Comparative Functional Outcomes After Corneal Crosslinking Using Standard, Accelerated, and Accelerated With Higher...

Area of Science:

• Ophthalmology
• Corneal Surgery
• Vision Science

Background:

• Keratoconus is a progressive corneal ectasia leading to vision impairment.
• Corneal crosslinking (CXL) is a standard treatment to halt keratoconus progression.
• Investigating accelerated CXL protocols may offer treatment efficiency without compromising outcomes.

Purpose of the Study:

• To compare the 12-month functional outcomes of standard versus accelerated corneal crosslinking (CXL) protocols in patients with progressive keratoconus.
• To evaluate the efficacy of different CXL protocols in improving visual acuity and corneal topography.

Main Methods:

• Three epithelium-off CXL protocols were used: standard (S3/30-CXL), accelerated with equivalent irradiance (A9/10-CXL), and accelerated with increased irradiance (A30/4-CXL).
• Efficacy was assessed at 12 months using Scheimpflug imaging, measuring changes in maximum keratometry (K Max), corrected distance visual acuity (CDVA), and other keratometric parameters.

Main Results:

• All three CXL protocols demonstrated improvements in K Max and CDVA at 12 months.
• No statistically significant differences in mean K Max or CDVA were observed between the standard and accelerated CXL groups.
• Greater changes in specific keratoconus indices were noted with the standard protocol compared to accelerated protocols, though overall functional outcomes were similar.

Conclusions:

• Standard and accelerated CXL protocols yield comparable 12-month functional outcomes for progressive keratoconus.
• While some keratoconus indices showed differential changes, both standard and accelerated CXL effectively stabilize and improve visual parameters.
• Correlations between changes in keratometric variables and CDVA were generally poor, with K Mean, central keratoconus index, and anterior asphericity showing better association with CDVA than K Max.