One-Year Comparative Outcomes of Conventional Versus Accelerated Corneal Cross-Linking in Progressive Keratoconus

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomedical Engineering

Background:

• Corneal collagen cross-linking (CXL) is used to halt keratoconus progression.
• Uncertainty exists regarding differences between conventional and accelerated CXL protocols at one year.
• This study analyzes 12-month outcomes of conventional (CXL 30) versus accelerated (CXL 10) CXL.

Purpose of the Study:

• To compare the efficacy of conventional (3 mW/cm² × 30 min) and accelerated (9 mW/cm² × 10 min) corneal collagen cross-linking (CXL) at 12 months.
• To interpret outcomes using the ABCD framework, Kmax, and curvature radii.
• To assess visual and tomographic changes post-CXL.

Main Methods:

• Single-center retrospective longitudinal analysis of prospectively collected clinical data.
• 22 eyes assessed at baseline and 1, 3, 6, and 12 months.
• Evaluated outcomes included ABCD stages, anterior/posterior radius of curvature (ARC/PRC), Kmax, pachymetric/elevation indices, UDVA, and BCVA.

Main Results:

• Both CXL protocols significantly improved visual acuity and reduced Kmax at 12 months.
• Median Kmax decreased from 56.5 to 52.3 D (CXL 30) and 59.3 to 58.3 D (CXL 10).
• Tomographic analysis revealed predominantly anterior changes, with a more pronounced anterior response in the CXL 30 group.

Conclusions:

• Conventional and accelerated CXL effectively stabilize keratoconus and provide functional gains at one year.
• Post-CXL remodeling beyond 6 months is primarily anterior, with conventional CXL showing a greater effect.
• Further long-term studies are needed to assess durability and optimize CXL protocols.