ESCRS - FP30.01 - A 10-Year Survival Analysis Of Failure Rates After Initial Conventional, Accelerated Or Iontophoresis Cxl For Keratoconus

A 10-Year Survival Analysis Of Failure Rates After Initial Conventional, Accelerated Or Iontophoresis Cxl For Keratoconus

Published 2026 - 44th Congress of the ESCRS

Reference: FP30.01 | Type: Free paper | DOI: 10.82333/m8zd-zq89

Authors: A/Prof. Thibaud Garcin* 1 , Ms Malika Hamrani 1 , Prof. Nacim Bouheraoua 1 , Prof. Vincent Borderie 1

15,National Hospital 15-20,Paris,France

Purpose

Keratoconus progression following primary collagen crosslinking (CXL) with different protocols at long term (more than 3-5 years) is not yet well documented in the literature.

To define risk factors for initial CXL failure with different protocols in keratoconic (KCN) eyes.

Setting

French tertiary ophthalmology department, National Hospital 15-20, GRC32, TITC, Sorbonne University, Paris

Methods

571 eyes from 415 patients who underwent initial CXL for progressive KCN between 2010 and 2024 and minimum 12-month follow-up after CXL were included: 177 (31%) conventional, 261 (46%) accelerated or 133 eyes (23%) iontophoresis CXL. Baseline visit was 0-6 months following initial CXL. The primary outcome was the Kaplan–Meier estimated rate of CXL failure within 1, 3, 5 and 10 years, defined as undergoing repeat CXL, or corneal keratoplasty (PK or deep anterior lamellar DALK) after initial CXL. The secondary outcomes were comparisons between the Kaplan–Meier estimated rate of conventional, accelerated or iontophoresis CXL failure, and risk factors of initial CXL failure.

Results

A total of 21 eyes (3.68%) from 18 patients (4.33%) experienced CXL failure, of which 11 eyes (9 patients) underwent (n=1) PK or (n=10) DALK. Overall, the estimated 1, 3, 5-year and 10-year CXL failure rates were 0.95%, 3.55%, 4.20%, and 5.72% respectively, without difference between repeat CXL and corneal keratoplasty (P=0.084). The estimated CXL failure rates were different between the 3 protocols (P=0.004). Multivariable Cox regression demonstrated that age >18 years (HR: 0.98; P = 0.047), accelerated or conventional CXL (respectively HR: 0.035 and 0.051; P < 0.001) were associated with lower CXL failure rates.

Conclusions

Approximately 1 in 25 eyes and 1 in 18 eyes with KCN that underwent CXL had repeat treatment or keratoplasty within 5 and 10 years respectively, and mainly required among younger patients and after iontophoresis CXL. No failure was observed after conventional CXL in this monocentic series.