Kanwal Latif1, Muhammad Saeed Iqbal1. 1. Department of Ophthalmology, Sir Syed College of Medical Sciences and Hospital, Karachi.
Abstract
OBJECTIVE: To assess the visual and topographical outcomes following accelerated trans-epithelial corneal crosslinking (TE-CXL) in progressive keratoconus. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Laser Vision Centre, Karachi, from January 2015 to December 2016. METHODOLOGY: Forty-five eyes of 25 patients affected with progressive keratoconus and treated with accelerated TE-CXL with riboflavin (vitamin B2) and ultra-violet A(UV-A) irradiation were enrolled in this study. The visual outcome was measured by ETDRS chart as improvement in best corrected visual acuity (BCVA) of at least one line or more as compared to pre-CXLBCVA. The topographical outcome was measured as decrease in maximum simulated keratometry values, astigmatism and spherical equivalent (SE) and an increase in central corneal thickness (CCT). K-max was defined as the steepest radius of curvature of the anterior corneal surface. SE was measured by subjective refraction, and K-max, astigmatism and CCTby scanning-slit corneal topography. Patients were followed-up 12 months post-treatment. RESULTS: At the end of follow-ups, mean BCVAshowed improvement of one line from LogMAR 0.58 ±0.067 to LogMAR 0.48 ±0.077. Seven (15.5%) eyes showed two lines of improvement while 3 (6.7%) eyes showed worsening of one line in BCVA. The mean K-max flattened by 0.7D. Mean astigmatism and SE decreased up to -0.5D and -0.4D, respectively. Mean preoperative CCTwas 454.31 ±36.34 µm, whereas mean postoperative CCTwas 456.47 ±35.60 µm with an average increase of 2.15 µm. No postoperative complications were reported. CONCLUSION: Based on topographical outcomes, accelerated TE-CXL is effective in preventing the progression of keratoconus without any safety concerns with improvement of vision in majority of cases.
OBJECTIVE: To assess the visual and topographical outcomes following accelerated trans-epithelial corneal crosslinking (TE-CXL) in progressive keratoconus. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Laser Vision Centre, Karachi, from January 2015 to December 2016. METHODOLOGY: Forty-five eyes of 25 patients affected with progressive keratoconus and treated with accelerated TE-CXL with riboflavin (vitamin B2) and ultra-violet A(UV-A) irradiation were enrolled in this study. The visual outcome was measured by ETDRS chart as improvement in best corrected visual acuity (BCVA) of at least one line or more as compared to pre-CXLBCVA. The topographical outcome was measured as decrease in maximum simulated keratometry values, astigmatism and spherical equivalent (SE) and an increase in central corneal thickness (CCT). K-max was defined as the steepest radius of curvature of the anterior corneal surface. SE was measured by subjective refraction, and K-max, astigmatism and CCTby scanning-slit corneal topography. Patients were followed-up 12 months post-treatment. RESULTS: At the end of follow-ups, mean BCVAshowed improvement of one line from LogMAR 0.58 ±0.067 to LogMAR 0.48 ±0.077. Seven (15.5%) eyes showed two lines of improvement while 3 (6.7%) eyes showed worsening of one line in BCVA. The mean K-max flattened by 0.7D. Mean astigmatism and SE decreased up to -0.5D and -0.4D, respectively. Mean preoperative CCTwas 454.31 ±36.34 µm, whereas mean postoperative CCTwas 456.47 ±35.60 µm with an average increase of 2.15 µm. No postoperative complications were reported. CONCLUSION: Based on topographical outcomes, accelerated TE-CXL is effective in preventing the progression of keratoconus without any safety concerns with improvement of vision in majority of cases.