Data: ‘Stiffen the bulge’

Orlando-Results from a prospective clinical trial show that corneal collagen crosslinking (CXL) is a promising modality for treatment of keratoconus (KC) and postLASIKectasia (PLE), said Peter S. Hersh, MD.

“The rationale for CXL to treat KC and PLE is based on the concept that these corneas are biomechanically weak, and so a treatment that strengthens the cornea may improve disease prognosis by making the cornea stiffer and hopefully preventing progression,” said Dr. Hersh, clinical professor of ophthalmology, University of Medicine and Dentistry, New Jersey–New Jersey Medical School, Newark. “And data from Theo Seiler, MD, PhD, and colleagues show conclusively that CXL increases corneal stiffness.”

The efficacy and safety of CXL are being investigated in a prospective, multicenter, randomized clinical trial that enrolled 205 eyes with KC and 175 eyes with PLE. After 1 year, eyes in the KC subgroup had significant improvement in Kmax (–1.6 D), while control eyes experienced corneal steepening. For the PLE group, the CXL eyes also had a decrease in Kmax (–0.7 D), while controls had a steepening.

A more in-depth analysis of 85 eyes treated at Dr. Hersh’s center, including 56 eyes with KC and 29 eyes with PLE, showed similar results, with an average overall improvement of 1.6 D in Kmax, but a less robust effect in eyes with PLE compared with eyes with KC. Almost one-third of eyes had Kmax flattening of more than 2 D, and best spectacle-corrected visual acuity (BSCVA) improved by an average of 1 Snellen line, with 22% of eyes gaining 2 or more lines. Three eyes lost 2 or more lines of BSCVA but without continued progression of keratectasia.

“We also gave patients questionnaires to explore subjective visual function, and the results showed that compared with preoperatively, they had significant improvements in night driving, glare, halo, starburst, difficulty reading, and foreign body sensation,” Dr. Hersh concluded.

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