Corneal collagen cross-linking treatment results with modified epithelial debridement technique

Background and aim: In cases with keratoconus, evaluation of one-year follow-up results of CXL with modified epithelial debridement technique according to topographic maps. Materials and Methods: We included 40 eyes of 40 patients who had been diagnosed with keratoconus. Detailed eye examinations were performed before and after all disease cross-linking therapy at 1 month, 3 months, 6 months, 12 months. Specular microscopic examination, Nidek CEM-530; topographic analysis, Sirius using a three-dimensional, moving Scheimpflug camera and plasido disk. Spherical eqivalan, corrected uncorrected and corrected best visual acuity, central corneal thickness (CCT), the anterior corneal surface is the highest point of the ectasine (KVf), the highest point of ectasin on the posterior corneal surface, keratometric values (simK1 and simK2), the most straight meridian (K1), the steepest meridian (K2) and their average, corneal endothelial cell number, percentage of hexagonal cells, coefficient of variation were recorded at each control. Results: Forty patients were enrolled, 20 female and 20 male, aged between 11 and 31 years. There is a story of keratoconus in the first degree relatives of 6 cases and second degree relatives of 5 cases. 23 eyes frequently rub their eyes, 2 eyes rub their eyes very frequently, and 15 eyes occasionally rub their eyes. According to the Amsler Krumeich classification, 16 cases were stage 1, 16 cases were stage 2, 8 cases were stage 3. Decrease was observed between the 1st, 3rd, 6th, and 12th hour spherical equivalent measurements before and after CXL with modified epithelial debridement (p=0.001). There was a significant increase in uncorrected visual acuity and best corrected visual acuity before and after CXL (p=0.001, p=0.001, respectively). There was no significant difference in the endothelial cell counts between the follow-up intervals (p=0.088). There was no significant difference between follow-up intervals in endothelial variation coefficient measurements (p=0.059). A statistically significant increase was detected in endothelial cell hexagonalities (p=0.008). After treatment, central corneal thickness decreased in the first months and increased after sixth month (p=0.001). At 12. month, CCT was thicker than pretreatment (p=0.001). There was a statistically significant difference in the time between the measurements of KVf (p=0.001). There was no significant difference between SimK1 and SimK2 values (p=0.158, p=0.226, respectively). A decrease was detected in the results of the comparison of K1 values over time (p=0.002). Statistically significant changes in K2 values were observed at different months before and after operation (p=0.001). The changes in the K1 and K2 measurements and in the mean values were statistically significant (p=0.001). Conclusions: Corneal collagen cross-linking therapy with modified epithelium debridement according to topographic map is an effective alternative to stop the progression of keratoconus and increase visual acuity. It is thought that there is not a serious negative effect on endothelial cell number and morphology. Keywords: Modified epithelial debridement, corneal endothelium, corneal colloidal cross-linking therapy, keratoconus