Tomographic changes after corneal collagen cross-linking for progressive keratoconus – one-year follow-up study

Abstract

Introduction/Objective The aim of this study was to evaluate the outcome of corneal collagen cross-linking (CXL) in patients with progressive keratoconus. Methods This retrospective single-centered interventional study included 52 eyes of 41 patients who underwent epithelium-off CXL procedure at the age > 18 years. Corneal tomography data, uncorrected, and best spectacle-corrected distant visual acuity (UDVA and CDVA, respectively) were analyzed at baseline and postoperatively over the initial 12-month period. In addition, the natural course of corneal tomographic changes was demonstrated at one, three, six, nine, and 12 months after the CXL procedure. Results At one year, mean UDVA improved significantly from 0.15 ± 0.22 (0.3 min – logMAR – 0 max logMAR) at baseline to 0.06 ± 0.09 logarithm of minimum angle resolution (logMAR) (0.1 min logMAR – 0 max logMAR) (p = 0.024). Mean CDVA was 0.45 ± 0.39 0.45 ± 0.39 logMAR (0.8 min logMAR – 0 max logMAR) at baseline and 0.06 ± 0.13 logMAR (1 min logMAR – 0 max logMAR) at one year (p = 0.039). Maximum keratometry showed a significant flattening of 1.36 D ± 1.53 D (p = 0.0032) at one year after CXL. Minimum keratometry significantly decreased with a mean change of 1.15 ± 1.20 (p = 0.011). Mean anterior and posterior best fit sphere (ABFS and PBFS, respectively) remained stable during the entire follow-up period. Mean reduction of corneal thickness after CXL was 47 ± 61 µm (p = 0.003). At one year, 29 (56%) eyes showed K max regression, 22 (53%) showed stabilization, and one (2%) showed progres-sion. Spearman correlation coefficients were calculated to assess the correlation between difference in preoperative corneal thickness (CT), in posterior elevation corneal thickness (PECT), and minimum corneal thickness, ΔCT (PECT – minCT) and radius difference Δr (r1-r2). Spearman rs > 0.3 proved statisti-cal significance and correlation. Conclusion In our study, CXL effectively prevented progression of keratoconus in 98% of eyes at one year, while improving visual acuity. The effect of CXL can be evaluated at the earliest after six months; at that time, the stability of the corneal shape was provided by following the CXL procedure. The main limitation of this study is the small number of patients included. © 2022, Serbia Medical Society. All rights reserved.