Comparison of epithelium-on customized remodeled vision and epithelium-off accelerated crosslinking in keratoconus treatment: 2-year study.

PURPOSE: To evaluate the effectiveness and safety of epithelium-on (epi-on) customized remodeled vision (CuRV) crosslinking compared with epithelium-off (epi-off) accelerated corneal crosslinking (aCXL) in stabilizing keratoconus and improving visual outcomes.

SETTING

Gemini Eye Clinic, Zlín, Czech Republic.

DESIGN

Prospective, observational, nonrandomized 1-center study.

METHODS

The study included 179 eyes (135 patients) with progressive keratoconus (grades 1 to 3-4). Patients received either epi-on CuRV (n = 77 eyes) or epi-off aCXL (n = 102 eyes) and were followed for 24 months. Distance visual acuities, refraction, maximum keratometry (Kmax), corneal thickness, wavefront aberrations, endothelial cell count, and adverse events were assessed.

RESULTS

CuRV demonstrated greater and sustained reductions in Kmax (-2.46 ± 2.64 diopters [D] vs -1.38 ± 2.13 D, P = .0018) and mean keratometry (-0.93 ± 1.62 D vs -0.52 ± 1.02 D, P = .0367) compared with aCXL over 2 years. CuRV resulted in a lower rate of Kmax increase (>1 D) compared with aCXL (1% vs 9%). Higher-order aberrations improved significantly in both groups, with greater overall reduction in the CuRV group.

CONCLUSIONS

The CuRV protocol, using topography-guided, pulsed UV-A exposure with oxygenation, effectively stabilizes keratoconus while improving corneal shape and reducing aberrations. Its noninvasive, epi-on approach offers potential advantages in safety, comfort, and recovery over standard aCXL.