Abstract
Previous research suggested that baseline corrected distance visual acuity (CDVA) and maximum keratometry (Kmax) are the predictors for effectiveness of corneal crosslinking (CXL) for keratoconus. The aim of this study was to validate the previously determined predictors in a new treatment cohort. A prospective cohort of 112 eyes in 90 consecutive patients was used to validate the results of 102 eyes in 79 patients from our previous prospective cohort. All patients were treated using epithelium-off corneal CXL in a tertiary hospital setting. Primary outcomes were changes in CDVA (LogMAR) and Kmax between baseline and 1-year post-treatment. Predictive factors for both outcomes were determined using univariable and multivariable analyses. Lower pretreatment CDVA was found to be the sole independent factor predicting an improvement in CDVA 1 year after CXL (β coefficient: −0.476, P < 0.01). Kmax flattening is more likely to take place in eyes with preoperative central cones (β coefficient: 0.655, P < 0.01). These results are consistent with our initial research and indicate high reproducibility in the new cohort. The previously postulated prediction model for postoperative CDVA showed limited predictive value in the validation cohort (R2 = 0.15). The clinical implication of these results is that patients with lower pretreatment visual acuity are more likely to benefit from CXL (with respect to visual acuity), and patients with more central cones will benefit more in terms of cone flattening. Furthermore, those results can be used to guide customization of the crosslinking treatment.
Highlights
Keratoconus is a progressive disease in which protrusion of the cornea causes visual impairment through the formation of irregular astigmatism [1, 2]
Age is associated with changes in visual acuity, as pediatric patients show better improvement than older patients in terms of corrected distance visual acuity (CDVA) following CXL [14, 15]
With respect to flattening of maximum keratometry (Kmax) following CXL, higher pretreatment Kmax (C54 D), a more central cone, and central cornea thickness C450 lm have all been reported as predictive factors [16,17,18,19,20,21]
Summary
Keratoconus is a progressive disease in which protrusion of the cornea causes visual impairment through the formation of irregular astigmatism [1, 2]. With respect to flattening of maximum keratometry (Kmax) following CXL, higher pretreatment Kmax (C54 D), a more central cone, and central cornea thickness C450 lm have all been reported as predictive factors [16,17,18,19,20,21]. The majority of these associations were established using univariable analyses, CDVA is known to be influenced by many interrelated factors [22]
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