Accelerated versus Conventional Corneal Collagen Cross-Linking for Progressive Keratoconus

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomedical Engineering

Background:

• Keratoconus is a progressive corneal ectasia leading to visual impairment.
• Corneal collagen cross-linking (CXL) is a standard treatment to halt keratoconus progression.
• Accelerated CXL (ACXL) offers shorter treatment times compared to conventional CXL (CCXL).

Purpose of the Study:

• To compare the efficacy of ACXL versus CCXL in managing visual, refractive, and topographic parameters in progressive keratoconus.
• To evaluate the long-term outcomes of both CXL methods over a 12-month follow-up period.

Main Methods:

• A comparative study involving 37 eyes (CCXL group) and 34 eyes (ACXL group) with progressive keratoconus.
• Patients underwent either CCXL (3 mW/cm2 for 30 min) or ACXL (18 mW/cm2 for 5 min).
• Outcomes assessed included visual acuity, refractive error, endothelial cell indices, and topographic parameters using generalizing estimation equation analysis.

Main Results:

• Both ACXL and CCXL demonstrated safety in slowing keratoconus progression over 12 months.
• CCXL showed significant improvements in corrected distance visual acuity (CDVA) and reductions in keratometry, SAI, KPI, and KCI.
• While ACXL reduced endothelial cell polymorphism and polymegethism, CCXL appeared superior in preventing overall keratoconus progression.

Conclusions:

• ACXL at 18 mW/cm2 is a safe method for slowing keratoconus progression.
• CCXL at 3 mW/cm2 may offer superior prevention of keratoconus progression compared to ACXL.
• Further research may elucidate optimal CXL protocols for different patient profiles.