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Pulsed light accelerated corneal collagen cross-linking using an 18mW/cm2 2 seconds on, 1 second off protocol for keratoconus: 1 year outcomes

Poster Details

First Author: V.Barnett UK

Co Author(s):    J. Than   O. Bowes   F. Allen   E. Trocme   S. Coutts   A. Barsam     

Abstract Details


Keratoconus is an ectatic disorder affecting approximately 1 in 1000 people, resulting in progressive myopia and irregular astigmatism secondary to conical protrusion and apical thinning of the cornea. Collagen cross-linking is the gold standard treatment for progressive disease. Accelerated cross-linking protocols have shown promise in terms of generating similar outcomes to traditional protocols in shorter periods of time. We propose a novel protocol using an epithelium-off pulsed accelerated CXL regime: actual treatment time 6 minutes 40 seconds increasing to a total of 10 minutes with pulsing (2 seconds on/1 second off) at 18mW/cm2 with total energy dose of 7.2J/cm2.


Department of Ophthalmology, Luton and Dunstable University Hospital, United Kingdom


Patients with progressive keratoconus, minimum corneal thickness �â�‰�¥375�Î�¼m, no further ocular comorbidities and no prior corneal surgery underwent the novel protocol. All patients underwent alcohol-assisted epithelial debridement (9mm diameter) followed by corneal soaking with dextran-free riboflavin 0.1%. Subsequent epithelium-off pulsed accelerated corneal CXL using KXL 1 UV-A source (Avedro Inc., Waltham, MS, USA) with a total treatment time of 6 minutes 40 seconds, increased to 10 minutes with pulsing (2 seconds on/1 second off). Total energy dose was 7.2J/cm2. BCVA, Kmax, corneal astigmatism, and minimum corneal thickness were recorded pre-operatively and 1 week, 1, 6, and 12 months post-operatively.


55 eyes of 50 patients underwent the protocol. Mean follow-up duration was 1 year. At last follow-up, mean BCVA improved from logMAR equivalent 0.4 to 0.2 (p<0.01) and mean Kmax improved from 57.4 to 56.3D (p<0.05). Mean corneal astigmatism increased from 3.7 to 4.0D (p<0.01). Minimum corneal thickness reduced from 472 to 456�Î�¼m (p<0.01). No complications were noted.


This audit demonstrates the safety and efficacy of our novel accelerated CXL protocol in stabilising progressive keratoconus. Further work with larger sample size, longer follow-up, and comparison versus gold standard Dresden protocol CXL is required to determine long-term safety and efficacy of this protocol.

Financial Disclosure:


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