Comparison of safety and efficacy of silicone hydrogel contact Lens-assisted CXL and accelerated CXL in keratoconus patients with thin corneas.

Abstract

To evaluate the efficacy and safety of silicone hydrogel contact lens-assisted corneal cross-linking (CL-CXL) and compare 12-month visual and topographic outcomes with accelerated CXL using hypo-osmolar riboflavin (A-CXL) in keratoconus patients with thin corneas (below 400 μm with epithelium). This retrospective study included 27 eyes of 27 keratoconus patients who underwent CL-CXL (n = 14) or A-CXL (n = 13). Uncorrected and corrected distance visual acuity (UDVA and CDVA) and data obtained from corneal topography were analyzed at baseline and again at 6- and 12-month follow-ups. Corneal demarcation line depth (DLD) was measured at one month, and changes in the corneal endothelial cell density (ECD) at 12 months were also assessed. Mean UDVA improved significantly in both groups at 12 months (all p < 0.05). Maximum keratometry (K-max) decreased by 1.04 ± 1.90 D in the CL-CXL group and by 0.87 ± 1.89 D in the A-CXL group at 12 months, which was not statistically significant (all p>0.05). Total corneal higher-order aberrations (HOAs) analysis showed a significant improvement in only the CL-CXL group at 12 months (p = 0.041). Average DLD was 227.18 ± 65.60 μm in the CL-CXL group and 245.30 ± 66.84 μm in the A-CXL group (p = 0.275). No significant change in ECD was found in either group (all p>0.05). Mean changes in UDVA, CDVA, K-max, K-mean, HOAs, and ECD were not statistically significant between the groups (all p>0.05). Silicone hydrogel CL-assisted CXL seems as effective as A-CXL in halting keratoconus progression in thin corneas with no side effects during the one-year follow-up period.