Open Access Highly Accessed Technical advance

Customized pachymetric guided epithelial debridement for corneal collagen cross linking

George D Kymionis12, Vasilios F Diakonis2*, Efekan Coskunseven3, Mirco Jankov4, Sonia H Yoo1 and Ioannis G Pallikaris2

Author Affiliations

1 Bascom Palmer Eye Institute, Miller School of Medicine, Miami University, FL, USA

2 Institute of Vision & Optics, Department of Medicine, University of Crete, Crete, Greece

3 World Eye Hospital, Istanbul, Turkey

4 University of Beogradu, Department of Medicine, Serbia

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BMC Ophthalmology 2009, 9:10  doi:10.1186/1471-2415-9-10

Published: 28 August 2009



We describe a modified method for deepitheliazation prior to corneal cross linking (CXL). The technique may overcome the current corneal pachymetric limitation parameter (over 400 microns) that is necessary for the safety of the procedure without affecting the overall benefits.


In a series of two patients, with inferior topographic steepening and regional thinning (less than 400 microns corresponding to the area of corneal steepening), CXL after customized epithelial removal was performed.


There were no intra- or postoperative adverse events seen by the nine month follow up examination. Stabilization of the corneal ectasia was observed up to nine months post-costumized pachymetric-guided epithelial removal.


The technique of customized pachymetric-guided epithelial removal is easy to perform and may overcome the limitations of the preoperative corneal pachymetry expanding the application of the procedure in patients with regional corneal thinning.