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Accelerated cross-linking improves visual acuity, corneal topography
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Accelerated corneal collagen cross-linking yielded results similar to those of conventional cross-linking while markedly reducing exposure time with the same treatment dose, according to a study.
The case series study included 39 eyes of 22 patients with keratoconus. Patients underwent an accelerated cross-linking procedure that comprised a 10-minute riboflavin 0.1% soak and 3 minutes of ultraviolet-A irradiation at a level of 30 mW/cm2. The epithelium was removed in all cases.
Patients were examined preoperatively and at 1 day, 3 days, 1 week, and 1, 3 and 6 months postoperatively.
Mean uncorrected distance visual acuity improved significantly, from 1.11 preoperatively to 0.89 at 6 months postoperatively (P < .01). Corrected distance visual acuity did not change significantly at any follow-up point.
Seventeen eyes gained more than two lines of uncorrected distance visual acuity. No eyes that lost lines of uncorrected distance visual acuity lost lines of corrected distance visual acuity.
Significant changes in mean maximum keratometry values occurred, from 49.95 D preoperatively to 49.19 D at 6 months (P < .01). No significant changes in endothelial cell density were seen from baseline to final evaluation, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.
Perspective
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Eric D. Donnenfeld, MD
The authors have evaluated the effect of accelerated transepithelial riboflavin UV cross-linking for keratoconus employing a high irradiance UV light source of 30 mW/cm2 for 3 minutes. Traditional riboflavin UV cross-linking using the Dresden protocol employs an irradiance of 3 mW/cm2 and the epithelium is removed. The major advantages of the new technique is a more rapid procedure and, more importantly, the preservation of the epithelium, which markedly reduces pain, expedites the patient’s ability to return to work, and reduces the risk of infectious keratitis. The unanswered question is that although the results of this study are very good, there is no head-to-head, prospective, controlled evaluation of the two different techniques. Additionally, long-term results cannot be evaluated with this trial. Regardless, the results of this trial are encouraging, and the authors should be congratulated for this important work.
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