ESCRS - PP14.14 - Iontophoretic Transepithelial Corneal Collagen Cross-Linking (I-Cxl-Te) In Young Patients With Progressive Keratoconus (P-Kc): 72-Month Follow-Up

Iontophoretic Transepithelial Corneal Collagen Cross-Linking (I-Cxl-Te) In Young Patients With Progressive Keratoconus (P-Kc): 72-Month Follow-Up

Published 2023 - 41st Congress of the ESCRS

Reference: PP14.14 | DOI: 10.82333/7q25-zh71

Authors: Mario Troisi* 1 , Maria Vittoria Turco 2 , Vito Turco 2 , Salvatore Troisi 2

1Ophthalmology,University of Naples Federico II,Naples,Italy;Ophthalmology,Salerno University Hospital,Naples,Italy, 2Ophthalmology,Salerno University Hospital,Salerno,Italy

The aim of this study is to evaluate the efficacy and safety of i-CXL-TE and accelerated irradiation protocol (10mW/cm2) with a 6-year follow-up  in patients aged between 12 and 32 years with tomographic (Kmax greater than 1.5 diopters), pachymetric (reduction of the thinnest point greater than 20 microns) or refractive progression (increase in cylindrical correction of > 0.75 diopters) in the 6 months prior to treatment. The results and the side effects, if any, were noted and reported in the study.

Young adult patients suffering from progressive keratoconus reported at the Cornea Unit of Salerno University Hospital were evaluated and treated with accelerated i-CXL-TE.

We examined 78 eyes of 59 patients (31 males and 28 females, with an average age of 19.4 years) with tomographic and refractive progression of KC in the previous 6 months who underwent i-CXL-TE with the accelerated protocol from 01.01.2016 to 12.31.2016. Epi-on imbibition was performed with dedicated 0.1% hypotonic riboflavin solution and ionophoretic method for 5', followed by UV-A irradiation at 370nm 10mW/cm2 for 9'. Clinical and tomographic follow-up (Scheimpflug camera) was performed at 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 60 and 72 months; endothelial count and macular OCT at 3, 12, 24, 36, 48, 60 and 72 months

The mean increase in Kmax values ​​was +1.81 +/- 0.34D over the 6 months prior to treatment. Post-treatment mean Kmax values ​​decreased by -0.51 +/-0.84D, -0.89 +/-0.94D, -1.13 +/-1.02D, -1.02 +/- -1.12D, -0.93 +/-1.13D , -0.97 +/-1.08, -0.91 +/- 1.12 at 6, 12, 24, 36, 48, 60 and 72 months, respectively; 7 eyes needed retreatment. In 64 eyes there was a reduction in Kmax values ​​at 72 months, in 71 eyes there was an improvement in visual acuity (BSCVA -0.21 +/-0.17 LogMar: p< 0.05); endothelial count, intraocular pressure, and OCT did not show statistically significant differences over the course of the study. We have not observed haze or other side effects.

The reduced execution time and the reduced invasiveness of the method allowed a good compliance of the patients permitting to carry out the treatment in pediatric and young adult patients. Treatment with i-CXL-TE was effective in arresting p-KC at 72 months of follow-up, with improvement of Kmax in 82% of patients; a statistically significant improvement in visual acuity was recorded in 91% of subjects. No haze or other relevant side effects were reported.