ArticleInternational ophthalmology2025
Comparison of conventional corneal crosslinking with the accelerated procedure in progressive keratoconus.
Article in International ophthalmology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
purposeTo evaluate the long-term efficacy of corneal crosslinking using the standard protocol (S-CXL) and the accelerated protocol (A-CXL) over a period of 8 years.
methodsThis retrospective cohort study included 61 eyes from 61 patients with progressive keratoconus (KC). They were treated with either the S-CXL (3*30, N = 16) or the A-CXL (9*10, N = 45). Visual acuity and corneal parameters, including higher-order aberrations (HOAs), corneal tomography, and corneal densitometry, were recorded prior to the intervention and at four follow-up visits using Scheimpflug tomography. A linear mixed model with Bonferroni correction was used to analyze the longitudinal data.
resultsAnterior corneal curvature parameters were significantly reduced in both groups at 3 and 8 years (all p ≤ 0.019). Central and thinnest corneal thickness decreased significantly after 12 and 36 months (p < 0.001). Surface variance and vertical asymmetry indices remained unchanged postoperatively, despite the significant reduction at 8 years in the A-CXL group (p < 0.001). The greatest increase in corneal optical density was observed in both groups at 6 months in the anterior layer up to a diameter of 10 mm, which roughly normalized at 12 months. HOA coma was reduced in both groups at 36 and 96 months (all p ≤ 0.012). In contrast, only the S-CXL group showed a borderline significant improvement in visual acuity after 96 months (p = 0.049) which should be interpreted cautiously due to differences in sample size and baseline characteristics. The rate of postoperative complications was comparable in both protocols.
conclusionIn an 8-year long-term follow-up, both S-CXL and A-CXL successfully halted KC progression. Non-inferiority of the accelerated protocol was demonstrated.
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