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Updated: Feb 13, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Progression of Keratoconus in Patients While Awaiting Corneal Cross-linking: A Prospective Clinical Study
Purpose:
To assess topographical changes in patients with keratoconus while awaiting corneal cross-linking (CXL) treatment.
Methods:
In this prospective, double-center, observational clinical study, patients with keratoconus were enrolled. Progression was defined as a change in the curvature within the cone area of at least 1.00 diopter (D) on tangential map and a thinning of 20 μm at the thinnest point after measurements taken at least 3 months apart. Morphological parameters were assessed at baseline (day of listing for CXL) and on the day of CXL treatment, including slit-lamp biomicroscopy, keratometry (maximum, minimum, and mean), and thinnest corneal thickness using corneal tomography (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany).
Results:
One hundred four eyes of 104 patients were included. The waiting time was 84.8 ± 62.9 days. Twenty-five percent of patients showed evidence of progression while waiting for treatment. Patients who progressed while waiting for treatment were younger (22.2 ± 6.79 years) compared to those who did not show evidence of progression (25.4 ± 5.62 years) (P = .02). Stratification by age groups showed a significant worsening of maximum keratometry of 1.18 ± 1.37 D in patients younger than 18 years compared to those 18 to 26 years of age and those older than 26 years (P = .002 and .042, respectively). The multivariate model confirmed that the progression steepening of the maximum keratometry while waiting for treatment was associated with age (P = .028).
Conclusions:
The results suggest that stratification of waiting time according to the patient's age is required to reduce the risk of further progression of keratoconus. [J Refract Surg. 2018;34(3):177-180.].
Insights
Younger keratoconus patients show significant progression while awaiting corneal cross-linking (CXL). Age stratification of CXL waiting times is crucial to mitigate disease advancement and preserve vision.
Area of Science:
- Ophthalmology
- Corneal Diseases
- Refractive Surgery
Background:
- Keratoconus is a progressive corneal ectasia.
- Corneal cross-linking (CXL) is a standard treatment to halt keratoconus progression.
- Topographical changes can occur while patients await CXL.
Purpose of the Study:
- To evaluate topographical changes in keratoconus patients during the waiting period for CXL.
- To identify factors associated with disease progression before CXL treatment.
Main Methods:
- Prospective, observational study of 104 keratoconus patients.
- Corneal tomography (Pentacam) used for measurements.
- Progression defined by curvature change (>1.00 D) or thinning (>20 μm) over at least 3 months.
Main Results:
- 25% of patients exhibited progression while awaiting CXL.
- Progressing patients were significantly younger (22.2 years) than non-progressing patients (25.4 years).
- Younger patients (<18 years) showed greater worsening in maximum keratometry.
Conclusions:
- Patient age is a significant factor in keratoconus progression during CXL waiting times.
- Waiting lists for CXL should be stratified by age to minimize disease advancement.
- Timely CXL treatment is essential, especially for younger individuals at higher risk.
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