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Differences in corneal clinical findings after standard and accelerated cross-linking in patients with progressive keratoconus

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Session Details

Session Title: Cross-Linking

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:30

Paper Time: 15:22

Venue: Room 4.6

First Author: : K.Kortuem GERMANY

Co Author(s): :    E. Vounotrypidis   A. Athanasiou   M. Mueller   C. Kern   S. Priglinger   W. Mayer     

Abstract Details


The purpose of this study was to identify differences in clinical corneal findings after standard and accelerated epithelial off cross-linking (CXL) during a long-term follow-up.


Retrospective, non-randomized, unmasked study at University Eye Hospital Munich. Data was extracted from the smart eye database at the institution.


Overall, 241 patients (184 male) were included in the study. 148 eyes were treated with the accelerated protocol and 138 with the standard protocol with epithelial off CXL, if diagnosed with keratoconus and a progression in Kmax of more than one dioptre during the preceding six months and additional minimal pachymetry measurement of 400 μm. Exclusion criteria were previous surgery, other corneal conditions or age above 50 years. Follow-up time was 36 months with clinical grading examination and keratometry at every visit. Outcome measures were the observed rate of corneal changes, differences between treatment groups and correlation with keratometry measurements.


In patients with accelerated CXL, significantly more clear corneas were seen at three (p=0.015) and six months (p=0.002) after surgery compare to standard protocol. The rate of clear corneas dropped from 52.2% pre-operation (OP) to a minimum of 19.3% after 6 months in the standard protocol group compared with 50.7% clear corneas pre-OP and a minimum of 40.8% in the accelerated group. In the standard protocol group, more striae were found three months after intervention than in the accelerated group (p=0.05). No differences in corneal measurements could be found.


In patients with accelerated CXL, fewer morphological corneal changes were observed than after conventional CXL. Especially the rate of clear corneas was significantly higher in the group treated with the accelerated method. However, rarely, corneal changes persisted for a long time. Accelerated CXL is at least as safe as standard CXL. There were also no significant differences in k-values in both methods as measured in Pentacam.

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