A New Surgical Technique To Deliver Riboflavin Beneath Corneal Epithelium: The Corneal Cross-Linking Epi-Pocket

Purpose: To describe a new technique to deliver riboflavin into the corneal stroma during Corneal Cross-Linking (CXL) without the removal of corneal epithelium. Methods: Keratoconus patients underwent CXL for progressive keratoconus. Riboflavin was delivered by manually creating an epithelial pocket (CXL Epi-Pocket). Verbal rating scale was recorded postoperatively. Best-corrected visual acuity, keratometric indices, corneal thickness and corneal densitometry were recorded at baseline and at 12-month follow-up. Results: Eighteen eyes of 18 patients were included in the study. At a 12-month follow-up, best-corrected visual acuity, K1, K2 and densitometry values were stable. Maximum keratometry (Kmax) reduced from 55.31 +/- 6.21 (SD) to 52.34d +/- 4.12d (SD) (P value = 0.032). the thinnest point went from 441 +/- 21.18 (SD) to 425.4 +/- 19.02 (SD) um (P value = 0.041). The verbal rating scale at 1, 2 and 3 days postoperatively were 1.76 +/- 0.19 (SD), 1.02 +/- 0.51 (SD) and 0.28 +/- 0.14 (SD). Conclusions: CXL Epi-Pocket is able to deliver riboflavin to halt the progression of keratoconus at a 12-month follow-up.