Characteristics Of Patients Who Progressed After Corneal Cross-Linking: A Save Sight Keratoconus Registry Study
Published 2024 - 42nd Congress of the ESCRS
Reference: FP18.06 | Type: Free paper | DOI: 10.82333/abcf-z537
Authors: Stephanie Watson* 1 , Marco Abbondanza 2 , Adam Watson 3 , Francisco Arnalich-Montiel 4 , Vincent Daien 5 , Himal Kandel 1
1Ophthalmology,Save Sight Institute, The University of Sydney,Sydney,Australia, 2Abbondanza Eye Centres,Rom,Italy, 3Eye Institute,Auckland,New Zealand, 4Cornea & External Diseases,Hospital Universitario Ramón y Cajal, IRYCIS,Madrid,Spain, 5Ophthalmology,University Hospital Montpellier,Montpellier,France
Purpose
The Save Sight Keratoconus Registry (SSKR) is the first international web-based multinational, interdisciplinary registry able to collect high-quality outcome data from patients in clinical settings. This study aimed to report the characteristics of patients who had progressed after corneal cross-linking (CXL) performed for keratoconus in 33 sites in Australia, New Zealand, France, Spain, and Italy with data collected by the Registry.
Setting
Academic and private ophthalmology practices in Australia and Europe.
Methods
A cross-sectional, real-world study was conducted utilising prospectively collected data from the web-based SSKR. Data collected included demographic details, medical history and index visit characteristics such as habitual visual acuity and corneal parameters. A total of 1,432 eyes (1,229 patients) with epithelium-off CXL for keratoconus which had follow-up data at 1-year in the SSKR were included. Demographic and clinical characteristics of the eyes which developed corneal steepening (‘progressors’; ≥1 D change in Kmax or K2) were compared with the eyes with improved or stable Kmax and K2 12 months post-CXL (‘non-progressors). The outcomes were compared using t-test, chi-squared test, and mixed-effects regression models.
Results
A total of 339 eyes (23.7%;318 patients; mean age 25.2±10.7 years; 71.1% male) were progressors, and 1,093 eyes (76.3%;911 patients; mean age 25.5±10.2 years; 71.0% male) non-progressors.
At baseline, progressors had worse mean visual acuity (70.7 vs 72.2 logMAR letters), Kmax (57.8 vs 56.4D), & K2 (51.2D vs 50.4D) than non-progressors (all p<0.05). The differences in minimum corneal thickness between the groups were not statistically significant (progressors 455.2 vs non-progressors 456.1 µm, p = 0.776). Progressors had worse visual outcomes than the non-progressors (mean gain VA: 2.1 vs 5.0 logMAR letters, respectively; p = 0001). Clinically significant haze was more common in non-progressors (12.4%) than in progressors (6.5%), p = 0.003.
Conclusions
In our real-world study, patients who progressed after epithelium-off CXL had similar demographic characteristics to those who did not progress. Progressors were likely to have worse visual acuity and steeper corneal curvature at baseline and had worse visual outcomes post-CXL than non-progressors. Whilst progressors were less likely to develop clinically significant haze post-CXL compared to non-progressors. Knowledge of patients at risk of progression may inform clinicians of the patient groups who require closer follow up after CXL.