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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)
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.
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.
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.
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 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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