ESCRS - PP14.16 - Visual, Refractive, And Corneal Densitometry Outcomes In Keratoconus Eyes With Extreme Corneal Flattening After Crosslinking.

Visual, Refractive, And Corneal Densitometry Outcomes In Keratoconus Eyes With Extreme Corneal Flattening After Crosslinking.

Published 2026 - 44th Congress of the ESCRS

Reference: PP14.16 | Type: Free paper | DOI: 10.82333/x18z-q440

Authors: Dr Maria A. Henriquez* 1 , Dr Natalia Cholaky 1 , Mr Rolando Rojas 1 , Mr Jose Chauca 2 , Dr Luis Izquierdo Jr 3

1Research department,Oftalmosalud Institute of Eyes,Lima,Peru, 2Research department,Oftalmosalud Institute of Eyes,Lima,Peru;Department of Statistics, Demography, Humanities and Social Sciences,Universidad Peruana Cayetano Heredia,Lima,Peru, 3Research department,Oftalmosalud Institute of Eyes,Lima,Peru;San Fernando School of Medicine,Universidad Nacional Mayor de San Marcos,Lima,Peru

Purpose

To evaluate visual, refractive, and corneal densitometry changes in eyes exhibiting extreme corneal flattening after corneal crosslinking (CXL) for progressive keratoconus (KC).

Setting

Research Department at Ofttalmosalud, Instituto de Ojos, Lima, Peru.

Methods

This prospective case-series study included eyes that underwent epithelium-off (epi-off) CXL between June 2015 and January 2022 in Lima, Peru. Inclusion criteria were extreme keratometric flattening (defined as >5.00 Diopters [D]) and a minimum follow-up of 1 year. Visual, refractive, tomographic, and pachymetric parameters, along with corneal densitometry, were analyzed pre- and postoperatively using Scheimpflug tomography (Pentacam, Oculus Optikgeräte GmbH).

Results

Fourteen eyes were included with a mean follow-up of 4.64 ± 1.95 years. Mean maximum keratometric (Kmax) flattening was −6.57 ± 3.31 D (range: -10.80 to -1.40; p<.001) and mean steeper K flattening was −4.91 ± 7.28 D (range: -23.20 to 13.20). Mean corneal densitometry increased significantly at the anterior, central, and posterior stromal levels, with the most pronounced changes observed within the 0–2 mm zones. The highest increase occurred at the 0 mm diameter in the anterior layer (12.22 ± 10.18), followed by the central (5.68 ± 6.34) and posterior (3.56 ± 2.03) depths (all p<.001).

Conclusions

Progressive extreme corneal flattening after CXL is associated with a significant increase in corneal densitometry across all corneal depths, predominantly in the central zone. This increased densitometry (haze/scarring) may be a contributing factor to the reduced visual acuity observed in some of these patients.