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Comparative analysis of outcomes of customised topography-guided cross-linking vs conventional cross-linking for keratoconus

Poster Details

First Author: S.Ramamurthy INDIA

Co Author(s):    G. Sachdev                    

Abstract Details


The purpose of the study was to compare the outcomes of Customised topography guided versus conventional cross linking in the management of Progressive Keratoconus


Cornea Services, The Eye Foundation, Coimbatore, India.


Prospective interventional study conducted between June 2016 to August 2017. Consecutive patients with documented progression of Keratoconus and a minimal thickness of 400u were included in the study. All patients underwent cross linking using the epithelium off approach. An accelerated 9mw/cm2 for 10 mins protocol was used in the conventional group(Group A). In the customized group (Group B), 3 concentric zones receiving 15, 10 & 5.4J/cm2 of energy centered around the highest point on the posterior float using a pulsed 30mW/cm2 beam. Outcome parameters included extent of flattening, improvement in visual acuity & depth of demarcation line.


60 eyes (30 in each group) were included in the study. At 6 months follow up a mean maximal flattening of 2.9D was achieved in Group B as compared to 1.1D in Group A (p=0.02). The I-S index, ratio of inferior to superior flattening, was also better in Group B (p = 0.032). Mean depth of demarcation line was 181u in Group A and 254u in Group B(p=0.04). Greater proportion of eyes had improvement in UDVA in Group B(62%) as compared to 18% in Group A. Extent of haze and specular counts were comparable between both groups at 3 months.


Customised topography guided cross linking provided superior flattening and greater improvement in visual acuity as compared to conventional crosslinking while maintaining the same degree of safety.

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