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Corneal cross-linking for progressive keratoconus: 10-year outcomes
First Author: E.Torres-Netto SWITZERLAND
Co Author(s): T. Seiler S. Adamcik F. Gilardoni H. Abdshahzadeh F. Hafezi
The purpose of this study was to analyse the 10-year outcomes following corneal cross-linking (CXL) for progressive keratoconus.
The study was conducted jointly by the ELZA Institute (Dietikon, Switzerland), the IROC Institut für Refraktive und Ophthalmo-Chirurgie (Zurich, Switzerland) and the Center for Applied Biotechnology and Molecular Medicine at the University of Zurich (Zurich, Switzerland).
Data were collected from CXL surgeries performed by surgeons at both ELZA Institute and IROC. Patients that had undergone a CXL procedure with the standard Dresden epithelium-off protocol (3mW/cm2 for 30 minutes, total fluence of 5.4J/cm2) between 2004 and 2009 were included in the study. Complete clinical evaluation and Scheimpflug imaging (Pentacam HR, Oculus Instruments, Wetzlar, Germany) were assessed preoperatively and at the last examination at least 10 years after surgery.
418 eyes were included in the initial analysis. Only patients with complete 10-year follow-up were taken into account. Eight eyes were excluded due to combined refractive procedures, six were excluded due to subsequent corneal transplantation and three were excluded due to repeated CXL procedures. Finally, thirty-six eyes were considered for the final analysis. Clinically, there was no significant change in spherical equivalent refraction and visual acuity. Thinnest pachymetry, asphericity of the anterior surface and flat keratometry remained stable. There was a significant reduction in steepest keratometry (p=0.002), mean keratometry (p=0.013), maximum anterior keratometry (1.2D, p=0.013) and astigmatism (p=0.028).
Corneal cross-linking with Dresden protocol was successful in halting the progression of keratoconus in a 10-year follow-up in most of the cases. Over this period, the topographic readings tend to decrease significantly, and despite those changes corrected visual acuity remained stable. Our long-term results confirm the effectiveness of corneal cross-linking for halting the progression of keratoconus