Accelerated versus conventional corneal collagen crosslinking: Short-term clinical outcomes in stabilizing keratoconus

Walaa Aldairi; Reham AlQahtani; Salem Alzaid; Ahmed Mousa; Rajiv Khandekar; Samar A Al-Swailem

doi:10.4103/sjopt.sjopt_49_22

Accelerated versus conventional corneal collagen crosslinking: Short-term clinical outcomes in stabilizing keratoconus

Saudi J Ophthalmol. 2022 Jul 11;36(1):47-52. doi: 10.4103/sjopt.sjopt_49_22. eCollection 2022 Jan-Mar.

Authors

Walaa Aldairi¹, Reham AlQahtani¹, Salem Alzaid¹, Ahmed Mousa¹, Rajiv Khandekar¹, Samar A Al-Swailem¹

Affiliation

¹ Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Abstract

Purpose: The purpose of the study is to compare the short-term outcomes of corneal collagen crosslinking (CXL) using the conventional (Dresden) protocol and an accelerated CXL (ACXL) protocol to stop keratoconus (KC) progression.

Methods: A chart review was performed for all the patients with KC who underwent CXL in the last 7 years. Data were compared at baseline and at all follow-up examinations for uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), keratometry (K), central corneal thickness, and complications of CXL. Pre- and post-intervention values were compared for each group. P < 0.05 was statistically significant.

Results: After the treatment, there was a statistically greater improvement in UCVA in the conventional CXL (CCXL) group (49%) compared to the ACXL group (34%) (P = 0.028). The improvement in BCVA was similar between the groups (P = 0.060). Gain of two lines of UCVA and stability were comparable between groups (P = 0.078 and P = 0.060, respectively). The average flat K and steep K values fluctuated remarkably across different follow-up assessments in both the groups. At 3 months of follow-up, there was a statistically significantly faster return to baseline levels of flat and steep Ks in the CCXL group (P = 0.028 and P = 0.002, respectively).

Conclusion: The findings of the current study confirm the efficacy and safety of accelerated high-fluence CXL compared to CCXL. Both protocols were effective in stabilizing KC at 9^th-month and the last follow-up visit. Larger prospective randomized controlled trials and longer follow-up are required to confirm our findings.

Keywords: Corneal collagen crosslinking; keratoconus; maximum keratometry; riboflavin.