ESCRS - PO260 - Accelerated Corneal Cross-Linking In Progressive Keratoconus – 5 Years Follow-Up

Accelerated Corneal Cross-Linking In Progressive Keratoconus – 5 Years Follow-Up

Published 2022 - 40th Congress of the ESCRS

Reference: PO260 | Type: Free paper | DOI: 10.82333/va2r-0q14

Authors: Julia Friedrich* 1 , Alexandra Sandner 1 , M. Ali Nasseri 2 , Mathias Maier 1 , Daniel Zapp 1

1Clinic of Ophthalmology,Klinikum rechts der Isar, TUM,Munich,Germany, 2Research,Technichal University of Munich,Munich,Germany

Purpose

To evaluate long-term results of accelerated corneal cross-linking (ACXL) in patients with progressive keratoconus.

Setting

Seventy four eyes of 53 patients with progressive keratoconus (documented Kmax progression > 1D/a) who underwent ACXL (18mW/cm2 for 5 minutes) were included in a retrospective observational clinical study. The investigation focused on tomographical and keratometric parameters, refractive data and visual outcomes at 5 years follow-up.

Methods

Corrected distance visual acuity (CDVA), slit lamp and Pentacam® examinations, including thinnest corneal point (TP), minimum radius (Rmin), corneal astigmatism and maximum anterior keratometry (Kmax) were performed two weeks before and in average 56 months after surgery. Pentacam® examination data of an intermediate visit 12 months to final visit was evaluated in a subgroup of 24 eyes to confirm continuous stability.

The ACXL protocol included corneal abrasion, hydroxymethylpropylcellulose(HPMC)-riboflavin eye drops every 5 minutes for a time of 30 minutes and irradiation with 18mW/cm2 for 5 minutes with riboflavin eye drops every minute during irradiation. Minimal corneal pachymetry of >400µm was ensured intraoperatively in every patient.

Results

All values improved statistically significant after 56 months (paired t-test; CDVA p=0,002; Kmax p<0,001; Rmin p<0,001; astigmatism p=0,03; TP p<0,001).

The subgroup analysis of 24 eyes including tomographical and keratometric parameters showed no statistically significant changes during the last 12 months of observation (paired t‑test; Kmax p=0,72; Rmin p=067; astigmatism p=0,72).

Treatment failure was rigorously defined by an increase of Kmax (>1D) during the 5 years follow-up and occurred only in 3 eyes (=4%).

Conclusions

ACXL is an effective and save treatment in patients with progressive keratoconus. Our results show an improvement of functional and tomographical results even post high energy ACXL (18mW/cm2 for 5 minutes) after a long-time period of 56 months. Our analysis shows stabilized conditions of former progressive keratoconus notably also during the last year of the observation period. Treatment failure-rate was 4%.