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Evaluation of safety and efficacy of new protocols of collagen cross-linking for keratoconus

Poster Details

First Author: M.Taneja INDIA

Co Author(s):    T. Singh   P. Krishna   S. Murthy              

Abstract Details


Off late various new protocols of Collagen Cross Linking (CXL) have been proposed by various groups, with the aim of improving the convenience of performing the procedure for the patient and the surgeon. However that confuses the surgeon as to which protocol to follow in a patient of progressive Keratoconus. The purpose of this study was to evaluate the safety and efficacy of different types of CXL protocols so as to know if different formulations of riboflavin and/or different methodologies of UV-A light exposure play a role in determining the safety and efficacy of CXL procedures for stabilizing Keratoconus.


The study was conducted at Cornea and Anterior Segment Services of L V Prasad Eye Institute, Hyderabad, India which is a tertiary care eye hospital.


Seventy one patients with progressive Keratoconus were included in the study and divided into 4 groups. Group A (n32) underwent CXL with conventional Dresden Protocol, group B (n16) underwent CXL with hypo-osmolar Riboflavin, group C (n15) underwent accelerated mode of CXL (18mw/cm2 UV-A for 5 minutes) and group D (n8) underwent trans-epithelial CXL procedure. All the patients were followed up for one year and Topography, Refractive and Specular study results were collected before and after one year of CXL procedure. All statistical analysis was performed using the R software (version 2.12) and adjusted p value was obtained by Bonferroni method.


Kmax value in Diopters (D) decreased by 1.41D (p=0.001) in group A, by 1.99 D (p=0.002) in group B, by 0.95 D (p=0.337) in group C. However in group D, the Kmax showed an increase in majority of the patients. Endothelial cell count was found to be marginally decreased by 74.25 cells/cm2 (p=0.11) in group A, 58 cells/cm2 (p=1.0) in group B and 74.74 cells/cm2 (p=0.78) in group C and no change in endothelial cell density was observed in group D. It was noted that 1 patient each in group A and group B developed sterile infiltrates.


The study results show that the conventional Dresden protocol remains the most efficacious protocol for CXL for progressive keratoconus with both Iso-osmolar and hypo-osmolar Riboflavin. The accelerated CXL procedure was also found be effective in arresting the progression of keratoconus, however the efficacy was less than that of the conventional Dresden protocol. The transepithelial CXL protocol does not appear to an effective CXL procedure for stabilizing Keratoconus. However, all the protocols were found to be safe for application in his study population.

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