ESCRS - POCOR393 - Customized Cross-Linking Strategies For Thin Corneas: A Risk-Stratified Approach In 145 Young North African Patients: A Study Conducted By A Young Ophtalmology Resident

Customized Cross-Linking Strategies For Thin Corneas: A Risk-Stratified Approach In 145 Young North African Patients: A Study Conducted By A Young Ophtalmology Resident

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR393 | Type: Free paper | DOI: 10.82333/exke-m669

Authors: Dr Aguenaou Sarah* 1 , A/Prof. El hassan Abdallah 1 , A/Prof. ibrahimi fatema 2

1ophtalmologie b ,hsr,rabat,Morocco, 2ophtalmologie b,hsr,rabat,Morocco

Purpose

To evaluate the efficacy and safety of a pachymetry-based corneal cross-linking (CXL) algorithm in young North African patients presenting with advanced keratoconus and significant corneal thinning (down to 400)

Setting

all patients were examined at the hôpital des specilaités , ophtalmology B department in rabat morocco ( north africa)

Methods

This retrospective study included 145 eyes of young patients ( 17 to 32 years old). Eyes were stratified into four groups based on intraoperative pachymetry:

  • Group A (> 400 μm): Standard Epi-off CXL.

  • Group B (330–400 μm): Contact Lens-Assisted CXL (CACXL).

  • Group C (300–330 μm): Transepithelial (Epi-on) CXL with penetration enhancers.

  • Group D (< 300 μm): CXL deferred; alternative management (Scleral lenses/DALK).

  • Follow-up included BCVA, Kmax, and endothelial cell density (ECD) at 6 and 12 months

Results

The mean age was 23,5 years.

  • Stabilization: Group A and B (CACXL) showed the highest rates of topographic stability (Kmax change < 1.0D in > 90% of cases).

  • Limitations: Group C (Epi-on) showed a higher rate of continued progression (15%) compared to the CACXL group, suggesting biological limits of transepithelial riboflavin penetration in highly aggressive phenotypes.

  • Safety: No significant endothelial cell loss , haze or desease progression was observed across Groups A, B, and C.

  • The < 300 μm Challenge: These cases represented a major therapeutic ceiling where CXL safety profiles were deemed insufficient, requiring surgical alternatives.

Conclusions

In the specific context of North African keratoconus—characterized by early onset and extreme thinning—a "one-size-fits-all" protocol is inadequate. A pachymetry-driven strategy, particularly the use of CACXL for the 330-400 μm range, provides an optimal balance between ectasia stabilization and endothelial protection.