Improvements maintained in long-term outcomes of accelerated CXL
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Five-year follow-up after epi-off accelerated cross-linking showed keratoconus stability, with meaningful improvement of vision, corneal curvature and higher-order aberrations in a group of pediatric and young adult patients.
“We have now the evidence that this protocol has all it takes to become the new standard for epi-off in our clinical practice and the treatment of choice for the management of progressing ectasia in the early stages of keratoconus,” Cosimo Mazzotta, MD, PhD, said at the virtual European Society of Cataract and Refractive Surgeons meeting.
Reducing treatment time while maintaining the efficacy of the original 3 mW Dresden protocol has been the objective of intense research over several years. The accelerated procedure (9 mW/cm²) allows shortening the treatment from 60 minutes to 20 minutes per patient, with 10 minutes of riboflavin imbibition (VibeX Rapid, Avedro/Glaukos) and 10 minutes of continuous UVA irradiation using the KXL system (Avedro/Glaukos).
“Patient comfort and compliance are greatly improved and waiting lists are dramatically reduced since we can perform double the number of treatments. In addition, due to the shorter exposure to UVA light, haze and other adverse events are greatly reduced. In 5 years, my regression rate, meaning a Kmax increase of 1 D, has been 8%, and I have never had one case of corneal transplantation,” Mazzotta said.
The study included 156 eyes of 88 patients with progressive keratoconus, divided into a young adult group of 68 patients between the ages of 19 and 31 years and a pediatric group of 20 patients, all treated bilaterally, between the ages of 8 and 18 years.
“Results were impressive. Complete stability of the cone was achieved in 92% of the eyes. UDVA and CDVA improved significantly from 0.2 to 0.06 logMAR, and maximum corneal curvature decreased by 1.5 D, together with significant reduction of coma aberration,” Mazzotta said.
No adverse events were reported, except mild temporary haze in 15% of the eyes, which did not affect visual acuity. OCT showed a mean demarcation line depth of 330 µm, comparable to what is obtained by the classic Dresden protocol.
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Mazzotta C, et al. 9 mW accelerated cross-linking could replace the 3 mW Dresden protocol in treating progressive keratoconus. Presented at: European Society of Cataract and Refractive Surgeons meeting; Oct. 2-4, 2020 (virtual meeting).
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