensive refraction (p < 0.001). No differences were observed between the groups in any other parameters before or after treatment.

CONCLUSIONS

Both epithelium-off and transepithelial ACXL effectively treat keratoconus. Transepithelial ACXL is slightly inferior to epithelium-off ACXL in maximum corneal curvature but superior in improving corneal thickness and DA parameters. Further studies are necessary to verify the efficacy, safety, and long-term stability of transepithelial ACXL in treating keratoconus.