SPECIALIST NURSE-LED CORNEAL CROSS-LINKING SERVICE FOR KERATOCONUS - THE WELSH EXPERIENCE

To evaluate the efficacy and safety of the first nurse-led cross-linking (CXL) service to be set up and implemented in Wales.

A single-centre retrospective study conducted at Singleton Hospital, Swansea.

Data collection was performed on all patients with progressive keratoconus who received CXL treatment at the nurse-led clinic using the accelerated epithelium-off CXL protocol from April 2022 until April 2023. Primary outcomes measured include corrected distance visual acuity (CDVA), K1, K2, Kmax and central corneal thickness (CCT). Data was compared between baseline and 10-week post treatment and baseline to 1-year post treatment using paired T-tests. Secondary outcomes measured include any intra and post-procedure complications.

A total 48 patients (n= 58 eyes) underwent treatment during this period. The mean age of the patients was 25.7 years old. No statistically significant difference was noted across K1, K2 and Kmax at 10-week mark. At 1-year post treatment (n=38 eyes), a significant difference in Kmax was observed, whereby it has decreased from 58.45 at baseline to 56.88 (p value = 0.02). Keratometric stabilisation was confirmed in 100% of all cases. CDVA was not significantly different at one year compared to baseline. 2.63% of eyes lost more than 2 lines of CDVA. This is comparable to that reported in current literature using the same CXL protocol. From safety profile point of view, no episode of adverse incident was recorded.

Our results demonstrate a safe and effective delivery of the CXL service at the nurse-led clinic. This highlights the complementary role that this new service could play in addition to the current services in increasing departmental capacity and reducing patient waiting times in a public health system.