Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management

Abstract

Purpose

To analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management.

Patients and methods

This study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively.

Results

Forty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by <1 D, 23 eyes (46.9%) improved from 1 D to <2 D and 7 eyes (14.3%) improved by ≥2 D. Both uncorrected distant visual acuity (UDVA) and corrected distant visual acuity (CDVA) showed statistically significant improvement from preoperative 1.34±0.29 (mean±SD) and 0.74±0.23 LogMAR to postoperative 0.99±0.32 and 0.50±0.22 LogMAR (P<0.0001) respectively. Both Kmax and SE refraction showed statistically significant and stable improvement from preoperative 51.95±1.90 and −7.90±3.14 D to postoperative 50.19±1.96 and −6.35±2.49 D (P<0.0001) respectively. Two eyes (4%) showed KC progression at the end of 5th follow-up year.

Conclusion

SCXL had good effectiveness and stability that halted KC progression over 5-year follow-up period. It had also unexpected improvement in the KC refractive components mainly the spherical and SE components.

Keywords:

• keratoconus
• standard cross-linking
• eye rubbing
• ectasia
• KC progression

Data Sharing Statement

The Excel sheet and patient data used to support the findings of this study are available from the corresponding author upon request.

Acknowledgment

The authors are grateful for the help and support of Dr. Mona Abo Ali, Mr. Hamza Mohammed, Mr. Seif Mohammed and Ms. Lina Mohammed as well as the EPK Group, they also appreciate the help and support of Prof. Foad Metry Yousef.

Disclosure

The authors report no conflicts of interest.