Epithelial Demarcation Line after Crosslinking

A 14-year-old girl with bilateral keratoconus was evaluated in our outpatient clinic. Pentacam imaging revealed the thinnest pachymetry to be 380 μm. In view of the patient’s age and thin pachymetry, a decision was made to proceed with collagen crosslinking (CXL) in the right eye. Accelerated CXL using customized epithelial debridement technique was performed, leaving an island of epithelium over the thinnest area of the cone. At 1 week, the epithelial island could be clearly differentiated from the new epithelium with a demarcation line in between (Fig A). Although there was no epithelial defect, the epithelial island had punctate staining with fluorescein (Fig B). (Magnified version of Fig A-B is available online at www.aaojournal.org).