EIGHT YEAR RESULTS OF ACCELERATED EPIOFF CORNEAL CROSS-LINKING IN PATIENTS WITH PROGRESSIVE KERATOCONUS

Evaluate the long-term functional results based on keratometric measurements, spherical and cylinder equivalent in patients with progressive keratoconus treated with 15 mW/cm2 pulsed-light epithelium-off accelerated CXL

Retrospective study in which 300 eyes from 200 patients affected by keratoconus with miminum thickness of 400 micron was treated with accelerated crosslinking between 2012 and 2020 in single center ( Eye Center Dr Rechichi) .

All patients were evaluated preoperatively, and a follow-up was performed at 1, 3, and 6 months and every year from 1 to 10 years after accelerated CXL. After epithelium removal and 10 minutes stromal soaking with riboflavin 0.1% hydroxypropyl methylcellulose solution, all eyes had 15 mW/cm2 pulsed- light epithelium-off accelerated CXL for 6 minutes of ultraviolet-A (UVA) irradiation (1 Second on/1 off), maintaining a total UVA exposure of 12 minutes at a fluence of 5.4 J/cm2. Follow-up examination included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, Scheimpflug tomography, and spectral- domain optical coherence tomography (SD-OCT).

We observed significant improving in all keratometric values during the follow-up. Kmax decrease become statistically significant at 1 year after CXL and remained statistically significant thereafter up to 8 years. Mean spherical equivalent and mean cylinder both improved during the follow-up. Also uncorrected and corrected visual acuity increased remaining statistically significant, at the 8 years after CXL. We did not observe any case of severe complication.

Our results show that 15 mW/cm2 pulsed-light epithelium-off accelerated CXL was effective and safe, stabilizing keratoconus progression through 8 years of follow-up.