Predictors for treatment outcomes after corneal crosslinking for keratoconus: a validation study

Area of Science:

• Ophthalmology
• Corneal Surgery
• Vision Science

Background:

• Keratoconus is a progressive corneal disease.
• Corneal crosslinking (CXL) is a standard treatment for keratoconus.
• Predictors for CXL effectiveness are crucial for patient selection and outcome prediction.

Purpose of the Study:

• To validate previously identified predictors of corneal crosslinking (CXL) effectiveness.
• To assess the predictive value of baseline corrected distance visual acuity (CDVA) and maximum keratometry (Kmax) in a new cohort.
• To determine if these predictors can guide customized CXL treatment.

Main Methods:

• Prospective cohort study validating previous findings.
• Inclusion of 112 eyes from 90 consecutive keratoconus patients treated with epithelium-off CXL.
• Analysis of CDVA and Kmax changes from baseline to 1-year post-treatment using univariable and multivariable analyses.

Main Results:

• Lower pretreatment CDVA independently predicted CDVA improvement 1 year post-CXL (β = -0.476, P < 0.01).
• Eyes with preoperative central cones were more likely to experience Kmax flattening (β = 0.655, P < 0.01).
• Results showed high reproducibility compared to the initial cohort, though the CDVA prediction model had limited predictive value (R² = 0.15).

Conclusions:

• Patients with lower baseline visual acuity are more likely to achieve visual acuity gains after CXL.
• Patients with more pronounced central corneal cones benefit more from CXL in terms of keratometry flattening.
• These findings support the use of baseline CDVA and Kmax to personalize CXL treatment strategies for keratoconus.