An effective treatment for progressive keratoconus with two-year outcomes: accelerated epithelium-on corneal cross-linking

Abstract

Purpose: Corneal collagen cross-linking (CXL) is a surgical technique for progressive keratoconus. There are several technical modifications with varying clinical outcomes. This study aimed to evaluate the long-term outcomes of the accelerated epithelium-on CXL. Materials and methods: A retrospective study was performed on progressive keratoconus patients treated via the accelerated epithelium-on CXL who completed the 24th-month follow-up. We included 111 eyes of 77 patients. Clinical variables, including visual acuity, aberrometry, topographic measurements, and refractive outcomes, were evaluated at the postoperative 12th and 24th months. Results: There was a significant improvement in postoperative visual acuity in 50.4% of patients (p<0.001). Baiocchi Calossi Versaci total index and lower low-order aberration values determined at the 12th-month and 24th-month follow-up visits were significantly higher than the baseline values (p=0.044 and p=0.033). The depths of the anterior chapter and its aqueous part, the anterior chamber volume, front apical keratometry, and the mean power of the pupil were significantly lower in the 12th and 24th-month evaluations than the baseline values (p<0.05). For the 12th-month evaluation, significant increments in the central corneal thickness (p=0.043) and back apical keratometry (p=0.034) were detected than the baseline values. The horizontal anterior chamber diameter (p=0.005) and the keratoconus area (p=0.001) were significantly different in the 24th-month evaluation than in the preoperative period. Conclusion: The study findings indicated that accelerated epithelium-on CXL stabilized disease progression and significantly improved visual acuity. Therefore, accelerated epithelium-on CXL stands out as one of the better options among the modified CXL techniques to treat progressive keratoconus surgically.