Abstract
To assess risk factors for progression following corneal collagen crosslinking (CXL) in eyes with keratoconus. Charts of patients who developed progression following conventional CXL treatment (Dresden protocol) were retrospectively evaluated in two centers (Center 1 and Center 2). 871 eyes of a total of 676 patients were analyzed. Progression was defined as > 1 diopter (D) increase in maximum keratometry (Kmax) readings compared to baseline. Progression was noted in 20 eyes of 20 patients (progression rate 3%). The mean age of the patients was 17.65 ± 5.76 (11-34)-years-old, and the mean follow-up following CXL was 36.70 ± 25.72 (12-84)-months-old. The gender distribution was 13 (65%) females and seven (35%) males. Four eyes (20%) had mild, 13 eyes (65%) had moderate, and three eyes (15%) had severe keratoconus at baseline. Fifteen eyes (75%) had allergic conjunctivitis, and 20 eyes (100%) reported eye-rubbing. Cone location was central in 17 (85%) eyes, and peripheral in 3 (15%) eyes. A mean of 2.21 ± 1.30 D (1.00-5.30 D) steepening was determined at Kmax 6 to 82months following CXL treatment. Progression rate was found to be higher in the patients under the age of 17years, female gender, allergic conjunctivitis, high preoperative Kmax (> 57 D), thin corneas (< 430µm). The majority of progressive patients were central cone and moderate keratoconus.
Highlights
Keratoconus is a bilateral noninflammatory ectasia of the cornea characterized by progressive corneal thinning leading to irregular astigmatism, progressive myopia, and corneal scarring [1]
Progression rate was found to be higher in the patients under the age of 17 years, female gender, allergic conjunctivitis, high preoperative Kmax (>57 D), thin corneas (
Patients with a diagnosis of keratoconus, with tomography findings such as asymmetric bow tie pattern, inferior-superior (IS) asymmetry obtained by high-resolution Scheimpflug imaging (Pentacam HR; Oculus GmbH, Wetzlar, Germany) and with clinical signs such as stromal thinning, Fleischer ring, or Vogt stria after CXL treatment were evaluated for progression over at least a 12-month follow-up period
Summary
Keratoconus is a bilateral noninflammatory ectasia of the cornea characterized by progressive corneal thinning leading to irregular astigmatism, progressive myopia, and corneal scarring [1]. It varies with environmental, genetic and ethnic factors, and prevalence rates differ in different races [2]. The initiation of CXL treatment has led to a marked decrease in the need for corneal transplant surgery in patients with progressive keratoconus [7]. Systematic analysis of the rate of change in disease progression is a sensitive tool for defining the treatment efficacy of CXL in preventing keratoconus progression [9, 10]
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