Observational studyJournal of cataract and refractive surgery2026
Comparison of epithelium-on customized remodeled vision and epithelium-off accelerated crosslinking in keratoconus treatment: 2-year study.
Observational study in Journal of cataract and refractive surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
purposeTo 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.
settingGemini Eye Clinic, Zlín, Czech Republic.
designProspective, observational, nonrandomized 1-center study.
methodsThe 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.
resultsCuRV 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.
conclusionsThe 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.
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