ESCRS - PP11.15 - Long-Term Safety And Efficacy Of Pulsed-Light High-Fluence Accelerated Cross-Linking In Patients With Keratoconus

Long-Term Safety And Efficacy Of Pulsed-Light High-Fluence Accelerated Cross-Linking In Patients With Keratoconus

Published 2022 - 40th Congress of the ESCRS

Reference: PP11.15 | Type: ESCRS 2022 - Posters | DOI: 10.82333/egr2-df58

Authors: Suphi Taneri* 1 , Anika Rost 2 , H. Burkhard Dick 3

1Center for Refractive Surgery Muenster,Münster,Germany;Ruhr-University,Bochum,Germany, 2Center for Refractive Surgery Muenster,Münster,Germany, 3Ruhr-University,Bochum,Germany

Purpose

High-fluence accelerated cross-linking (CXL) may improve patient comfort and clinical safety due to shorter treatment duration, but lowered treatment efficacy relative to conventional CXL have been reported. Administering UVA light with pulsed time intervals can increase stromal oxygen bioavailability which may improve the efficacy of accelerated CXL. This study evaluates the long-term tomographic outcomes and safety profile of pulsed accelerated CXL in progressive keratoconus patients with 2 years or longer follow up results.  

Setting

Center for Refractive Surgery, Eye Department at St. Francis Hospital Muenster, Germany.

Methods

This retrospective study identified 15 progressive keratoconus eyes that underwent pulsed accelerated epi-off CXL (30mW, 1 sec on/off, 8min, 7.2J/cm2) with the KXL system and Vibex Rapid riboflavin solution. All patients were treated in our center between the dates of 08/2013 – 01/2017 and have post-operative follow up examinations for 2 years or longer. Efficacy outcome parameters evaluated include maximum keratometry (Kmax), minimum keratometry (Kmin), corneal astigmatism (Topo Cyl), pachymetry at thinnest cornea point (TCT). Patient safety parameters were assessed via endothelial cell count (ECD) and other clinical adverse events such as corneal infiltrate, infectious keratitis and ulcer. 

Results

15 eyes of 10 patients (8 males; 2 females) with 2 years or longer follow up (range 2-4 years) after pulsed accelerated CXL were identified. Patients’ mean age at time of treatment was 25.6±9.6 years. Compared to baseline, clinical results at the latest post-operative exam showed a mean difference in Kmax flattening of -0.61±1.42D (p < 0.0284). Otherwise, no statistical significance was found in mean differences of other efficacy factors (Kmin -0.63±1.85D, Topo Cyl -0.17±0.77D, TCT -10.21±28.8µm). Mean ECD at the latest post-CXL exam was 2292.78±273.12 (p = 0.75). No corneal infiltrate, infectious keratitis, ulcer or other complications were observed.

Conclusions

Accelerated CXL improves patient comfort with shorter treatment duration but may have reduced long-term efficacy relative to conventional CXL. Pulsed-light can reduce enhanced oxygen consumption rate; subsequently, the higher oxygen bioavailability may induce higher level of CXL reactions in stroma during accelerated CXL. Long term outcomes of 2 years or greater continued to show mean Kmax flattening of statistical significance in this study cohort. There were no clinical complications or change in endothelial cell count noted at the latest follow up examination. Pulsed-light high-fluence accelerated CXL appears to be a safe and efficacious treatment for progressive keratoconus patients.