International Ophthalmology

, Volume 38, Issue 6, pp 2585–2592 | Cite as

Standard, transepithelial and iontophoresis corneal cross-linking: clinical analysis of three surgical techniques

  • Settimio RossiEmail author
  • Carmine Santamaria
  • Rosa Boccia
  • Luigi De Rosa
  • Francesco Maria D’Alterio
  • Francesca Simonelli
  • Giuseppe De Rosa
Original Paper



To evaluate the clinical results of standard, transepithelial (TE) and iontophoresis (I) corneal cross-linking (CXL), in patients with progressive keratoconus.


Thirty eyes of 30 patients with progressive keratoconus treated by CXL (10 by standard-CXL, 10 by TE-CXL and 10 by I-TE-CXL) with 12 months of follow-up. Pre- and postoperative ophthalmologic testing were: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive examination (spherical error, spherical equivalent), corneal topography (corneal astigmatism, simulated maximum, minimum and average keratometry), aberrometry (coma and spherical aberration), pachymetry and endothelial cell density.


In all groups, UDVA and CDVA improved significantly after treatment. Furthermore, a significant improvement in spherical error, spherical equivalent, topographic and aberrometric outcomes was observed in 3 groups at 1 year posttreatment. No significant variations were recorded in corneal thickness and endothelial cellular density.


Our results showed efficacy, clinical and refractive stability after standard-CXL, TE-CXL and iontophoresis-CXL.


Keratoconus Corneal topography Corneal disease Corneal cross-linking Iontophoresis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Approval was obtained from the Ethical Committee of the Second University of Naples, and the patients gave their informed consent prior to their inclusion. The procedures used in this study adhered to the tenets of the Declaration of Helsinki.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  • Settimio Rossi
    • 1
    Email author
  • Carmine Santamaria
    • 2
  • Rosa Boccia
    • 1
  • Luigi De Rosa
    • 1
  • Francesco Maria D’Alterio
    • 1
  • Francesca Simonelli
    • 1
  • Giuseppe De Rosa
    • 1
  1. 1.Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental SciencesUniversity of Campania “Luigi Vanvitelli”NaplesItaly
  2. 2.Day Surgery Center – Refractive SurgeryNaplesItaly

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