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Accelerated versus standard corneal cross linking in the treatment of ectasia post refractive surgery and penetrating keratoplasty: a medium term randomized trial.

ABSTRACT: AIM:To compare the clinical outcomes of the standard corneal cross linking (CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty. METHODS:Totally 120 eyes of 83 patients scheduled to receive either standard CXL (3 mW/cm2 for a period of 30min) or accelerated CXL (18 mW/cm2 for a period of 5min). The main outcomes for comparison were the change in: maximum-K reading (K-max), manifest refractive spherical equivalent (SE), central corneal thickness (CCT), and the best corrected distance visual acuity (CDVA). RESULTS:One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group. CONCLUSION:Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.

SUBMITTER: Khairy HA

PROVIDER: S-EPMC6848878 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Accelerated versus standard corneal cross linking in the treatment of ectasia post refractive surgery and penetrating keratoplasty: a medium term randomized trial.

Khairy Hany A HA Elsawy Moataz F MF Said-Ahmed Khaled K Zaki Marwa A MA Mandour Sameh S SS

International journal of ophthalmology 20191118 11

<h4>Aim</h4>To compare the clinical outcomes of the standard corneal cross linking (CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.<h4>Methods</h4>Totally 120 eyes of 83 patients scheduled to receive either standard CXL (3 mW/cm<sup>2</sup> for a period of 30min) or accelerated CXL (18 mW/cm<sup>2</sup> for a period of 5min). The main outcomes for comparison were the change in: maximum-K reading (K-max), manifest ref ...[more]

PMID: 31741859

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Project description:IntroductionTo compare the results of an accelerated corneal cross-linking (CXL) protocol (9 mW/cm2, 10 min) with the standard CXL protocol (3 mW/cm2, 30 min) in patients with Down syndrome (DS) who have keratoconus (KC).MethodsTwenty-seven 10- to 20-year-old patients with DS who had bilateral progressive KC were enrolled in a contralateral randomized trial and completed 2 years of follow-up examinations. Fellow eyes were randomly allocated to the accelerated CXL group or the standard CXL group. The main outcome measure was change in maximum keratometry (Kmax) centered on the steepest point (zonal Kmax - 3 mm) with a non-inferiority margin of 1.0 diopter (D). Vision and refraction tests, ophthalmic examinations, and corneal tomography were performed at baseline and at 6, 12, and 24 months after CXL. Failure was defined as an increase of ≥ 1.0 D in zonal Kmax - 3 mm within a 12-month period.ResultsThe mean age (± standard deviation) of the patients was 15.71 ± 2.40 years. The within-group change in zonal Kmax - 3 mm was not significant after 2 years in either group, and within-group zonal Kmax - 3 mm remained stable. At 2 years after CXL, the mean change in the zonal Kmax - 3 mm was - 0.02 ± 0.81 D and - 0.31 ± 0.86 D in the accelerated CXL and standard CXL groups, respectively (P = 0.088). At 1 year of follow-up, three patients in the accelerated CXL group showed treatment failure (mean change in zonal Kmax - 3 mm + 2.12 ± 0.11 D); no patients in the standard CXL group showed treatment failure. At 2 years of follow-up, these three patients showed a decrease of - 0.43 ± 0.18 D in zonal Kmax - 3 mm from a baseline value of 55.11 ± 0.32 D. The 2-year trends of the inferior-superior asymmetry and vertical coma were statistically significantly different between the two groups, with the accelerated CXL protocol showing superiority in patients with higher baseline values.ConclusionIn young patients with Down syndrome, the accelerated CXL protocol was able to halt disease progression and may be an alternative for the standard CXL protocol. In advanced KC, the efficacy of the accelerated approach was delayed and appeared later in the follow-up. In asymmetric cornea, the accelerated CXL resulted in centralization of the corneal cone.Trial registrationIranian Registry of Clinical Trials, IRCT20100706004333N3.

Dataset Information

Accelerated versus standard corneal cross linking in the treatment of ectasia post refractive surgery and penetrating keratoplasty: a medium term randomized trial.

Publications

Accelerated versus standard corneal cross linking in the treatment of ectasia post refractive surgery and penetrating keratoplasty: a medium term randomized trial.

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