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Comparative analysis of safety and efficacy of topography guided customized cross-linking and standard cross-linking in the treatment of progressive keratoconus

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First Author: S.Ramamurthy INDIA

Co Author(s):    G. Sachdev   S. B                 

Abstract Details

Purpose:

To compare the safety and efficacy of topography guided customized corneal crosslinking (PiXL) with standard crosslinking (CXL) for the treatment of progressive keratoconus.

Setting:

A tertiary eye care hospital in India

Methods:

In a prospective interventional analysis, eyes with progressive keratoconus underwent standard crosslinking (homogenous 9mm ultraviolet-A irradiation of 9mW/cm2, total fluence of 5.4J/cm2) versus topography guided customized crosslinking (30mW/cm2 pulsed irradiance, total fluence ranging from 5.4J/cm2 to 15J/cm2, in concentric circles centered on the posterior float maximum). Following parameters were analyzed at preoperative, and 1,6 and 12 months’ postoperative visit: corrected spectacle distance visual acuity, manifest refraction, corneal tomography, higher order aberration profile and endothelial cell count. Anterior segment optical coherence tomography evaluation was done at one-month postoperative visit to assess depth of demarcation line.

Results:

64 eyes of 45 patients (32 eyes in each group) were included. There was a significant reduction in maximum keratometry and Inferior-superior asymmetry in the PiXL group at both 6 months and one-year postoperative visit (p=0.001 and 0.06). Corrected spectacle distance visual acuity (CSDVA) improved significantly in the PiXL (0.05 ± 0.08 log MAR, P=0.02) versus the standard CXL (0.01 ± 0.025 log MAR, P = .26) group. A greater depth of stromal demarcation line was observed in the customised CXL group (P=0.02). No significant complications were noted in either cohort.

Conclusions:

PiXL demonstrated similar safety with significantly greater keratometry flattening and corneal regularization vis-à-vis standard CXL. This resulted in significant improvement of spectacle corrected visual acuity for eyes with mild to moderate keratoconus.

Financial Disclosure:

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