Improving keratoconus management with central corneal regularization and corneal collagen cross-linking protocol treatment
V. 173 N. 3 (2022), Research article
V. 173 N. 3 (2022)

Improving keratoconus management with central corneal regularization and corneal collagen cross-linking protocol treatment : doi: 10.7417/CT.2022.2431

Research article
Pubblicato 2022-05-26
R. Napolitano
Eye Clinic, Policlinico Umberto 1, “Sapienza” University of Rome, Italy
E. Tonti
Eye Clinic, Policlinico Umberto 1, “Sapienza” University of Rome, Italy
F. Cifariello
Casa Di Cura Villa Maria, Campobasso, Italy
N. Sabater-Cruz
Institut Clinic d’Oftalmologia, Barcelona, Spain
L. Spadea
Eye Clinic, Policlinico Umberto 1, “Sapienza” University of Rome, Italy
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Parole chiave

corneal crosslinking
excimer laser ablation
keratoconus
ribloflavin
central corneal regularization

Abstract

Purpose: To evaluate safety and efficacy of customized central corneal regularization (CCR), together with simultaneous accelerated corneal collagen cross-linking (A-CXL) – CCR-CXL protocol, to treat keratoconus-related corneal ectasia.
Design: Retrospective, comparative observational case series.
Methods: Patients that had undergone combined CCR-CXL protocol. Main inclusion criteria were keratoconus visual acuity deterioration and contact lens intolerance. All patients underwent complete ophthalmological evaluation, corrected distance visual acuity (CDVA) and Scheimpflug-corneal tomography. Central corneal regularization was performed by ablation using flying spot laser. Subsequently, the stroma was saturated with 0.17% riboflavin-5-phosphate added every 2 minutes, followed by A-CXL 9 mW/cm2 for 10 minutes. CDVA, medium keratometry value (Kmed), and total corneal morphological irregularity index (CMI) of patients were analyzed before surgery and after 1, 3 and 12 months. A P value of .05 or less was considered statistically significant.
Results: 46 eyes of 39 keratoconus patients were treated. At 1 month, the mean CDVA (LogMar) increased from 0.19 ± 0.02 to 0.12 ± 0.02 (P < .05), and the difference remained stable at month 12. Kmax decrease was statistically significant from 57.02 ± 5.65 to 50.21 ± 4.48 (P < .05). CMI decreased significantly from 47.8 ± 2.84 to 30.1 ± 2.4 (P < .01).
Conclusions: CCR-CXL protocol is safe and effective in arresting keratectasia progression and increasing corneal optic regularity in keratoconus. These findings showed a significant improvement in CDVA, keratometry values and corneal optical aberrations after being treated with the CCR-CXL protocol.

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