Abstract
Purpose To report predictive factors of outcome of conventional epithelium-off corneal crosslinking (CXL) in the treatment of progressive keratoconus. Methods This is a monocentric observational retrospective study conducted at Eye and Ear International Hospital, Lebanon. All patients with progressive keratoconus who underwent CXL between January 2008 and January 2016, with minimal 3-years follow-up were included. Primary treatment outcomes were maximum keratometry (K max), best-corrected distance visual acuity (CDVA), and failure. Failure was defined as an increase of 1.00 diopters (D) or more in K max and/or an increase of 0.1 logMAR or more in CDVA and conversion to corneal transplantation. Statistical analysis was done to identify predictors of treatment success. Univariate and multivariate analyses were performed to determine the correlations between baseline parameters and outcomes, and an equation for predicting K max and CDVA was created. Results 156 eyes of 102 patients were enrolled. The mean age was 23.85 ± 6.52 years. Failure occurred in 31 eyes (19.87%). Gender and thinnest pachymetry did not have any impact on postoperative outcomes. Concerning the CDVA outcome, multivariate analysis showed that a better preoperative CDVA was associated with higher improvement in CDVA, and higher baseline K max and higher posterior mean K were associated with a worse outcome CDVA. Regarding postoperative K max, a higher baseline K max, a worse baseline CDVA, and a younger age were associated with less flattening postoperatively. Conclusion CXL is a safe and effective method in treating progressive keratoconus. However, the clinical benefits can differ among patients, and in our series, a nonnegligible number of cases show a continued progression of their ectasia. Further studies to identify predictors of postoperative progression prior to the procedure could help sort out good responders to treatment.
Highlights
Corneal ectasia is a degenerative noninflammatory eye condition characterized by a loss of corneal stability, which leads to progressive thinning and bulging of the cornea
Our study included 156 eyes from 102 patients who underwent standard epitheliumoff corneal CXL according to Dresden protocol. e study involved a greater proportion of men 106 (68%) than women 50 (32%). e mean patients’ age at the time of the procedure was 23.85 ± 6.52 years old, and follow-up duration was 3 years (Table 1)
Concerning the corrected distance visual acuity (CDVA) outcome, baseline CDVA (p < 0.01), baseline K max (p < 0.01), and baseline posterior mean K were the only independent predictors. is means that a better preoperative CDVA would be associated with higher improvement in CDVA and a higher baseline K max and higher posterior mean K were associated with a worse outcome CDVA
Summary
Corneal ectasia is a degenerative noninflammatory eye condition characterized by a loss of corneal stability, which leads to progressive thinning and bulging of the cornea. Treatment options for keratoconus consist of wearing spectacles and soft or rigid contact lenses (CL) [3]. Journal of Ophthalmology who cannot tolerate CL wear or do not achieve a good vision with spectacles or CL, the implantation of an intracorneal ring segment (ICRS) may be advised. In some advanced cases with severe corneal scarring or thinning, corneal transplantation like deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK) may be the unique option to restore a good vision [4]. None of those treatments aim to counter the progression of the disease [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
