Visual and topographical outcomes following accelerated trans-epithelial corneal cross-linking in progressive keratoconus
First Author: M.Iqbal PAKISTAN
Co Author(s): K. Latif
Accelerated Trans-epithelial corneal cross-linking (ATE-CXL) has proved to be a safe procedure with good postoperative compliance due to rapid recovery, reduced postoperative pain and less risk of stromal scarring. But its effect on keratoconus progression and visual improvement still remain controversial. The aim of this study was to assess the visual and topographical outcomes following ATE-CXL in patients of progressive keratoconus.
Laser Vision Center, Karachi, Pakistan
Forty five eyes of 25 patients affected with progressive keratoconus have been treated with ATE-CXL. The visual outcome was measured by ETDRS chart as improvement in best corrected visual acuity (BCVA) of at least one line or more. The topographical outcome was measured as decrease in maximum simulated keratometry values (K-max), astigmatism and spherical equivalent (SE) and an increase in central corneal thickness (CCT). SE was measured by subjective refraction while K-max, astigmatism and CCT by scanning-slit corneal topography with minimum follow-up of 12 months.
Mean BCVA showed improvement of one line from LogMAR 0.58±0.067 pre-CXL to LogMAR 0.48±0.077 post-CXL (p <0.001). In 7(15.5%) eyes 02 lines of improvement were seen, while 3(6.7%) eyes showed worsening of one line in BCVA. The mean K-max flattened by 0.7D. Mean astigmatism and SE decreased up to -0.5D and -0.4D respectively. Mean preoperative CCT was 454.31±36.34µm, whereas mean postoperative CCT was 456.47±35.60µm with an average increase of 2.15µm. No postoperative complications were reported.
Accelerated TE-CXL shows evolution of an established technique and seemed to be safe and effective in management of progressive keratoconus. Based on topographical outcomes we found ATE-CXL as an effective procedure to halt the progression of keratoconus without any safety concerns with significant visual improvement in majority of cases. The reduced treatment time and less postoperative discomfort made the procedure itself more patients friendly.