Corneal Biomechanics After Accelerated Cross-linking: Comparison Between 18 and 9 mW/cm² Protocols

To determine 1-year corneal biomechanical changes after accelerated corneal cross-linking in patients with progressive keratoconus and compare them between 5-minute (18 mW/cm²) and 10-minute (9 mW/cm²) protocols.

In this non-randomized clinical trial, cases in both groups were examined with the Corneal Visualization Scheimpflug Technology (Corvis ST; Oculus Optikgeräte GmbH, Wetzlar, Germany) at baseline and at 6 and 12 months after treatment. Extracted indices included intraocular pressure (IOP), central corneal thickness (CCT), first and second applanation times, lengths, and velocities (T1, T2, L1, L2, V1, and V2), highest concavity time (HCT), deformation amplitude (DA), peak distance between bending points, and radius of curvature.

Mean patient age, baseline maximum keratometry, CCT, and IOP were similar between groups. After adjusting for CCT and baseline values with repeated measures analysis of covariance, at 1 year after the procedure, IOP (13.14 ± 1.41 vs 12.12 ± 1.49 mm Hg, P = .034) and T1 (6.84 ± 0.20 vs 6.67 ± 0.23 ms, P = .036) were higher in the 5-minute group, but T2 (21.31 ± 0.27 vs 21.58 ± 0.28 ms, P = .007), HCT (16.06 ± 0.51 vs 16.31 ± 0.48 ms, P = .017), and DA (1.03 ± 0.09 vs 1.10 ± 0.08 mm, P = .028) were lower. Other inter-group differences were not statistically significant (all P > .050). All 1-year changes were independent of cone position (all P > .050).

At 1 year after cross-linking in cases of mild and moderate keratoconus, corneal biomechanics appeared stable or stronger than baseline with both 5- and 10-minute protocols. However, mild cases who had the 5-minute protocol showed better improvement based on Corvis ST indices. [J Refract Surg. 2017;33(8):558-562.].