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

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.