Comparison of collagen cross-linking alone, collagen cross-linking with intrastromal corneal ring segments, and collagen cross-linking with topography-guided photorefractive keratectomy: a prospective non-randomized interventional study

Session Details

Session Title: Cornea & Miscellaneous
Session Date/Time: Saturday 22/02/2020 | 08:30-11:10
Paper Time: 08:54
Venue: Auditorium des Ministres.

First Author: N.Singal CANADA
Co Author(s): N. Singal  S. Ong Tone  R. Stein  W. Hatch  A. Slomovic  S. El-Defrawy  

Abstract Details

Purpose:

To compare accelerated collagen crosslinking (CXL) alone, CXL with simultaneous intrastromal corneal ring segments (CXL-ICR), and CXL with simultaneous topography-guided photorefractive keratectomy (CXL-TG-PRK) in progressive keratoconus, pellucid marginal degeneration (PMD) or laser in-situ keratomileusis (LASIK)-induced ectasia.

Setting:

Kensington Eye and Bochner Eye Institutes, Toronto, Canada

Methods:

Four hundred fifty-two eyes from 375 subjects with progressive keratoconus, PMD or LASIK-induced ectasia underwent accelerated (9 mW/cm2, 10 minutes) CXL (n=204), CXL-ICR (n=126) or CXL-TG-PRK (n=122). Visual and topographic outcomes using a comparative analysis adjusting for preoperative maximum keratometry (Kmax) was evaluated one year after surgery

Results:

Change in logMAR UDVA was significant with CXL-ICR (-0.31, 95% CI[-0.38 to -0.24]) and CXL-TG-PRK (-0.16, 95% CI[-0.24 to -0.09]), but not CXL alone.  Change in CDVA was significant in all three groups: -0.12 (95% CI[-0.15 to -0.10]) with CXL alone, -0.23 (95% CI[-0.27 to -0.20]) with CXL-ICR and -0.17 (95% CI[-0.21 to -0.13]) with CXL-TG-PRK. Improvement in CDVA was greater with CXL-ICR than CXL alone (-0.08±0.02;p<0.0001) and CXL-TG-PRK (-0.05±0.02;p=0.005). Change in Kmax was significant with CXL-ICR (-3.21D, 95% CI[-3.98 to -2.45]) and CXL-TG-PRK (-3.69D, 95% CI[-4.49 to -2.90]).

Conclusions:

We recommend CXL for keratoconic patients who meet our inclusion criteria. CXL-ICR may be more effective for eyes with more irregular astigmatism and worse CDVA, and CXL-TG-PRK for eyes requiring improvements in irregular astigmatism but still have good CDVA.

Financial Disclosure: