Customized Topography-Guided Corneal Collagen Cross-linking for Keratoconus

Area of Science:

• Ophthalmology
• Corneal Surgery
• Vision Science

Background:

• Keratoconus is a progressive corneal ectasia leading to vision impairment.
• Corneal collagen cross-linking (CXL) aims to halt keratoconus progression.
• Conventional CXL (C-CXL) uses a standardized protocol.

Purpose of the Study:

• To compare the efficacy and safety of topography-guided CXL (TG-CXL) versus conventional CXL (C-CXL).
• To evaluate outcomes in patients with progressive keratoconus.

Main Methods:

• Prospective, nonrandomized clinical trial involving 60 eyes with progressive keratoconus.
• TG-CXL group (30 eyes) received topography-guided treatment.
• C-CXL group (30 eyes) received standard Dresden protocol treatment.
• Evaluated outcomes included Kmax, I index, CDVA, demarcation line, and stromal cell/nerve density at 1 year.

Main Results:

• TG-CXL showed significant improvements in Kmax and I index compared to C-CXL.
• CDVA improved significantly in the TG-CXL group but not significantly in the C-CXL group.
• TG-CXL resulted in a shallower demarcation line in the surrounding cornea and less stromal damage with faster healing.

Conclusions:

• TG-CXL is as safe as C-CXL for progressive keratoconus.
• TG-CXL demonstrates superior efficacy in corneal flattening (Kmax, I index) and visual acuity improvement (CDVA).
• TG-CXL creates a biological gradient aiding nerve and cell recovery in the cornea.