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Chiara Bonzano, Donatella Musetti, Riccardo Scotto, Marta Sturloni, Carlo Alberto Cutolo, Carlo Enrico Traverso; Delayed re-epithelialization after epithelium-off crosslinking: associated factors and impact on keratoconus progression. Invest. Ophthalmol. Vis. Sci. 2019;60(9):349.
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Corneal collagen crosslinking (CXL) is a safe procedure for the treatment of progressive keratoconus (KC). Delayed re-epithelialization (DRE) is a possible complication of epithelium-off CXL (epi-off CXL). This study aims to investigate the demographic and corneal factors associated with DRE.
A retrospective chart review was performed to identify patients treated with epi-off CXL at Clinica Oculistica, University of Genova, Italy. A bandage contact lens was always fitted for 3-5 days after CXL to reduce discomfort and to promote epithelial healing. DRE was defined as a corneal epithelial defect, detected by fluorescein staining, that persisted more than 10 days. Slit-lamp examination, anterior segment optical coherence tomography (AS-OCT), corneal topography and, corneal in-vivo confocal microscopy (IVCM) were always performed preoperatively and at each follow-up visit (1, 3, 6, 12 months). Logistic regression was used to assess the baseline factors associated with DRE.
Data from 153 eyes were included. The mean patients’ age was 24.9±8.5 years, and 47 (30.7%) were females. The average re-epithelialization time was 4.7 ± 1.8 days. Six eyes (3.9%) experienced DRE. In the multivariate logistic model, both the patient’s age (OR=1.30, 95% CI 1.1 to 1.6; p=0.019) and the corneal steepest meridian readings (OR=0.44, 95% CI 0.19 to 0.99, p=0.046) were associated with DRE. Male gender was associated with a slower early nerve regrowth (1 to 6 months) (p=0.048) but not with the occurrence of DRE (p=0.271). Preoperative central corneal thickness was not related with DRE (p=0.066). Moreover, DRE was not associated with KC progression after epi-off CXL (p=0.520).
The association between DRE and age may reflect the age-related decrease in the corneal healing response. Gender seems to affect re-innervation measured by IVCM but not the re-epithelialization time. DRE does not seem to affect the efficacy of epi-off CXL treatment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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