Three-year follow-up of accelerated versus standard corneal cross-linking in paediatric Keratoconus

Einan‐Lifshitz, Adi; Achiron, Asaf; Hed, Shira; Hecht, Idan; Dubinsky‐Pertzov, Biana; Knyazer, Boris

doi:10.1038/s41433-022-02093-4

Cited by 5 publications

(17 citation statements)

References 39 publications

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“…Furthermore, they reported that mean K max improved by 1.4 D at postoperative year 4 versus 1.44 D at postoperative year 3 in our study; respectively. In agreement with this study, Einan‐Lifshitz et al (2022) compared SCXL and ACXL and concluded that ACXL was no‐inferior to SCXL in postoperative visual and topographic outcomes after 3 years follow‐up period. In addition, Turhan et al (2021) compared SCXL and ACXL (9 mW/cm 2 × 10 min/5.4 J/cm 2 ) and concluded that both protocols are safe and effective in halting progression for 2 years suggesting that ACXL as an alternative to SCXL.…”

Section: Discussionsupporting

confidence: 83%

Analysis of the outcomes of three different cross‐linking protocols for treatment of paediatric keratoconus: A multicentre randomized controlled trial

Iqbal

Gad

Kotb

et al. 2023

Acta Ophthalmologica

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PurposeTo analyse long‐term outcomes of standard cross‐linking (SCXL), accelerated cross‐linking (ACXL) and transepithelial cross‐linking (TCXL) in the treatment of progressive paediatric keratoconus regarding stability, safety and efficacy.MethodsThis prospective multicentre randomized controlled trial included 97 eyes of 97 paediatric patients with stages I–III ABCD keratoconus grading system, who were randomized into three groups; SCXL group (control group, n = 32; 3 mW/cm2 × 30 min/5.4 J/cm2), ACXL (n = 33; 18 mW/cm2 × 5 min/5.4 J/cm2) and TCXL (n = 32; 18 mW/cm2 × 5 min/5.4 J/cm2). Subjective refraction, uncorrected and corrected visual acuity, keratometry and pachymetry measurements using corneal topography were recorded preoperatively and 1, 2 and 3 years postoperatively.ResultsSCXL group exhibited significant successive improvements in the mean visual, refractive and keratometric parameters throughout the entire postoperative 3 years while ACXL group exhibited significant improvements in visual and keratometric parameters in the first postoperative year that remained stable in second and third postoperative years. TCXL group exhibited significant progressive deterioration in all mean parameters compared to SCXL and ACXL (p < 0.0001). Both SCXL and ACXL revealed final 100% success rate with good stability while TCXL revealed final 22% failure rate with keratoconus progression (p < 0.0001).ConclusionSCXL and ACXL were comparable in halting keratoconus progression and achieved good stability and safety; however, SCXL was more efficient than ACXL as it yielded greater significant postoperative mean visual, refractive and keratometric improvements achieving smoother corneal remodelling. Both SCXL and ACXL were much superior to TCXL. SCXL is the best CXL treatment option for paediatric keratoconus while ACXL is a good and effective alternative.

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Section: Discussionsupporting

confidence: 83%

Analysis of the outcomes of three different cross‐linking protocols for treatment of paediatric keratoconus: A multicentre randomized controlled trial

Iqbal

Gad

Kotb

et al. 2023

Acta Ophthalmologica

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“…The most common outcomes were stability in Kmax (+1 to −1 dioptre change) 31 and 2 or more dioptres of flattening. Over the follow‐up there was a reduction in the proportion of stable patients: 41.0% (347/975) at 1‐year to 28.6% (42/168) at 5‐years and an increase in those flattening by 2 or more dioptres from 31.2% (264/975) at 1‐year to 38.1% (56/168) at 5‐years.…”

Section: Resultsmentioning

confidence: 99%

“…The most common outcomes were stability in Kmax (+1 to À1 dioptre change) 31 and 2 or more dioptres of flattening. Over the follow-up there was a reduction in…”

Section: Kmaxmentioning

confidence: 99%

Five‐year corneal cross‐linking outcomes: A Save Sight Keratoconus Registry Study

