Ten Years Topographical And Clinical Outcomes Of 45Mw/Cm2 Accelerated Transepithelial Corneal Cross-Linking For Keratoconus Patients

Transepithelial accelerated corneal cross-linking procedure (ATE-CXL) was introduced to avoid the potential risks of epithelial removal, which is more comfortable, accelerate postoperative recovery, conserve corneal morphology, and reduce complications. Long-term results after 45 mW/cm² ATE-CXL have not been reported. We conducted this study to explore the long-term clinical efficiency of accelerated transepithelial CXL.

This prospective case series study aimed to assess the 10-year topographical and clinical outcomes of 45 mW/cm² ATE-CXL for keratoconus patients. 

Patients treated for keratoconus in our hospital since October 2013 were enrolled. Fifteen eyes from 15 patients were finally enrolled in our study. The mean age of participants were 23.7 years. Inclusion criteria included patients with keratoconus symptom and clinical signs, and corneal topography map consistent with keratoconus. Exclusion criteria included patients with a history of corneal surgery, corneal pachymetry less than 380 mm as measured with a Pentacam. KXL System (Avedro) was used to conduct ultraviolet treatment with pulsed illumination for 1 second at 45 mW/cm², delivering a surface dose of 7.2 J/cm².

All surgical procedures progressed successfully. No patients received additional surgery. Mean follow-up time was 119±6.1 months, longest 125 months. The preoperative and 10-years postoperative CDVA was stable during the follow-up. The pre-operative mean maximum keratometry (Kmax) value was 56.2 ± 9.1 diopters (D), and the thinnest corneal thickness (TCT) was 457.1 ± 44.6μm. Mean Kmax was 56.7 ± 9.6 D, 10 years post-operatively (P = 0.78). TCT changed to 453.17 ± 46.7μm at 10 years post-operatively (P = 0.70). Anterior central elevation value and posterior central elevation value showed no significant changes over the 10 years of follow-up. A slight decrease was observed in ECD while the change was with no significant difference.

As is shown by our study, long-term follow-up after 45 mW/cm² ATE-CXL was safe and stable. In the further, comparative, case control studies are needed. In vivo measurement of corneal biomechanical parameters, such as ORA and Corvis ST still need investigation.