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Long-term results of femto assisted deeper corneal stromal cross-linking in early and established keratoconus

Poster Details

First Author: L.Daniel Ponniah INDIA

Co Author(s):    H. Anandan                    

Abstract Details


To compare Femto assisted cross-linking with the conventional cross-linking procedure, and study its long-term outcomes to prove deeper cross-linking better dampens ectasia progression


A prospective non-randomised comparative clinical trial followed by single-arm longitudinal analysis at the Department of Cornea and Refractive surgeries at a tertiary care eye hospital in South India


A prospective non-randomized comparative clinical trial followed by single-arm longitudinal analysis of Femto CXL. Keratoconus with pachymetry over 400 microns were enrolled. In phase 1 Femto CXL,(Group1) creation of a femto-assisted stromal pouch,160 microns deep, into which riboflavin was infused & subsequent UVA was compared with an Epi-off conventional CXL (Group 2) by 1 year. Vision in LogMAR, Pachymetry in microns, MaximumK, MeanK, Astigmatism values in Diaptors, were analyzed at 1year in addition to OCT derived demarcation line (DL) by 1 month. In phase 2, Group1 subjects were followed annually to 3 years for stability using repeated measure statistics


47 Group1 and 21 Group2 subjects enrolled. In Phase1, UCVA improved by 1 line in both groups, Pachymetry remained same in Group1 ( 475±37), significantly reduced by 28 mic.(p=0.002) in Group2 (434±56 to 406±66). Astigmatism reduced by 0.32D in Group1, increased in Group2 by 0.33D. Both groups flattened corneas. DL was deeper in Group1 p=0.0001(394mic.) against Group2 (243mic.) In Phase2 (44 in 2 years; 42 in 3 years), Pachymetry was maintained, UCVA marginally improved (0.63, 0.61), BCVA was maintained (0.16), Astigmatism (2.93, 2.91), Kmax (47.88, 47.86) and Kmean (46.07,46.11) were maintained in 2 and 3 years respectively


Corneal cross-linking deeper than 250 microns could be achieved with Femto assisted stromal pouch for deeper diffusion of riboflavin than with Conventional cross-linking procedures. Femto assisted cross-linked corneas remained stable with no progression after 3 years

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