Accelerated corneal crosslinking works
An accelerated corneal collagen crosslinking (CXL) approach appears to be safe for treating patients with progressive keratoconus
An accelerated corneal collagen crosslinking (CXL) approach appears to be safe for treating patients with progressive keratoconus, and delivers comparable visual and corneal biomechanical results to the standard Dresden protocol while reducing treatment time 60 minutes to 18 minutes, Thomas Kohnen MD, PhD, told the 2017 American Society of Cataract and Refractive Surgery Symposium in Los Angeles, USA.
In a retrospective study of 12 patients with progressive keratoconus Dr Kohnen and colleagues conducted at Goethe University, Frankfurt, Germany, accelerated CXL increased corneal densitometry as measured by Scheimpflug imaging three months after surgery, particularly in the anterior stromal layer within the central concentric zones of 0.0mm to 2.0mm, and 2.0mm to 6.0mm. Mean spherical equivalent, maximum keratometry and simulated keratometry were not significantly changed, while mean central corneal thickness decreased significantly from 470.08 ±32.02 microns before treatment to 453.08 ±35.44 microns afterward.
In a second retrospective study comparing 29 Dresden Protocol and 29 accelerated CXL patients, all keratoconus indices improved in both groups, with progression stagnating in the accelerated group and regressing slightly in the Dresden group. Increased corneal density was evident on imaging up to 12 months after treatment.
These studies suggest accelerated CXL is safe and effective for treating progressive keratoconus using 18mW/cm2 for five minutes, greatly reducing treatment time, Dr Kohnen said. However, more study and development are needed. “There is a small advantage for the Dresden protocol compared to the accelerated protocol but further studies are required for direct comparison.”