Epithelium-off corneal cross-linking versus transepithelial diluted alcohol and iontophoresis-assisted corneal cross-linking in keratoconus patients with thin corneas

Aims: To evaluate the efficacy and safety of transepithelial diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL) and compare 24-month visual and topographic outcomes with accelerated CXL using hypo-osmolar riboflavin (A-CXL) in keratoconus patients with thin corneas (below 400 μm with epithelium). Methods: This retrospective study included keratoconus patients who underwent DAI-CXL or A-CXL. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and data obtained from corneal topography were analyzed at baseline and 12 and 24 months of follow-up. Corneal demarcation line depth (DLD) at 1 month and corneal endothelial cell density (ECD) at 24 months were also evaluated. Results: The study included 25 eyes of 25 keratoconus patients (mean age: 25.48±6.69 years, male: 52%). DAI-CXL and A-CXL groups consisted of 13 and 12 patients, respectively. In both groups, median UDVA improved significantly at 24 months (p