Three-Year Follow-Up Of Accelerated Versus Accelerated Contact Lens–Assisted Cross Linking For Progressive Keratoconus In Adults
Published 2024 - 42nd Congress of the ESCRS
Reference: FP18.02 | Type: Free paper | DOI: 10.82333/8vjj-nh14
Authors: Anna Bunin* 1 , Soosan Jacob 2 , Ran Matlov Kormas 3 , Nir Amitai 1 , Tomer Kerman 1 , Erez Tsumi 1 , Boris Knyazer 1
1Ophthalmology,Soroka Medical Center,Beer Sheva,Israel, 2Dr. Agarwal’s Refractive and Cornea Foundation, Dr. Agarwal’s Eye Hospital,Chennai,India, 3Ophthalmology,Kaplan Medical Center,Rehovot,Israel
Purpose
The contact lens-assisted corneal cross-linking (CA-CXL) is one of methods to treat the keratoconus patients with corneal under 400 microns. Less is known on the long-term efficacy of contact lens-assisted corneal cross-linking (CA-CXL) in keratoconus patients. The purpose of our study was to compare the clinical and tomographic properties of patients with keratoconus treated with accelerated corneal cross-linking (A-CXL) versus accelerated contact lens–assisted corneal cross-linking (A-CACXL).
Setting
The study was conducted at the Department of Ophthalmology at Soroka University Medical Center, Beer-Sheva, Israel (SUMC), between March 2021 and February 2022. The study was approved by the Institutional Review Board (IRB) of the Ben-Gurion University of the Negev, Israel
Methods
Patients were enrolled who underwent A-CXL and A-CACXL due to progressive keratoconus from January 2015 to 2018 in this retrospective case–control study. The treatment group (minimum corneal thickness of less than 400 µm after epithelium removal; 30 patients, 30 eyes) was treated with A-CACXL; the control group (minimum corneal thickness of 400 µm or greater, 32 patients, 32 eyes) was treated with A-CXL. Assessments occurred before treatment, 1 year and 3-year postoperatively. Demographic, clinical, and tomographic data were obtained from
outpatient clinic reports.
Results
Both groups showed a significant improvement in visual acuity compared to baseline at 3-year follow-up (A-CXL: 0.63–0.44 LogMAR UCVA, p< 0.03; 0.32-0.18 LogMAR BCVA, p< 0.001. A-CACXL: 0.93–0.66 LogMAR UCVA, p < 0.05; 0.51-0.33 LogMAR BCVA, p< 0.04). In this study, there was no significant difference in tomographic parameters between the two protocols postoperatively in Kmax, Kmean, or corneal astigmatism. Progression of keratoconus was halted at similar rates for both groups (73% treatment, 87% control, P =0.2).
Conclusions
A-CACXL halted keratoconus progression in 73% of eyes with rates comparable to A-CXL. Visual outcomes improved for both groups, with similar keratometry changes. In this long-term study we found, that A-CACXL is an effective and safe option for patients with keratoconus and thin corneas, with results similar to A-CXL treatment in patients with a minimum corneal thickness of 400 µm or greater