Ferdi

Kandel

Nguyen

et al. 2022

Clinical Exper Ophthalmology

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Background: We aimed to determine the long-term outcomes of epitheliumoff cross-linking (CXL) in keratoconus patients.Methods: An observational registry study from 41 centres across 5 countries was carried out. Primary outcomes included the mean change in visual acuity (VA), Kmax, K2, and thinnest corneal thickness (TCT) at 1-5 years. Secondary outcomes included the percentage of eyes with worsening, stable and improving outcomes.Results: There were 976 eyes of 794 patients with 1-year of complete follow-up, 501 eyes with 2-years, 355 with 3-years, 235 with 4-years and 162 with 5-years. There was a significant improvement in mean VA from baseline by 3.7 logMAR letters (p < 0.001) in year 1, and 6.9 (p < 0.001) in year 5. Mean Kmax decreased by 1.2 dioptres (D; p < 0.01) in year 1. During subsequent years the Kmax flattening appeared sustained but this was not statistically significant. K2 flattened significantly from baseline in year 1 and then remained stable. At 1 year, 4.1% patients were poor responders to CXL in terms of VA, losing ≥15 letters. The proportion of the poor responders remained unchanged: 4.9% at 5-years. The proportion of poor responders in terms of Kmax remained similar: 5.9% steepening by ≥2D at 1-year and 7.5% at 5-years. The proportion of K2 poor responders remained stable with 4.7% steepening by ≥2D at 1-year and 5.8% at 5-years.Conclusions: Cross-linking is effective at stabilising keratoconus up to 5 years in most patients. However, a small proportion of eyes failed to stabilise and had reduced vision.

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“…The most danger complication of ketatoconus is corneal perforation caused by corneal thinning. 27 The long-term study of S-CXL found that MCT is still decreasing, 28,29 which may be related to post-CXL progression. 30 Additionally, slightly MCT thinning was discovered after 3 years of the EF I-CXL protocol.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Predictors of Iontophoresis-assisted Transepithelial Corneal Cross-linking for Progressive Keratoconus Based on “LASSO” Regression: 3 Year Results

Liu

Shen

Wang

et al. 2022

Preprint

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Purpose: To report the 3 year efficacy and predictors of transepithelial corneal cross-linking assisted by iontophoresis (I-CXL) for 10 min using the least absolute shrinkage and selection operator (LASSO) regression in Chinese patients with progressive keratoconus.Methods: This retrospective study included 30 eyes of 25 patients, of mean age 18.48 ± 4.02 years (range: 11 to 28 years). All patients underwent stromal imbibition of riboflavin solution for iontophoresis for 10 min, followed by epithelium-on CXL. The uncorrected distance visual acuity (UDVA; in logarithm of the minimum angle of resolution [LogMAR] units), corrected distance visual acuity (CDVA; in LogMAR units), spherical equivalent (SE); max keratometry (Kmax); minimum corneal thickness (MCT); the index of surface variance (ISV); the index of vertical asymmetry (IVA); the keratoconus index (KI); the center keratoconus index (CKI); and the index of height decentration (IHD), corneal optical coherence tomography (OCT), and confocal microscopy were evaluated at baseline and postoperatively at 1, 3, 6, 12, 24, and 36 months. Predictors of changes in CDVA and Kmax 3-year postoperatively compared with baseline were analyzed using the LASSO regression with internal tenfold cross-validation, as indicated by average root mean squared error (RMSE) and R-squared (R2) values.Results: Corneal OCT at 1 month detected the demarcation line in 24 eyes (80%), at a mean depth of 238.97 ± 53.69 μm. Average CDVA improved from 0.26 ± 0.17 LogMAR at baseline to 0.19 ± 0.13 LogMAR at 3 years (P < 0.05), average Kmax decreased from 59.72 ± 8.71 diopters (D) at baseline to 58.03 ± 7.96 D at 3 years (Delta: −1.68 ± 3.15 D, P < 0.05). ISV, IVA, KI, and IHD also decreased significantly. After LASSO regression for predictor selection, ten parameters (age, gender, baseline UDVA, CDVA, SE, MCT, ISV, IVA, KI, and IHD) were the predictors of CDVA changes 3 years after I-CXL (RMSE = 0.0054; R2 = 0.89). Age, baseline MCT, KI, and CKI value were associated with Kmax changes (RMSE = 7.3828; R2 = 0.57).Conclusions: I-CXL for 10 min is safe and effective in patients with keratoconus, with good 3 year outcomes and the symmetry indices could predict the improvement of CDVA at 3 year after I-CXL.

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Three-year follow-up of accelerated versus standard corneal cross-linking in paediatric Keratoconus

Cited by 5 publications

References 39 publications

Analysis of the outcomes of three different cross‐linking protocols for treatment of paediatric keratoconus: A multicentre randomized controlled trial

Analysis of the outcomes of three different cross‐linking protocols for treatment of paediatric keratoconus: A multicentre randomized controlled trial

Five‐year corneal cross‐linking outcomes: A Save Sight Keratoconus Registry Study

Efficacy and Predictors of Iontophoresis-assisted Transepithelial Corneal Cross-linking for Progressive Keratoconus Based on “LASSO” Regression: 3 Year Results

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