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First Author: A.Behndig SWEDEN
Co Author(s): J. Beckman-Rehnman P. Hallberg C. Lindén
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To compare the refractive changes after corneal crosslinking with and without mechanical compression of the cornea using a sutured rigid contact lens.
University Hospital Eye Clinic
In this prospective, open, longitudinal, randomized case-control study, 60 eyes of 42 keratoconus patients aged 18 to 28 years planned for corneal crosslinking and corresponding age- and sex matched control subjects were included. They were recruited from the Department of Ophthalmology, Umeå University Hospital, Sweden. The patients were assigned to either conventional corneal crosslinking (CXL) or corneal crosslinking with mechanical compression using a flat rigid contact lens sutured to the cornea during treatment (CRXL). The contact lens was removed one hour post-treatment. Subjective refraction and ETDRS visual acuity, axial length measurement, keratometry and ultrasonic pachymetry were performed before and at one and six months after the treatment.
The keratoconus patients had lower visual acuity, higher refractive astigmatism and higher keratometry readings than the controls (p<0.007). In the CXL group, visual acuity increased from 0.19ḟ0.26 logMar to 0.14ḟ0.18 logMar (p=0.026), and the spherical equivalent increased from -1.91ḟ2.78 to -1.44ḟ2.42 (p=0.033). No changes were seen after CRXL (p=0.204 and 0.243, respectively). Keratometry readings decreased after CXL from 45.9ḟ3.3 to 45.3ḟ3.5 (p<0.001), but not after CRXL (p=0.516). The axial length decreased in the CXL group, likely due to post-treatment corneal thinning (p=0.026), but not in the CRXL group (p=0.812).
In this first evaluation of mechanical compression of the cornea combined with crosslinking, the results did not surpass those of conventional CXL treatment. Rather, some variables indicated an inferior effect. Further evaluation of the method and modification of the treatment parameters will be needed. Possibly, a greater crosslinking effect is necessary to stabilize the cornea in its flattened position.