Visual Recovery with Cryopreserved Amniotic Membrane After Epi-Off Corneal Cross-Linking in Keratoconus Patients: A...

This study assessed whether application of cryopreserved amniotic membrane (AM) improves recovery after collagen cross-linking (CXL) using the Dresden protocol in patients with progressive keratoconus.

This single-centre, retrospective, non-randomized, comparative study included consecutive patients with progressive keratoconus who underwent epi-off CXL followed by bandage contact lens (BCL) or cryopreserved AM (Prokera Slim). Patients were assessed preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Outcomes included best-corrected visual acuity (BCVA), maximum keratometry (K_max), complete re-epithelialization, and complications.

A total of 62 eyes (46 patients) were treated with AM after CXL, and 46 eyes (39 patients) received BCL. At 6 months post-op, a significantly greater proportion of eyes in the AM group returned to baseline BCVA versus the BCL group (85.7% vs 64.9%, p < 0.05). BCVA logMAR was significantly better in the AM treatment group compared to the BCL group at 6-months (0.19 ± 0.21 vs 0.31 ± 0.28, respectively; p=0.046). The change in K_max values was comparable between the groups at all time points. The proportion of eyes with a healed epithelial defect at 1 week postoperatively was comparable between the groups (69.6% BCL vs 66.1% AM, p = 0.71). There were three complications (one each of infiltrative keratitis, infectious keratitis, and persistent epithelial defect) in the BCL group and none in the treatment group (p = 0.07).

The use of AM after epi-off CXL resulted in no post-operative complications and improved BCVA six months after surgery compared to a BCL. Prospective, randomized controlled studies are warranted to verify these findings.