الفهرس 
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Abstract
Transepithelial CXL was developed to avoid the early postoperative pain and post-operative complications associated with the standard (epi-off) CXL technique, by avoiding epithelial debridement. Our study aimed to compare the clinical effects and safety of trans-epithelial technique versus epithelial-off technique of CXL, regarding clinical effects and using corneal tomography and corneal OCT. In this study, 41 eyes of 23 keratoconus patients were included. All were presented with progressive keratoconus. group 1 included 21 patients and group 2 included 20 patients. The mean values of the preoperative examinations were as follows: UCVA were 0.84 ± 0.55 in epithelium-on (group 1) and 0.86 ± 0.4 in epithelium-off (group 2). BCVA, in (group 1) 0.41 ± 0.3 and in (group 2) 0.5 ± 0.39. SE, in (group 1) -4.45 ± 5.71 and in (group 2) -6.66 ± 5.11. Ks in (group1) 50.33 ± 5.95 and in (group 2) 50.16 ± 5.48. Kf in (group 1) 45.85 ± 3.81 in (group 2) 45.26 ± 3.68. Kmin in (group 1) 45.56 ± 3.72 in (group 2) 44.7 ± 3.32. Kmean in (group1) 48.08 ± 4.75 and in (group 2) 47.69 ± 4.35. Pachymetry at thinnest location in (group1) 456.05 ± 43.6 and in (group 2) 455.32 ± 26.71. Topographic Cylinder in (group1) 4.48 ± 3.07 and in (group 2) 4.89 ± 3.41. Corneal thickness showed in (group 2) marked post-operative thinning along the follow up period, but this is very mild in (group 1). We can state that trans-epithelial CXL is not as effective as the epithelium-off CXL in halting the progression of keratoconus. Nevertheless, even with a smaller effect, this procedure may be recommended preferably for use with thin corneas and in pain-intolerant patients, as trans-epithelial technique is more superior in terms of postoperative complications and pain. However, standard epi-off CXL remains the gold standard in treatment of progressive keratoconus. This conclusion should be interpreted with caution due to the relatively small number of patients included in the study. Further studies with larger number of patients and longer follow up are recommended.