Official ESCRS | European Society of Cataract & Refractive Surgeons


The independent effects of various cross-linking treatment modalities on treatment effectiveness in keratoconus

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Session Details

Session Title: Keratoconus

Session Date/Time: Monday 16/09/2019 | 14:00-16:00

Paper Time: 15:36

Venue: Free Paper Forum: Podium 2

First Author: : D.Godefrooij THE NETHERLANDS

Co Author(s): :    S. Roohé   R. Wisse                          

Abstract Details


To investigate the one-year outcomes of using various corneal cross-linking (CXL) techniques for treating keratoconus.


Prospective longitudinal cohort study performed at a tertiary academic medical centre.


670 eyes in 461 patients with progressive keratoconus who underwent CXL and were followed for one year. Eight combinations of CXL modalities were assessed, including two different CXL techniques (transepithelial or epithelium-off), seven riboflavin formulations, and two ultraviolet-A protocols (conventional 3 mW/cm2 or accelerated 9 mW/cm2). Patients treated using the Dresden protocol were used as the reference group. Primary outcomes were maximum keratometry (Kmax) and mean keratometry (Kmean) one year after treatment. Secondary outcomes were uncorrected and corrected distance visual acuity, manifest refractive spherical equivalent, and corneal thickness one year after treatment.


Four treatment modalities differed significantly from the reference group in terms of both Kmax and Kmean: the transepithelial CXL group, one riboflavin formulation (Meran), and both the 9 mW/cm2 protocol (Vibex Rapid and Collagex). Overall, visual outcome, manifest refractive spherical equivalent, and corneal thickness were similar among the treatment modalities. Infections were rare (1.6% of cases); however, re-treatment was required for 33.3% of cases that underwent transepithelial CXL.


Transepithelial crosslinking, the use of Meran riboflavin, and applying the accelerated irradiation protocol appeared to be associated with reduced efficacy in terms of controlling keratoconus progression. Importantly, one-third of cases treated using transepithelial CXL required re-treatment.

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