Correlation between corneal demarcation line depth in epithelium-off and trans-epithelium accelerated corneal cross linking and keratoconus progression

AIM:To compare corneal demarcation line(DL)depth in both accelerated epithelium-off and trans-epithelium cross linking(CXL)using anterior segment optical coherence tomography(AS-OCT)and its relation to maximum keratometry(Kmax)progression in both techniques.METHODS:A prospective comparative interventional study where patients with mild to moderate keratoconus(KC)were classified into two groups:accelerated epitheliumoff and trans-epithelium CXL based on corneal pachymetry.Assessment of corneal DL depth was carried out after 3mo by AS-OCT.Kmax readings were evaluated after one year follow up using the Scheimpflug imaging system.RESULTS:Study included 74 eyes of 44 patients.Group A underwent epithelium-off CXL(41 eyes),while Group B underwent trans-epithelium CXL(33 eyes).At 3mo follow up,mean corneal DL depth in Group A was 219.9±58.4μm while in Group B was 127.2±7.8μm(P<0.05).The mean Kmaxchangedfrom51.9±3.9to51.3±4.2dioptersin Group A and from 53.1±4.1 to 53.6±5 diopters in Group B with insignificant difference in Kmax changes in either group(P>0.05).In addition,no significant change in corneal pachymetry was found in both groups(meanchange at 1y:6.4±4.7 and-10.1±2.3μm in Groups A and B respectively).CONCLUSION:Despite a significantly deeper corneal DL depth created by accelerated epithelium-off CXL technique compared to accelerated trans-epithelium CXL,there is no significant impact on keratoconus progression.