Two-year outcomes of accelerated contact lens-assisted corneal crosslinking versus accelerated corneal crosslinking:...

To compare the 24-month outcomes of accelerated contact lens-assisted corneal crosslinking (A-CACXL) in thin corneas (< 400 microns) versus conventional accelerated CXL (A-CXL) in progressive keratoconus patients.

This study included progressive keratoconus patients who underwent A-CACXL (9 mW/cm² for 10 min) and A-CXL (9 mW/cm² for 10 min). A-CACXL was performed in cases with the thinnest corneal thickness of 400 μm or less. Preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), keratometric, tomographic, aberrometric values, and Regularization Index (RI) were compared at a 2-year follow-up.

The study enrolled 41 eyes; 20 eyes underwent A-CACXL and 21 eyes underwent A-CXL. Preoperative BSCVA, Kmax, K1, and K2 values were similar in both groups (p > 0.05). Preoperative thinnest corneal pachymetry measurements were significantly less in A-CACXL group (384.8 ± 25.2 vs. 450.4 ± 35.7; p < 0.001). ΔBSCVA, RI, and ΔKmax were similar in A-CACXL and A-CXL groups (- 0.14 ± 0.27 vs. - 0.17 ± 0.18; 5.9 D ± 4.9 D vs. 4.6 D ± 2.5 D; - 2.0 ± 3.5 D vs. - 2.0 ± 3.1 D; respectively). A-CACXL showed 95% of eyes halting progression, with 60% showing regression, similar to A-CXL (57.1% regression, 100% halting progression) (p = 0.521). In the A-CACXL group, curvature-based index (ARC) improved significantly (p = 0.002), pachymetric indices (ARTmax, RPIavg) worsened significantly (p = 0.002, 0.026), while no change was observed in aberrometric parameters (p > 0.05).

In eyes with thin corneas and progressive keratoconic condition, the safety and effectiveness of A-CACXL seemed comparable to that of A-CXL at the 2-year follow-up. Both techniques yielded similar visual, keratometric, tomographic, and aberrometric results.