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Samuel Jakob Küchler, Christoph Tappeiner, Dan Epstein, Beatrice E Frueh; Progression after corneal cross-linking in keratoconus eyes with KMax≥58.0 D. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2921.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the effectiveness of corneal cross-linking (CXL) in keratoconus eyes with KMax values ≥58.0D
Retrospective analysis of CXL (standard Dresden epi-off) in progressive keratoconus. Inclusion criteria were KMax≥58.0D and a minimum follow-up of 1 year. Corneal topography and tomography were performed preoperatively and at 1 and 2 years. Those values were compared by paired T-Test. Sixty-one eyes of 56 patients with a mean age of 31.1 years (range 12 to 57 years) were included. Forty-two of these eyes had a 2-year follow-up. Progression was defined as in increase in KMax of ≥1.0D over 1 year.
Preoperative KMax was 63.88 ± 6.05D (mean±SD). At 1 year it was 62.85 ± 5.90D. This represented a significant decrease in steepness (p=0.0029). Fifteen of the 61 eyes (i.e. 24.6%) showed progression at 1 year. Five of the 61 steepened >2.0D (8.2%). Mean pachymetry at the thinnnest point was 433.72±44.81μm preoperatively, and 422.79±41.70μm at 1 year.For the eyes with a 2-year follow-up, KMax was 63.21 ± 5.25D pre-CXL and 61.81 ± 5.05D at 2 years. This represented a significant decrease in steepness (p=0.0089). Progression occurred in 9 out of 42 eyes (21.4%). Mean pachymetry was 437.29±43.14μm preoperatively and 420.67±39.17μm at 2 years.Two eyes underwent a second CXL and one a lamellar keratoplasty.
In progressive keratoconus with preoperative KMax ≥58.0D, progression was seen in 24.6% of eyes at 1 year and 21.4% at 2 years after CXL. This is a considerably higher incidence of progression than previously reported. Earlier CXL studies of very steep keratoconus corneas included only a small number of eyes. To the best of our knowledge, this study represents the largest number of such corneas analyzed with respect to long-term post-CXL progression.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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