Accelerated epi-off cross-linking stabilizes keratoconus
Keratoconus progression was stabilized and vision improved at 2-year follow-up in a study of the safety and efficacy of epithelium-off 15 mW accelerated cross-linking pulsed-light treatment.
Several accelerated protocols have been proposed over the years to shorten CXL time and improve patient comfort. At the same time, the role of oxygen for the photochemical activation of riboflavin was proven in several studies, and it was shown that pulsed light might provide better oxygen penetration and diffusion.
This study demonstrated that 15 mW accelerated CXL and pulsed-light delivery at the standard 5.4 J/cm² might be an ideal combination.
A total of 132 eyes of 96 patients with stage 2 keratoconus were included in the study. Pulsed-light 15 mW/cm² accelerated CXL was performed using topical anesthesia after removal of the epithelium and riboflavin 0.1% application over 10 minutes on the entire corneal surface. Ultraviolet A irradiation time was 12 minutes over a total treatment time of 22 minutes.
After treatment, cornel biomicroscopy and spectral-domain OCT showed a distinct demarcation line at a mean of 280 µm depth. Mean uncorrected and corrected distance visual acuity improved significantly between baseline and 24 months.
This combination, the authors noted, allows reduction in treatment time and increased patient comfort with reduced postoperative glare disability, reduced subepithelial nerve plexus damage and less postoperative haze.
“The present study confirms the clinical safety of 15 mW accelerated CXL pulsed-light treatment with epithelium removal and its efficacy based on the stabilization of keratoconus progression with no complications during a 24-month follow-up,” the authors said. – by Michela Cimberle
Disclosure s : The authors report no relevant financial disclosures.