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Session Title: Cross-linking
Session Date/Time: Monday 07/10/2013 | 14:30-16:30
Paper Time: 15:32
Venue: Elicium 2 (First Floor)
First Author: : E.Chan AUSTRALIA
Co Author(s): : C. Wittig-Silva F. Islam T. Wu M. Whiting G. Snibson
To assess the efficacy and safety of corneal collagen cross-linking (CXL) for progressive keratoconus after 3 years.
The Royal Victorian Eye & Ear Hospital and the Centre for Eye Research Australia, Melbourne, Australia
This is an unmasked, prospective, randomised, controlled trial. 100 eyes with progressive keratoconus were randomised to the CXL treatment or a control group and were followed at 3, 6, 12, 24 and 36 months. CXL was performed using riboflavin 0.1% solution containing 20% dextran which was instilled over 15 minutes prior to and during UVA irradiation ((3mW/cm2)(UV-X; IROC, Zurich, Switzerland) for 30 minutes. Outcome parameters included maximum (Kmax) and minimum (Kmin) simulated keratometry value on computerised videokeratography, uncorrected (UCVA) and best spectacle corrected visual acuity (BSCVA), sphere and cylinder on subjective refraction, thinnest point on elevation topography and ultrasound pachymetry, intraocular pressure and endothelial cell density.
In control eyes, Kmax increased from baseline by a mean of 1.20D, 1.70D and 1.75D at 12, 24 and 36 months respectively (all p<0.001). In treated eyes, Kmax flattened from baseline by -0.72D, -0.96D and -1.03D at 12, 24, and 36 months respectively (all p<0.001). A similar trend was seen in Kmin. In the control group, UCVA worsened at 36 months (+0.10 LogMAR, p=0.034). In the CXL group, UCVA improved at 12 months (-0.14 LogMAR, p=0.008), 24 months (-0.13 LogMAR, p=0.02) and 36 months (-0.15 LogMAR, p=0.009) and BSCVA improved by -0.09 LogMAR (p=0.006) at 36 months. There was a significant reduction in corneal thickness measured using elevation computerised videokeratography in both groups at 36 months but not in the treatment group when measured using the ultrasonic pachymeter. The manifest cylinder increased by 1.17D (p=0.02) in the control group at 36 months. There was no significant difference in any other outcome parameters. There were two eyes with minor complications which did not affect their final visual acuity.
Keratoconus stabilised in eyes treated with CXL with a modest decrease in corneal curvature and an improvement in visual acuity. Conversely, eyes in the control group demonstrated progression over the same period.
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