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. 2020 Oct 8;9(10):3222.
doi: 10.3390/jcm9103222.

Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus

Kazutaka Kamiya  1 , Shunsuke Kanayama  2 , Masahide Takahashi  2 , Nobuyuki Shoji  2
Affiliations

Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus

Kazutaka Kamiya et al. J Clin Med. .

Abstract

Customized cross-linking has been proposed as an alternative to conventional cross-linking in patients with progressive keratoconus, targeting greater flattening of the cone region and improved visual function. Epithelium-on cross-linking aims to reduce complications associated with epithelial removal, while the addition of oxygen aims to maintain treatment effect. Our study evaluates the combination of these novel treatment strategies to achieve a minimally invasive treatment targeting maximal functional outcomes. This prospective study included 42 eyes undergoing epithelium-on, accelerated, oxygen-supplemented, customized corneal cross-linking for progressive keratoconus. Outcome measures, including refraction, visual acuity, and corneal tomography were obtained at baseline and at 1, 3, and 6 months, and 1 year postoperatively. Logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity was significantly improved, from 0.87 ± 0.53 preoperatively, to 0.78 ± 0.56 1 year postoperatively (Wilcoxon rank sum test, p = 0.016). LogMAR best spectacle-corrected visual acuity was also significantly improved, from 0.19 ± 0.36 preoperatively, to 0.11 ± 0.33 postoperatively (p = 0.004). Manifest refractive cylinder was significantly decreased, from 4.50 ± 2.96 D preoperatively, to 3.27 ± 2.61 D postoperatively (p = 0.004). The baseline maximum keratometry (Kmax) was 53.04 ± 7.91 D, significantly flattening to 52.25 ± 7.31 D by 1 month, and remaining relatively stable at 1 year postoperatively (52.31 ± 7.50 D) (p < 0.001). No significant adverse events occurred in any eye. Epithelium-on, accelerated, oxygen-supplemented, customized corneal cross-linking is a promising new treatment approach, with reduced maximum keratometry, reduced astigmatism, and improved visual acuity at 1 year, with a favorable safety and patient comfort profile.

Keywords: CuRV; corneal topography; customized CXL; epi-on; keratoconus; oxygen; visual acuity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Application of the oxygen delivery goggles (Boost Goggles, Avedro Inc., Waltham, MA, USA). The difference map shows flattening of 3.0 D in the steep areas and steepening of 1.6 D in the previously flat areas.
Figure 2
Figure 2
Distribution of preoperative Amsler–Krumeich staging.
Figure 3
Figure 3
A representative example of corneal tomography at preoperative (a), 1-year postoperative (b), and the difference map showing the change in corneal tomography (c).
Figure 4
Figure 4
Distribution in changes in Kmax from preoperative values at 1-year post-procedure.
See this image and copyright information in PMC

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