Role Of Ethnicity And Age In Corneal Curvature And Thickness Changes Following Corneal Cross-Linking For Keratoconus
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR322 | Type: Poster | DOI: 10.82333/twzm-2j72
Authors: Dr Bandar Alenezi 1 , Dr Yousef Saad Al-Shammari* 2 , Dr Fadil Khoyratty 3 , A/Prof. Susmito Biswas 4 , Dr Sulaiman Aldakhil 5 , Dr Saif Alrasheed 5 , A/Prof. Hema Radhakrishnan 6
1College of Applied Medical Sciences,Qassim University,Buraydah,Saudi Arabia, 2Cornea, cataract and refractive surgery,Dhahran Eye Specialist Hospital,Dhahran,Saudi Arabia; Department of Ophthalmology, Dr Sulaiman AlHabib Hospital,Khobar,Saudi Arabia, 3Department of Ophthalmology,Imperial College NHS Trust,London,United Kingdom, 4Manchester University NHS Trust and Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health,The University of Manchester,Manchester,United Kingdom, 5Department of Optometry, College of Applied Medical Sciences,Qassim University,Buraydah,Saudi Arabia, 6Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health,The University of Manchester,Manchester,United Kingdom
Purpose
To investigate corneal cross-linking (CXL) effect on corneal curvature and thickness
in two different keratoconic populations based in the Middle East (Saudi Arabia) and Europe
(UK), and to explore whether age and ethnicity play a role in CXL outcomes.
Setting
Multicenter retrospective study conducted at a tertiary corneal referral hospital in Greater Manchester, United Kingdom, and a tertiary eye specialist hospital in the Eastern Province of Saudi Arabia.
Methods
208 eyes of 197 keratoconic patients (130M and 67F), aged 13–52 years were
included for UK cohort and 362 eyes of 329 keratoconic patients (226M and 136F), aged 12–
51 years, were included for Saudi cohort. All patients underwent epithelium-off accelerated
CXL (UV-A irradiation of 10 mW/cm2 for nine minutes) and riboflavin 0.1% solution in both
locations. Patients were divided into age groups: ≤18 years, 19–27 years, and ≥28 years. CXL
outcomes were assessed using Scheimpflug-imaging during 3-year follow-up and compared
across cohorts from both countries.
Results
Baseline maximum keratometry (Kmax) and pachymetry were 64.32±8.07D &
441±33.52μm for UK, and 54.60±7.59D and 462±36.38μm for Saudi. At three-years post-CXL,
Kmax improved or stabilized (change in Kmax > -1D) in 47 eyes (82.45%) in UK and 188 eyes
(84.30%) in Saudi, with significant improvements of 1.30±3.00D (p=0.003) and 1.2±2.91D
(p<0.001), respectively. Pachymetry significantly reduced for both cohorts (p=0.001 and
p<0.001, respectively). Kmax did not show significant changes in any age group post-CXL in
UK, whereas Kmax significantly improved in all age groups in Saudi.
Conclusions
Conclusions: Keratoconus presented at a more severe stage in UK cohort compared to Saudi
cohort. Despite this difference in baseline severity, CXL contributed to stabilize keratoconus
progression in most patients in both populations. When each cohort considered independently,
CXL effect was comparable across all age groups with no age group demonstrating greater
benefit.