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Corneal cross‐linking in advanced keratoconus, is it still effective?
Author(s) -
Alenezi Bandar,
Khoyratty Fadil,
Biswas Susmito,
Radhakrishnan Hema
Publication year - 2021
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2020.0212
Subject(s) - keratoconus , keratometer , corneal collagen cross linking , ophthalmology , medicine , corneal topography , visual acuity , significant difference , scheimpflug principle , cornea
Purpose The study aims to investigate the effectiveness of corneal cross‐linking (CXL) treatment in keratoconus patients. Methods A total of 167 eyes of 159 progressive keratoconic patients (109 males and 58 females) aged 19 to 52 years old were included in the study. Epithelium debridement was performed for all patients, followed by riboflavin and UV‐A accelerated CXL (9.86 mW/cm 2 for 9 min). To explore the effect of keratoconus severity on CXL outcomes, patients were divided into two groups based on the preoperative measurements of maximum keratometry (Kmax): Group A (Kmax < 62D) and Group B (Kmax ≥ 62 D). Corrected distance visual acuity (CDVA), corneal curvature and thickness were measured pre‐CXL and at 1, 2 and 3 years post‐CXL treatment using the Oculus Pentacam. Results Results showed a significant improvement in CDVA on logMAR chart (0.19 ± 0.41, p = 0.04) at 3 years follow‐up. Kmax reduced significantly by 1.61 ± 3.02D, p = 0.02 (from 64.35 ± 6.85D to 63.19 ± 6.99D) at 3 years after CXL. Pachymetry measurements showed a significant reduction at 1 year (p = 0.01), 2 years (p = 0.00005) and 3 years (p = 0.2) following CXL. CXL induced a significant reduction in Kmax measurements in Group A at 3 years follow‐up (1.50 ± 2.17D, p = 0.02); however, there was no significant change observed at 3 years following CXL in Group B (p = 0.19). Kmax reduced or at least stabilised in all patients in Group A at 3 years follow‐up; however, 25% of eyes in Group B showed a Kmax worsening of ≥1D. Conclusions The findings of the current study show the effectiveness of CXL to stabilise the progression of keratoconus and significantly improve corneal curvature measurements. The progression of keratoconus is more likely to stabilise after CXL in eyes with lower Kmax measurements.