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Nerve deficits persist 5 years after cross-linking for keratoconus
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Corneal collagen cross-linking did not resolve nerve deficits in keratoconic corneas, according to a study.
The observational study included 19 patients with early-stage keratoconus who underwent standard epithelium-off cross-linking and 19 age-matched healthy volunteers.
Primary outcome measures were central corneal subbasal nerve density, subbasal nerve analysis, subbasal nerve architecture and ocular surface touch sensitivity. Patients were followed for up to 5 years postoperatively.
Mean preoperative subbasal nerve density determined by manual nerve-tracing analysis was 21 mm/mm2 in healthy corneas and 10.3 mm/mm2 in patients with stage 1 or stage 2 keratoconus. The difference was statistically significant (P < .001).
Mean preoperative subbasal nerve density determined by automated nerve-tracing analysis was 20.2 mm/mm2 in healthy corneas and 8.9 mm/mm2 in keratoconic corneas. The difference was statistically significant (P < .001).
“Fully automated nerve analysis led to the same conclusions as manual analysis, despite wider limits of agreement and a tendency to underestimate nerve density when fewer nerves were present,” the study authors said. “Nevertheless, automation minimizes human bias and could enable near real-time analysis in the clinic.”
Nerves continued to regenerate for up to 5 years after cross-linking, but nerve density was significantly lower in keratoconic corneas than in healthy corneas (P < .001). Touch sensitivity was restored to normal by 6 months.
Keratoconic corneas had more frequent nerve loops, crossings and greater crossing angles than healthy corneas before surgery. All three findings increased after surgery in keratoconic corneas.
Regenerating subbasal nerves remained disoriented at 5 years in keratoconic corneas. – by Matt Hasson
Disclosure: The authors report no relevant financial disclosures.
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Parissi M, et al. JAMA Ophthalmol. 2016;doi:10.1001/jamaophthalmol.2015.4518.
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