Corneal Crosslinking With Riboflavin and UVA Light in Progressive Keratoconus: Fifteen-Year Results

• Published in: American journal of ophthalmology 2023-06, Vol.250, p.95-102
• Main Authors: Raiskup, Frederik, Herber, Robert, Lenk, Janine, Ramm, Lisa, Wittig, Dierk, Pillunat, Lutz E., Spoerl, Eberhard
• Format: Article
• Language: English
• Subjects: Adult; Collagen - therapeutic use; Corneal Topography; Cross-Linking Reagents - therapeutic use; Follow-Up Studies; Humans; Keratoconus - diagnosis; Keratoconus - drug therapy; Photochemotherapy - methods; Photosensitizing Agents - therapeutic use; Retrospective Studies; Riboflavin - therapeutic use; Ultraviolet Rays
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2023.01.022

To analyze the 15-year results of corneal crosslinking (CXL) in progressive keratoconus. Retrospective follow-up analysis of interventional study patients. This study included keratoconic eyes with progressive disease treated from 2001 to 2006 at the Department of Ophthalmology, Carl Gustav Carus University Hospital, TU Dresden, Germany. CXL was performed by applying riboflavin and ultraviolet A (UVA) light according to a standard protocol. The best-corrected distance visual acuity (BCVA), slitlamp examination, and corneal topography as well as corneal thickness values were recorded preoperatively and 15 years after the treatment. A total of 42 eyes received a complete follow-up of 15 years. The mean age of the patients at baseline was 26.9 (95% CI: 25.0-28.8) years. The maximum keratometry was 61.6 (95% CI: 58.2 - 64.9) diopters (D) preoperatively and 55.1 (95% CI: 51.6-58.4) D postoperatively; the decrease was statistically significant (P < .001). The mean keratometry value changed from 50.3 (95% CI: 48.3-52.4) D to 47.5 (95% CI: 45.3-49.4) D (P < 0.001). Furthermore, the thinnest corneal thickness decreased statistically significantly by 40 (95% CI: 24-56) µm (P < .001). The BCVA improved statistically significantly from 0.4 to 0.2 logMAR after the treatment. Retreatment was needed in 14% of cases. Mild scarring of the superficial stromal corneal layers was observed in 36% of the eyes, and in 67% of them visual acuity was stable or even improved. The CXL procedure proved to be an effective method in the treatment of keratoconic eyes in the progressive stage of the disease, and achieved long-term stabilization without the occurrence of serious complications or side effects.