Age-Related Long-Term Functional Results after Riboflavin UV A Corneal Cross-Linking

Area of Science:

• Ophthalmology
• Corneal Surgery
• Vision Science

Background:

• Progressive keratoconus (KC) is a degenerative corneal disease.
• Corneal cross-linking (CXL) is a treatment to halt KC progression.
• Long-term functional outcomes of CXL across different age groups require further analysis.

Purpose of the Study:

• To conduct a comparative prospective long-term functional analysis of Riboflavin UV A corneal cross-linking (CXL).
• To evaluate CXL outcomes in three distinct age groups of patients with progressive KC.
• To assess visual acuity, corneal topography, and aberrometry changes at 48 months post-treatment.

Main Methods:

• Prospective study involving 516 eyes of patients with progressive KC, divided into paediatric (≤18), intermediate (19-26), and adult (≥27) groups.
• Epithelium-off CXL performed using the Siena protocol with a Vega CBM X linker.
• Functional analysis included uncorrected (UCVA) and best spectacle-corrected (BSCVA) visual acuity, corneal topography (Kmax), and surface aberrometry (coma) at 48 months follow-up.

Main Results:

• All age groups demonstrated improvements in UCVA and BSCVA at 48 months.
• Mean reduction in Kmax was observed across groups: -0.9 D (paediatrics), -0.6 D (intermediate), and -0.5 D (adults).
• Significant improvements in coma values were noted, with over 90% of patients achieving long-term KC stabilization.

Conclusions:

• Epithelium-off Riboflavin UV A cross-linking is a highly effective first-line therapy for progressive KC.
• The treatment shows particular benefit for paediatric patients and individuals under 26 years old.
• Long-term functional analysis supports CXL as a standard of care for halting KC progression and improving visual outcomes.