الفهرس 
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Abstract
Keratoconus is described as a disease characterized by progressive corneal steepening, most typically inferio-temporal, with eventual corneal thinning, induced myopia, and both regular and irregular astigmatism.
Treatment of keratoconus depends on the severity of the condition and can be divided into two categories surgical and nonsurgical.
A new technique of collagen cross linking has been developed aiming at slowing down or arresting the progression of keratoconus to delay or avoid the need for keratoplasty. Unlike other treatment methods that only address the refractive effect of the disease; this new method treats and prevents the underlying pathophysiological mechanism.
This study aims to compare standard versus trans-epithelial corneal collagen cross-linking for treatment of progressive keratoconus.
This is a prospective comparative study carried out at Tanta Ophthalmic Hospital and Tiba Eye Center in Shebin Elkom between January 2015 and January 2016.This study included 30 eyes of 30 patients with progressive keratoconus divided into two groups: group (A) included 15 eyes that were treated by standard CXL and group (B) included 15 eyes that were treated by trans-epithelial CXL with 3 months of follow up.
All patients underwent complete ophthalmic testing that included pre- and postoperative uncorrected visual acuity, best corrected visual acuity, manifest refraction (sphere and cylinder), corneal topography using Pentacam (Allegro-Oculyzer) to asses average K reading, topographic astigmatism, elevation value of the anterior and posterior surface of the cornea, thickness of the cornea in the thinnest location, anterior chamber depth (ACD), and corneal volume.
There was significant improvement of all parameters 3 months after CXL in both groups, while there was more improvement in uncorrected, best corrected visual acuity and manifest refraction in group (A) and there was more improvement in anterior, posterior elevations and corneal thickness in group (B). No significant variations were recorded in other parameters. No complications were noted.
This study not only demonstrated a halt in keratoconus progression, but also showed a significant improvement in visual acuity and refractive results due to a decline in the irregular astigmatism after CXL. These outcomes provide an indication of the efficacy and safety of standard CXL and the potential for TE CXL to be an appropriate therapy for progressive keratoconus with thin cornea.