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Accelerated Pulsed High-Fluence Corneal Cross-Linking for Progressive Keratoconus.

Daniel M Gore1, Marcello T Leucci2, Su-Yin Koay1

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American Journal of Ophthalmology
|August 21, 2020
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Summary
This summary is machine-generated.

Accelerated corneal collagen cross-linking (CXL) effectively halts progressive keratoconus in most eyes over two years. This safe, pulsed UVA treatment shows refractively neutral results, stabilizing corneal ectasia.

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Area of Science:

  • Ophthalmology
  • Corneal Science
  • Biomedical Engineering

Background:

  • Keratoconus is a progressive ectasia causing visual impairment.
  • Corneal collagen cross-linking (CXL) aims to halt keratoconus progression.
  • Accelerated CXL techniques are being investigated for efficiency.

Purpose of the Study:

  • To evaluate the 2-year outcomes of accelerated corneal collagen cross-linking (CXL) using the Avedro KXL system.
  • To assess the efficacy of CXL in halting disease progression in patients with progressive ectasia.
  • To report on the safety and refractive neutrality of accelerated CXL.

Main Methods:

  • A prospective interventional case series included 870 patients (1,192 eyes) with progressive keratoconus.
  • Accelerated CXL involved riboflavin 0.1% soak and pulsed UVA (30 mW/cm², 4 minutes).
  • Corneal tomography, refractive error, and endothelial cell density were assessed at baseline and up to 24 months.

Main Results:

  • Keratometric stabilization was achieved in 98.3% of eyes at 24 months.
  • Modest corneal flattening was observed in advanced keratoconus (Kmax 63.2 D to 61.9 D, P=.02).
  • No significant changes in mean CDVA, manifest refraction, or endothelial cell density were noted.

Conclusions:

  • Accelerated pulsed CXL is a safe and effective treatment for progressive keratoconus.
  • The procedure demonstrates refractively neutral outcomes at the 2-year follow-up.
  • CXL successfully halts disease progression in the majority of treated eyes.