A novel computational approach to plan customized corneal cross-linking (CXL)
First Author: P.Thakur INDIA
Co Author(s): R. Shetty A. Sinha Roy P. Khamar Z. Dadachanji
To use a computational approach to determine the region of biomechanical degeneration in keratoconus (KC) and use it for planning customized corneal cross-linking (CXL)
A prospective, interventional study in a tertiary care eye hospital
10 KC eyes underwent a customized CXL (Avedro Inc, USA). The maximum energy used was 7.5 J/cm2 and intensity used was 10 mW/cm2. The maximum UV on time was 13.5 mins. The customized profile was a family of concentric circles. A computation approach using inverse finite element and artificial intelligence optimization was used to estimate the region of mechanical degeneration (loss of elastic modulus). The concentric circles were positioned on this region such that the outermost circle did not exceed the central 8 mm zone of the cornea. Paired t-test was used to evaluate outcomes at 6-months.
K1 and K2 decreased (mean and 95% CI) by -1.05D [-1.8 ,-0.3] and -1.17D [-2.27,-0.07], respectively. Kmax decreased by -1.91D [-3.15,-0.66]. Defocus decreased by 1.99µm [0.55,3.44]. Spherical aberration decreased by 0.35µm [0.09,0.62]. RMS of both lower and higher order aberrations decreased by 14%.
This safety study demonstrated the safety of customized CXL using this computational approach. The change in corneal parameters were superior to the results of published outcomes. Further study with larger sample size is required to validate the findings of this study.