Quality Of Life Improvement In Keratoconus Patients After Corneal Crosslinking And Intracorneal Ring Segment Implantation
Published 2023
- 41st Congress of the ESCRS
Reference: PO0694
| Type: Free paper
| DOI:
10.82333/ppf7-za93
Authors:
Bruna Cunha* 1
, Pedro Gil 1
, Catarina Barão 1
, Diogo Hipolito-Fernandes 1
, Sara Crisostomo 1
, Vitor Maduro 1
, Nuno Alves 1
, João Feijão 1
1Ophthalmology,Centro Hospitalar Universitário de Lisboa Central,Lisboa,Portugal
Purpose
The Keratoconus Outcomes Research Questionnaire (KORQ) assesses the keratoconus-specific health-related quality of life (QoL) impact in terms of activity limitation and symptoms. It has been established that Keratoconus patients have worse QoL, as the cornea becomes steeper and visual acuity decreases. Corneal crosslinking (CXL) and intracorneal ring segment (ICRS) implantation are used to halt the disease progression and for visual rehabilitation. The purpose of this study was to evaluate the change in QoL of keratoconus patients 6 months after surgical treatment, and its association with visual and refractive outcomes.
Setting
Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
Methods
Observational cross-sectional study of keratoconus patients selected for CXL and ICRS implantation. Patients were invited to fill the KORQ questionnaire, at two visits: before the surgical procedure and 6 months postoperative. Each patient was scored using published spreadsheets for the 2 dimensions: functional activity and symptoms (lower scores are associated with better QoL). KORQ scores were associated with clinical and demographic data, including age, best corrected visual acuity (BCVA), maximum simulated keratometry (Kmax), flat, steep and average keratometry (K1, K2, Km), spherical equivalent, thinnest pachymetry, type of corneal surgery (CXL or ICRS) and Amsler-Krumeich keratoconus stage.
Results
Ten patients met the inclusion criteria (mean age of 21.9 years, SD: 3.51; 15-27); equal gender distribution. Seventy percent of patients underwent CXL and 30% ICRS implantation. Mean BCVA in the worst (operated) eye improved by 0.27 logMAR (SD: 0.80; range: -1.30 to 0.65). Mean Km and Kmax in the worst eye flattened by -0.73 diopters, D (SD: 2.80; -5.3 to 3.25) and -2.55 D (SD: 4.88; -11.6 to 1.9), respectively. Interventions improved symptoms score QoL (postop -0.11 vs preop 0.46; p=0.04) without statistical significance in the functional activity score (postop 0.18 vs preop 0.64; p=0.10). QoL improvement was not correlated with BCVA improvement in the worst eye. QoL scores improvement was not significantly different between CXL or ICRS.
Conclusions
The study of patient-reported outcomes (PROMs) is a hot topic in current health research, particularly important for keratoconus which impacts young active patients. These preliminary results confirm the positive impact that CXL and ICRS have in keratoconus-specific health-related QoL, possibly with a more significant influence in terms of symptoms than in functional activities. A relatively small sample precludes us from expanding our conclusions, but recruitment is ongoing and results will be updated as more patients fulfil the 6-month follow-up period. The addition of PROMs and its link to clinical outcomes is a decisive piece to include in the puzzle of evidence-based recommendations for the surgical management of keratoconus.