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Short-term refractive outcomes and safety of accelerated corneal collagen cross-linking compared to conventional cross-linking

Poster Details

First Author: H.Matalia INDIA

Co Author(s):    N. C   A. Ranganath   R. Shetty              

Abstract Details


To evaluate the safety of accelerated corneal collagen cross-linking with riboflavin (ACXL) at 30mW/cm2 for 3 minutes and its short-term effectiveness in comparison with conventional corneal collagen cross-linking with riboflavin (CXL) at 3mW/cm2 for 30 minutes. As the total energy delivered for the collagen cross-linking remains same, both groups are comparable to each other. However, there is no data available on the outcome of 30mW/cm2 for 3 minutes and its comparison with the conventional Dresden protocol. In this study we would like to compare these two treatment protocols and their outcome.


Narayana Nethralaya, Narayana health City, Superspeciality Eye Hospital and Postgraduate Institute of Ophthalmology, Bangalore, India


Eighty seven patients were included in the study. Mean age of diagnosis was 22.37 years. Males were 56% and females were 44%. All patients underwent corneal topography (Oculyzer, WaveLight, Chicago, USA). Patients with progressive keratoconus underwent cross-linking with the ACXL group receiving UVA radiation of 30mW/cm2 for 3 minutes and CXL group receiving UVA radiation of 3mW/cm2 for 30 minutes. Outcome measures studied were corrected distance visual acuity (CDVA), mean manifest cylinder, keratometry (K1, K2, Kmax), stromal haze (measured on densitometry) and corneal thickness. Data collected pre-operatively and up to six months post-operatively was analyzed.


Of the 87 eyes studied, 45 eyes underwent ACXL, and 42 eyes underwent CXL. The CDVA and manifest cylinder remained stable in both groups at six months (p>0.05). Post-surgery, Kmax remained stable in ACXL group, but decreased (1.6D at 6 months) in CXL group (p<0.0008). No progression of keratoconus was seen in any patient at six months. Corneal haze increased post-surgery in both groups (p<0.001) but intensity was higher in the CXL group compared to ACXL (p<0.001 at 3 and 6 months). There was an inverse relation between corneal haze and thickness post-operatively. No complications were noted in ACXL group.


ACXL using 30mW/cm2 for 3 minutes appears to be a safe procedure and the early results are comparable with conventional CXL using Dresden protocol of UVA radiation of 3mW/cm2 for 30 minutes. Keratometry shows progressive flattening following CXL and not ACXL. No progression as well as complications was noted in both groups.

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