Safety and efficacy of accelerated cornea cross-linking to arrest progression of corneal ectasia in a tertiary referral center in the UK

Abstract

Purpose : Corneal collagen cross-linking (CXL) is nowadays the gold-standard procedure to stabilize progression ofectatic disorders. The initial Dresden protocol has been progressively replaced by new accelerated protocols that allow reduced treatment time without compromising safety and efficacy. We present our data on accelerated CXL from a tertiary Ophthalmology center in the UK.

Methods : Prospective non-randomized interventional clinical study including all consecutive patients with topographic evidence of progressing corneal ectatic disorder who underwent accelerated CXL (9mW/cm²for 10’; 5.4J/cm²). Outcomes regarding best-corrected visual acuity (BCVA; LogMAR), sphere, cylinder, spherical equivalent (SE), topographical indices and complications were collected preoperatively and at 1, 3, 6, 12, 18, and 24 months postoperatively and analyzed accordingly.

Results : 67 eyes of 58 patients (males=43; 74%) were included. Mean age was 21.1 years (SD 4.9, range 14-38). Mean follow-up time was 14.9 months (SD 6.49, range 3-34). 64 eyes (95.5%) were treated for keratoconus, 2 for pellucid marginal degeneration and 1 for post-LASIK ectasia. Mean preoperative BCVA was 0.4 (SD 0.4) and at last follow-up 0.3 (SD 0.4), with no statistically significant differences between timepoints (p>0.05). Subjective refraction values (sphere, cylinder and SE) did not show any statistically significant differences between timepoints (p>0.05). Mean pre-operative keratometric values were: K₁54.3D (SD 5.2), K₂46.1D (SD 9.2) and K_m50.8D (SD 4.4), remaining stable at last follow-up: K₁56.4D (SD 6.4), K₂47.9D (SD 4.4) and K_m52.2D (SD 5.0) (p>0.05). One eye (1.5%) presented a sterile corneal infiltrate 5 days after CXL that resolved completely after one month of intensive topical treatment with antibiotics and steroids, with no residual corneal scarring or haze.

Conclusions : Accelerated CXL successfully stabilized all corneal ectatic disorders in our study, and reduced surgical time, potentially increasing the efficiency of CXL. Our results confirm that progression of ectasia was successfully halted with CXL, with no serious complications. Accelerated CXL is a safe and effective alternative to the Dresden protocol.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.