Long-term outcomes of corneal crosslinking

Area of Science:

• Ophthalmology
• Corneal Surgery
• Vision Science

Background:

• Keratoconus (KCN) is a progressive ectatic disorder affecting corneal shape.
• Standard Dresden Protocol (SDP) has been the gold standard for CXL since the early 2000s.
• Modifications like accelerated and transepithelial CXL aim to improve outcomes and reduce complications.

Purpose of the Study:

• To review contemporary research (2018-2023) on long-term outcomes (≥2 years) of corneal crosslinking (CXL) for progressive keratoconus (KCN).
• To evaluate the efficacy and safety of various CXL protocols in adult and pediatric populations.

Main Methods:

• Systematic review of studies published between 2018 and 2023.
• Analysis of long-term (≥2 years) visual and topographic outcomes.
• Assessment of safety profiles across different CXL protocols.

Main Results:

• The standard Dresden Protocol (SDP) demonstrates long-term disease stabilization and improvement in visual and topographic indices up to 13 years.
• Accelerated and transepithelial CXL protocols are well-tolerated alternatives with comparable efficacy to SDP.
• Pediatric populations showed higher post-CXL progression rates, but all reviewed protocols exhibited excellent safety.

Conclusions:

• SDP remains effective for long-term keratoconus stabilization.
• Newer CXL protocols offer effective alternatives with good safety profiles.
• Pediatric patients may require closer monitoring due to potentially higher progression rates post-CXL.