June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
5-year outcomes of corneal cross-linking: A Save Sight Keratoconus Registry study
Author Affiliations & Notes
  • Alex Ferdi
    Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
  • Vuong Nguyen
    Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
  • Himal Kandel
    Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
  • Jeremy Tan
    Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
  • Francisco Arnalich Montiel
    Hospital Universitario Ramón y Caja, Spain
  • Marco Abbondanza
    Studio Oculistico Abbondanza di Milano, Italy
  • Stephanie Watson
    Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Alex Ferdi, None; Vuong Nguyen, None; Himal Kandel, None; Jeremy Tan, None; Francisco Arnalich Montiel, None; Marco Abbondanza, None; Stephanie Watson, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 2339. doi:
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    • Get Citation

      Alex Ferdi, Vuong Nguyen, Himal Kandel, Jeremy Tan, Francisco Arnalich Montiel, Marco Abbondanza, Stephanie Watson; 5-year outcomes of corneal cross-linking: A Save Sight Keratoconus Registry study. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2339.

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

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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.

 

Figure 1. Line plots showing final clinical measurements at each year of follow-up from 1-5 years. A) visual acuity, B) thinnest corneal thickness, C) Kmax, D) K2.

Figure 1. Line plots showing final clinical measurements at each year of follow-up from 1-5 years. A) visual acuity, B) thinnest corneal thickness, C) Kmax, D) K2.

 

Figure 2. Bar blots of percentage of eyes with worsening, stability and improvement in clinical parameters at 1 to 5-years. A) visual acuity, B) TCT = thinnest corneal thickness, C) Kmax, D) K2.

Figure 2. Bar blots of percentage of eyes with worsening, stability and improvement in clinical parameters at 1 to 5-years. A) visual acuity, B) TCT = thinnest corneal thickness, C) Kmax, D) K2.

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