Topography-Guided Transepithelial Accelerated Corneal Collagen Cross-Linking for Low Refractive Error Correction in Keratoconus Treatment: A Pilot Study.

Ling Sun,Jing Zhao,Xingtao Zhou,Xiaoyu Zhang,Yang Shen,Mi Tian

doi:10.3389/fbioe.2022.830776

Abstract

Purpose: To investigate the safety and efficacy of topography-guided transepithelial accelerated corneal collagen cross-linking for low refractive error correction in patients with keratoconus. Methods: This was a prospective self-controlled study. Eighteen patients (18 eyes) were enrolled and assessed at 6 visits (pre-operation, 1 w, 1 month, 3 months, 6 months, and 1 year postoperatively). The examination at every visit included analysis of uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, and corneal endothelial cell counts. Data are expressed as mean ± standard deviation (SD). The p-value was determined using repeated-measures analysis of variance. Results: No complications occurred in any eye during 1 year follow-up period. At each visit after the operation, the corneal K values and spherical equivalent (SE) were reduced, while the visual acuity values were increased compared with those preoperatively, although these results were not statistically significant (p > 0.05). UCVA of nearly 1/3 of the patients was enhanced by at least 3 lines at each follow-up visit. During the whole follow-up, corneal endothelial cell counts were stable (p > 0.05). Regarding topography, part of the corneal cone was flattened after the operation. Conclusion: Topography-guided transepithelial-accelerated corneal collagen cross-linking is safe and may correct low refractive error in keratoconus treatment. Further studies and improvements are required in this regard.

Highlights

Keratoconus is a chronic ectatic corneal disease that leads to progressive corneal thinning and irregular astigmatism
Part of the corneal cone was flattened after the operation
Several case reports of topography-guided transepithelial corneal collagen cross-linking have been published, and the results have shown that patients demonstrated improved vision and decreased corneal curvature (Kanellopoulos, 2014; Kanellopoulos et al, 2014)

Summary

Introduction

Keratoconus is a chronic ectatic corneal disease that leads to progressive corneal thinning and irregular astigmatism. A substantial number of keratoconus patients suffer severe visual impairment, which may severely disrupt their lives These individuals usually use spectacles and rigid gas-permeable contact lenses to improve their visual acuity; these instruments are inconvenient and can damage the cornea when keratoconus progresses. Some scientists have hypothesized that corneal collagen cross-linking may be used in the treatment of low refractive error correction if this technique can be modified to obtain more obvious corneal flattening. This new technique could benefit patients who are unsuitable for corneal ablation. The concept of topography-guided corneal collagen cross-linking was proposed, and a related system was developed (KXL II device, Avedro Inc., Waltham, MA, United States)

Methods

Results

Conclusion