Abstract
Purpose :
To report outcomes of 662 eyes of 534 patients undergoing corneal cross-linking (CXL) for keratoconus performed in 32 centres across Australia, New Zealand, Spain and Italy.
Methods :
Data from routine clinical practice was captured through the Save Sight Keratoconus Registry. Patients with no prior intervention who had undergone epithelium-off CXL were included.
Primary outcomes included the final visual acuity (VA), measured with the patient’s habitual visual correction method, Kmax, K2 and thinnest corneal thickness (TCT) at 1 to 5-years.
Secondary outcomes included the percentage of 1 to 5-year completers with worsening, stable and improving VA, Kmax, K2 and TCT. CXL ultraviolet light protocols and the frequency of adverse events were also reported.
Results :
Eligible for inclusion were 662 eyes (1 year), 327 (2 years), 231 (3 years), 166 (4 years) and 117 (5 years). For the 5-year completers, visual acuity improved by 8.1 (3.5, 12.7) logMAR letters (p=0.003). Conversely, Kmax (p=0.26), K2 (p=0.34) and TCT (p=0.20) did not change significantly (Figure 1).
From 1 to 5 years there was an increasing proportion eyes that gained 15 of more letters (from 13.5% to 24.8%) and flattened by 2D or more in Kmax (from 29.5% to 43%) (Figure 2).
The most commonly used UV duration was, in minutes, 10 (358 eyes), 30 (250 eyes), 8 (22 eyes), 9 (18 eyes) and 4 (17 eyes) durations.
In the 1st and 5th years, the number of eyes with adverse events included: corneal haze [89 (13.4%), 0 (0%)], scarring [16 (2.4%), 1 (0.9%)], sterile infiltrates [6 (0.9%), 0 (0%)], stromal oedema [4 (0.6%), 0 (0%)], microbial keratitis [2 (0.3%), 0 (0%], persistent epithelial defect [4 (0.6%) 1 (0.9%)], recurrent erosion [2 (0.3%, 0 (0%)] and steroid response [1 (0.2%), 0 (0%)], respectively.
Conclusions :
Our real-world data across multiple countries supports CXL as an effective treatment for progressive keratoconus, with positive outcomes including improved VA and stable Kmax, K2 and TCT sustained at 5 years. CXL has a good safety profile with few adverse events occurring, particularly at 5 years.
This is a 2020 ARVO Annual Meeting abstract.