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. 2024 Feb 8:18:393-407.
doi: 10.2147/OPTH.S450916. eCollection 2024.

Transepithelial Accelerated Crosslinking for Progressive Keratoconus: A Critical Analysis of Medium-Term Treatment Outcomes

Rodrigo Vilares-Morgado  1   2 , Ana Margarida Ferreira  1   2 , Ana Maria Cunha  1   2 , Raúl Moreira  1   2 , Luís Torrão  1   2 , Pedro Neves-Cardoso  1   2 , João Pinheiro-Costa  1   2   3
Affiliations

Transepithelial Accelerated Crosslinking for Progressive Keratoconus: A Critical Analysis of Medium-Term Treatment Outcomes

Rodrigo Vilares-Morgado et al. Clin Ophthalmol. .

Abstract

Purpose: To report the 4-year outcomes of transepithelial accelerated corneal collagen crosslinking (TE-ACXL) in the treatment of eyes with progressive keratoconus (KC).

Methods: Eyes of patients who underwent TE-ACXL (6mW/cm2 for 15 minutes) for progressive KC and presented 48 months of follow-up were included. Corrected distance visual acuity (CDVA), keratometry measurements (Kmax, maximum keratometry, Kmean, mean keratometry and Astg, corneal astigmatism), thinnest corneal thickness (PachyMin), and topographic, and tomographic indices (specifically the posterior radius of curvature from the 3.0 mm centered on the thinnest point of the cornea (PRC), and the D-index) were analysed preoperatively and every 12 months after TE-ACXL, up to 48 months. Progression after TE-ACXL was considered when eyes presented ≥1 criteria: (1) increase of ≥1D in Kmax or increase of ≥0.75D in Kmean or increase of ≥1D in Astg; (2) reduction of ≥0.085 mm in PRC; (3) decrease ≥5% in PachyMin.

Results: 41 eyes from 30 patients were included, with a mean age at crosslinking of 20.90±4.69 years. There was a significant increase in Kmean (+0.64±1.04 D, p<0.001; +0.98 ± 1.49 D, p<0.001; +1.27±2.01 D, p<0.001; +1.13±2.00 D, p=0.006) and a significant decrease in PRC throughout follow-up (-0.12±0.22, p=0.002; -0.15±0.24, p<0.001; -0.17±0.43, p=0.021; -0.16±0.43, p=0.027). PachyMin decreased significantly at 36 and 48 months (-8.50±15.93 μm, p=0.004; -7.82±18.37, p=0.033). According to our progression criteria, there was a major progression rate throughout follow-up (57.1%, 61.1%, 58.8%, and 67.9%, respectively). Surgery and follow-up were uneventful in all subjects. Eleven eyes (26.8%) required further procedures, ≥36 months after the initial TE-ACXL, due to persistent progressive disease.

Conclusion: TE-ACXL proved to be a safe therapeutic option for progressive KC. However, its efficacy is deemed unsatisfactory, as a notable proportion of affected eyes may continue to advance within a 4-year timeframe, necessitating additional procedures to halt the disease's course.

Keywords: epi-on crosslinking; keratoconus progression; progressive keratoconus; trans-epithelial corneal crosslinking.

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Conflict of interest statement

The authors have no conflicts of interest to declare for this work.

Figures

Figure 1
Figure 1
Distribution of baseline Pentacam® topographical keratoconus classification (KC; Pentacam®-derived Amsler-Krumeich stages).
Figure 2
Figure 2
Corrected distance visual acuity (CDVA) in logMAR notation at baseline, 12, 24, 36, and 48 months after Trans-Epithelial Accelerated Crosslinking (TE-ACX).
Figure 3
Figure 3
Maximum keratometry (Kmax) in diopters (D) at baseline, 12, 24, 36, and 48 months after Trans-Epithelial Accelerated Crosslinking (TE-ACX).
Figure 4
Figure 4
Mean keratometry (Kmean) in diopters (D) at baseline, 12, 24, 36, and 48 months after Trans-Epithelial Accelerated Crosslinking (TE-ACX).
Figure 5
Figure 5
Minimum pachymetry (PachyMin) in micrometres (μm) at baseline, 12, 24, 36, and 48 months after Trans-Epithelial Accelerated Crosslinking (TE-ACX).
See this image and copyright information in PMC

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