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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Successful Regression in Patients with Progressive Keratoconus by Corneal Crosslinking
Tobias Röck1, Eva-Maria Konrad1, Daniel Röck1
1Department für Augenheilkunde, Universitäts-Augenklinik, Eberhard-Karls-Universität Tübingen, Deutschland.
Background:
Since 2019, corneal collagen crosslinking (CXL) is included in the catalog of procedures covered by statutory health insurance in Germany. CXL is an established ophthalmological procedure for the last 20 years. The aim of this investigation was the measurement of progression before and after CXL.
Material Und Methods:
65 consecutive eyes with progressive keratoconus from 53 patients were included in the retrospective study, which were observed at the University Eye Hospital Tübingen at least two years before and at least two years after CXL. The time of observation took place from October 2009 until March 2018. Parameters of interest had been the best corrected visual acuity (BCVA) and the keratometric values from the elevation maps measured by a Scheimpflug camera.
Results:
65 eyes of 53 patients had been documented. The study population included 46 (86.8%) male and 7 (13.2%) female subjects. The mean age was 24 ± 8 years. The averaged observation time between the primary consultation and CXL showed 25 ± 15 months. Preoperatively the mean BCVA pointed out in a significant increase (0.13 ± 0.17 [first visit] vs. 0.23 ± 0.22 [preOP], p < 0.0001) while the mean Kmax resulted in a statistically significant increase (46.34 ± 3.33 dpt [first visit] vs. 48.78 ± 4.17 dpt [preOP], p < 0.0001). The mean thinnest point of the cornea showed a significant decrease (490.48 ± 34.23 µm [first visit] vs. 468.62 ± 29.84 µm [preop], p < 0.0001). Postoperatively the mean BCVA resulted in a significant improvement at the 12th postoperative month in comparison to the preoperative measurement (0.23 ± 0.22 [preOP] vs. 0.16 ± 0.14 [12 months], p = 0.04 respectively 0.17 ± 0.17 [24 months], p = 0.0006). The mean Kmax demonstrated in the 12th postoperative month a significant reduction (48.78 ± 4.17 dpt [preOP] vs. 47.91 ± 3.41 dpt [12 months], p = 0.0009 respectively 48 ± 4.56 dpt [24 months], p = 0.0051). The mean thinnest point of the cornea indicated a decrease at the 12th postoperative month (468.62 ± 29.84 µm [preOP] vs. 459.82 ± 35.88 µm [12 months], p = 0.0078 respectively 453.47 ± 43.39 µm [24 months], p = 0.0227).
Conclusion:
CXL is a successful procedure for the therapy of progressive keratoconus.
Insights
Corneal collagen crosslinking (CXL) effectively treats progressive keratoconus by improving visual acuity and reducing corneal steepness. This ophthalmological procedure demonstrates significant positive outcomes in patients, stabilizing the condition over time.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Vision Science
Background:
- Corneal collagen crosslinking (CXL) has been an established ophthalmological procedure for 20 years.
- Since 2019, CXL is covered by statutory health insurance in Germany for keratoconus treatment.
- Progressive keratoconus necessitates effective therapeutic interventions to prevent vision loss.
Purpose of the Study:
- To measure the progression of keratoconus before and after corneal collagen crosslinking (CXL).
- To evaluate the impact of CXL on best-corrected visual acuity (BCVA) and keratometric values.
- To assess the long-term efficacy of CXL in managing progressive keratoconus.
Main Methods:
- Retrospective study of 65 eyes from 53 patients with progressive keratoconus.
- Observation period of at least two years before and two years after CXL (October 2009 - March 2018).
- Measurement of best-corrected visual acuity (BCVA) and keratometric values (Kmax) using Scheimpflug imaging.
Main Results:
- Preoperatively, BCVA significantly increased, while Kmax significantly increased and the thinnest corneal point significantly decreased.
- Postoperatively, BCVA significantly improved at 12 and 24 months compared to pre-CXL measurements.
- Kmax significantly reduced at 12 and 24 months post-CXL, and the thinnest corneal point also decreased significantly.
Conclusions:
- Corneal collagen crosslinking (CXL) is a successful therapeutic procedure for progressive keratoconus.
- CXL demonstrates significant improvements in visual acuity and corneal topography.
- The findings support CXL as an effective treatment for stabilizing and improving keratoconus.
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