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Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
2016 (English)In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, bjophthalmol-2016-309210Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: To assess the refractive improvements and the corneal endothelial safety of an individualised topography-guided regimen for corneal crosslinking in progressive keratoconus.

METHODS: An open-label prospective randomised clinical trial was performed at the Department of Clinical Sciences, Ophthalmology, Umeå University Hospital, Umeå, Sweden. Thirty-seven patients (50 eyes) with progressive keratoconus planned for corneal crosslinking were included. The patients were randomised to topography-guided crosslinking (photorefractive intrastromal crosslinking (PiXL); n=25) or uniform 9 mm crosslinking (corneal collagen crosslinking (CXL); n=25). Visual acuity, refraction, keratometry (K1, K2 and Kmax) and corneal endothelial morphometry were assessed preoperatively and at 1, 3, 6 and 12 months postoperatively. The PiXL treatment involved an asymmetrical treatment zone centred on the area of maximum corneal steepness with treatment energies ranging from 7.2 to 15.0 J/cm(2); the CXL treatment was a uniform 9 mm 5.4 J/cm(2) pulsed crosslinking. The main outcome measures were changes in refractive errors and corneal endothelial cell density.

RESULTS: The spherical refractive errors decreased (p<0.05) and the visual acuity improved (p<0.01) at 3, 6 and 12 months after PiXL, but not after CXL. The between-groups differences, however, were not significant. K2 and Kmax decreased at 3, 6 and 12 months after PiXL (p<0.01), but not after CXL (p<0.01 when comparing the two treatments). No corneal endothelial cell loss was seen after either treatment.

CONCLUSIONS: Individualised topography-based crosslinking treatment centred on the ectatic cone has the potential to improve the corneal shape in keratoconus with decreased spherical refractive errors and improved visual acuity, without damage to the corneal endothelium.

TRIAL REGISTRATION NUMBER: NCT02514200, Results.

Place, publisher, year, edition, pages
2016. bjophthalmol-2016-309210
Keyword [en]
Cornea, Degeneration, Optics and Refraction
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-134194DOI: 10.1136/bjophthalmol-2016-309210PubMedID: 27899371OAI: oai:DiVA.org:umu-134194DiVA: diva2:1091885
Available from: 2017-04-28 Created: 2017-04-28 Last updated: 2017-04-28

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CiteExportLink to record
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