Topography-guided CXL shows effective, stable outcomes in progressive keratoconus
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Key takeaways:
- Topography-guided corneal cross-linking for progressive keratoconus leads to superior corneal steepening with significant improvement of vision.
- Study results support using the procedure for progressive keratoconus.
VILAMOURA, Portugal — Topography-guided corneal cross-linking for progressive keratoconus leads to stable inferior corneal Kmax flattening and superior corneal steepening, with significant improvement of vision, according to a study.
“More energy is applied to the keratoconic cone, usually in the center-inferior cornea. The overall redistribution of biomechanical stress leads to changes in the superior part of the cornea as well,” Celso Costa, MD, said at the European Society of Cataract and Refractive Surgeons winter meeting.
The study included 27 eyes of 24 patients who underwent topography-guided corneal cross-linking (TG-CXL). Following removal of the epithelium with phototherapeutic keratectomy, riboflavin was applied every 2 minutes for 10 minutes, and topography-guided UVA irradiation was then performed in three concentric circular areas centered on the thinnest corneal point, with treatment energies ranging between 10 J/cm2 and 5.4 J/cm2 and fluence of 10 mw/cm2. Maximum irradiation exposure was in the innermost circle.
Data were collected at baseline and 3, 6 and 12 months after the treatment on subjective refraction, best corrected visual acuity, central corneal thickness, corneal thinnest point, maximum keratometry (Kmax) and mean anterior keratometry values within five points of a 3 mm diameter circle centered on the pupil in the superior (S index) and inferior (I index) halves of the cornea.
“We obtained a statistically significant difference in the Kmax, which decreased, in the S index, which increased, and in the I index, which decreased. Results were stable between 6 and 12 months, so we can conclude that we have achieved keratometric stability,” Costa said.
A statistically significant improvement in BCVA and spherical equivalent was also observed, although the cylinder did not change.
“Our results support TG-CXL as a valuable procedure in progressive keratoconus,” Costa said.
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Costa C. Topography-guided corneal crosslinking for keratoconus — Is it enough to treat the cone? Presented at: European Society of Cataract and Refractive Surgeons winter meeting; March 10-12, 2023; Vilamoura, Portugal.
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