Posters

Fate of the untreated fellow eye of patients with bilateral keratoconus with unilateral collagen cross-linking

Poster Details

First Author: P.Padmanabhan INDIA

Co Author(s):    V. Padmanaban                    

Abstract Details

Purpose:

To report the fate of the untreated fellow eye of patients with bilateral keratoconus (KC) who underwent collagen crosslinking (CXL) in one eye.

Setting:

Department of Cornea and Refractive surgery in a tertiary eye care centre, Medical Research Foundation, Chennai, India

Methods:

This was a retrospective contralateral study of patients with bilateral keratoconus who showed progression in atleast one eye, underwent CXL in the eye with more advanced disease.    Both eyes were evaluated at 3, 6, 12 months and annually thereafter.  Untreated eyes that showed progression of disease were treated with CXL – the parameters of both eyes  only until that point were analysed as part of the study after which the patient exited the study.  Refractive, corrected distance visual acuity (CDVA), topographic & tomographic parameters  were compared bilaterally.

Results:

A total of 411 patients (151 paediatric, 260 adults), mean age 21.5±6.5 years, with bilateral KC were studied.  Mean follow up after unilateral CXL was 4.1±3.2 years.  At last follow up, there was a significant improvement in mean CDVA and topographic astigmatism, mean flattening of Kmax by 1.16±3.81D(p<0.001) in the treated eyes.    Untreated fellow eyes showed mean steepening of Kmax by 1.88±4.5D(p<0.001). Both treated and fellow untreated eyes showed significant thinning, but significantly more so in the treated eye (-28.7±42µ) than untreated eyes (-14.8±33.5µ). 18% of treated eyes and 25% of untreated eyes showed steepening >1D at last follow-up.

Conclusions:

CXL results in significant improvement in vision, refractive and keratometric status in eyes with progressive KC, even though it also results in significant thinning.  Untreated eyes need to be closely watched for progression.  Our study also shows that all treated eyes do not necessarily improve after CXL and all untreated eyes do not necessarily worsen if not subjected to CXL.   The importance of avoiding triggering factors like eye-rubbing and treating co-morbidities like allergies needs to be emphasized.

Financial Disclosure:

None