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Alex Ferdi, Vuong Nguyen, Jeremy Tan, Yves Kerdraon, John Males, Nigel Morlet, Peter Beckinsale, Richard A Mills, Chris Go, Mark Daniell, Elsie Chan, Daniel Barthelmes, Amparo Herrera-Bond, Marco Garcia, Mark C Gillies, Stephanie L Watson; The outcomes of corneal cross-linking for Keratoconus from routine clinical practice across 3 sites in Australia: Results from the Save Sight Keratoconus Registry. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4380. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report the 12-month outcomes of 54 eyes undergoing corneal cross-linking (CXL) for keratoconus performed in 3 routine clinical practices in Australia.
Outcomes and adverse events were recorded prospectively in a custom-designed database, the Save Sight Keratoconus Registry. Index visit parameters, such as visual acuity (VA, in Logarithm of the Minimal Angle of Resolution [logMAR]), maximum keratometry [Kmax], steep keratometry [K2], pachymetry, as well as treatment parameters (epithelial status, riboflavin type, UV duration) were recorded. Index visit parameters associated with the 12-month VA outcome were identified using mixed effects linear regression.
Median change in VA after 12 months was +4.5 logMAR letters (Quartiles 1 and 3 [Q1, Q3]: -4.8, 10.8); Kmax -0.3 D (Q1, Q3: -2.3, 0.4); K2 -0.2 (Q1, Q3: -1.4, 0.3) and pachymetry -14.0 microns (Q1, Q3: -23.8, -2.0). There was a significant improvement in VA (p = 0.048), reduction in Kmax (p = 0.027) and reduction in pachymetry at 12 months (p = 0.002). VA at the index visit was the strongest predictor for the 12-month VA outcomes (p < 0.001). There was no significant change in K2 at 12 months (p = 0.074).Treatments were epithelial-off (n=54) with UV exposure that was accelerated (n= 40) or according to the Dresden protocol (n=14).Adverse events occurred in 31 eyes and included corneal haze (27 eyes), microbial keratitis (1 eye), persistent epithelial defect (4 eyes), scarring (4 eyes), and sterile infiltrates (1 eye) from a total of 54 eyes within the first 12 months of follow-up. Haze was recorded in 7 eyes during the second year of follow-up. Eyes that experienced microbial keratitis or scarring within the first 12 months of follow-up had a median VA loss of -15 and -9 (Q1, Q3: -17.5, -2.25) letters at 12 months, respectively. Eyes that experienced haze, persistent epithelial defect or sterile infiltrates within the first 12 months of follow-up had a median VA change of +6 (Q1, Q3: -1, 11), +4 (Q1, Q3: 1.75, 6.0) and +0 letters at 12 months, respectively.
In routine clinical practice CXL can stabilize visual acuity and keratometric parameters. Although complications such as keratitis or scarring can result in visual loss, corneal haze does not appear to have a detrimental effect on visual outcomes at 12 months.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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