March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
A Multifactorial Treatment Analysis and Algorithm for Corneal Collagen Crosslinking
Author Affiliations & Notes
  • Steven A. Greenstein
    Cornea and Laser Eye Institute- Hersh Vision Group, Teaneck, New Jersey
  • Peter Hersh
    Cornea and Laser Eye Institute- Hersh Vision Group, Teaneck, New Jersey
  • Footnotes
    Commercial Relationships  Steven A. Greenstein, None; Peter Hersh, Avedro, Inc. (C)
  • Footnotes
    Support  Department of Ophthalmology from Research to Prevent Blindness, Inc., New York, New York.
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 6808. doi:
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      Steven A. Greenstein, Peter Hersh; A Multifactorial Treatment Analysis and Algorithm for Corneal Collagen Crosslinking. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6808.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To determine preoperative predictors of best spectacle corrected visual acuity (BSCVA) and maximum keratomtery (Kmax) outcomes after corneal collagen crosslinking (CXL), and to determine a treatment algorithm to select those patients who will benefit most from CXL.

Methods: : CXL was performed on 104 eyes with either keratoconus (kc) or post LASIK ectasia (ec). A multiple regression and odds ratio analysis were performed to determine predictors of BSCVA and Kmax outcomes. In the regression analysis, preoperative predictors included uncorrected and best corrected visual acuity, Kmax, thinnest pachymetry, haze, disease, cone location, gender, and age. Improvement of BSCVA was defined as an improvement of ≥2 Snellen lines of BSCVA at 1 year postoperatively. Improvement of Kmax was defined as an improvement of ≥2D of Kmax at 1 year postoperatively. Worsening of BSCVA and Kmax was defined as a loss of ≥1 Snellen lines of BSCVA, and ≥1D of Kmax steepening at 1 year postoperatively.

Results: : In a multifactorial regression analysis, all preoperative measurements were found to be significantly predictive of 1 year postoperative BSCVA (r2=0.5, p<0.001), and 1 year postoperative Kmax (r2=0.9, p<0.001). When analyzed individually, within the above multivariable regression analysis, preoperative BSCVA (coefficient=0.4, p<0.001) was a significant predictor of 1 year postoperative BSCVA. Patients with a preoperative BSCVA of 20/40 or worse were 5.9x (CI = 2.2x-16.3x) more likely to improve by 2 or more Snellen lines than patients with a BSCVA better than 20/40. Patients with a Kmax ≥ 55D were 5.2x (CI = 2.0x-13.0x) more likely to experience an improvement of ≥2D of Kmax, compared to those patients with a Kmax< 55D at 1 year.

Conclusions: : Our multifactorial analysis suggests that all patients with progressive kc or ec will benefit from CXL treatment with regard to stabilization of the disease. In general, patients with worse BSCVA and higher keratometry, particularly when their preoperative BSCVA is 20/40 or worse and/or their preoperative Kmax is 55D or worse, are most likely to experience improvement after CXL. With regard to patients with stable keratoconus, a treatment algorithm based on these results may suggest those patients who may obtain a significant clinical improvement.

Clinical Trial: : NCT00647699

Keywords: keratoconus • cornea: clinical science • refractive surgery 

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