Corneal crosslinking for the treatment of keratoconus: results in
the initial 50 cases
Pierre Fournié, Jean-Louis Arné, François Malecaze
Purpan Hospital, Toulouse, France
The authors acknowledge no financial interest
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Treatment Procedure
1. Topography: 1. Topography: progressive type of progressive type of keratoconuskeratoconus >1D in 6-12 >1D in 6-12 monthsmonths >2D in 12-24 >2D in 12-24 monthsmonths2. Pachymetry: 2. Pachymetry: Corneal thickness Corneal thickness > 400 > 400 mm
3. Partial 3. Partial epithelium epithelium removalremoval8-9 mm8-9 mm
4. Apply 4. Apply Riboflavin: 1 Riboflavin: 1 drop every drop every minute for 20 minute for 20 minmin
5. Slit lamp 5. Slit lamp inspection inspection (blue light)(blue light)““yellow flare”yellow flare”
6. UVA (370nm)6. UVA (370nm)3 mW/cm3 mW/cm22
1 drop of 1 drop of Riboflavin every Riboflavin every 2 min for 30 2 min for 30 minmin
Preoperative Data
Treated eye (CXL) Contralateral eye
number 53 eyes (of 53 patients)
age 24.74±7.92 (range 17 to 40)
6M follow-up 53
12M follow-up 36
24M follow-up 15
BSCVA (decimal) 0.53±0.25 (0.1 to 1) 0.79±0.27 (0.1 to 1)
Kmax (D) 53.42±5.4 (43.49 to 66.1)
48.76±5.1 (41.85 to 65.8)
Cylinder (D) 5.28±2.76 3.67±2.73
Pachymetry () 482±59 471±62
Maximum K values (Kmax)
46474849505152535455
preopn=53
M1n=53
M3n=53
M6n=53
M12n=36
M24n=15
diopters
CXLcontra
p<.05
PreopPreop Post CXL 1 yearPost CXL 1 year Differential mapDifferential map
6 months (n=53) 1 year (n=36)
"Stabilization" Kmax (±1D)
66% (n=35) 61.1% (n=22)
"Regression" Kmax (<1D)
24.5% (n=13) 30.5% (n=11)
"Progression" Kmax (>1D)
9.5% (n=5) 8.4% (n=3)
BSCVA (Decimal)
00,10,20,30,40,50,60,70,80,9
1
preopn=53
M1n=53
M3n=53
M6n=53
M12n=36
M24n=15
CXLcontra
p<.05
05
101520
2530
3540
-3 -2 -1 0 1 2 3 4
lines of visual acuity
% of eyes
34%
sta
bili
zati
on
41% improvement
++ ++
6 months
Cylinder
0
1
2
3
4
5
6
7
preopn=53
M1n=53
M3n=53
M6n=53
M12n=36
M24n=15
diopters
CXLcontra
Pachymetry
420
430
440
450
460
470
480
490
500
preopn=53
M1n=53
M3n=53
M6n=53
M12n=36
M24n=15
CXLcontra
Endothelial Cell Count
2200
2300
2400
2500
2600
2700
2800
2900
preopn=53
M1n=53
M3n=53
M6n=53
M12n=36
M24n=15
CXLcontra
Ocular Response Analyzer
0123456789
preopn=53
M1n=53
M3n=53
M6n=53
M12n=36
M24n=15
CRFCH
p>.05
Conclusions
• In vitro studies show that riboflavin and UVA significantly stiffen the anterior 200-300 m of the cornea
• In our series, Riboflavin/UVA collagen crosslinking appears to be an efficacious procedure in inhibiting the progression of irregular astigmatism due to keratoconus while– stabilizing (±1D in 61.1%) or reducing (at least 1D in 30.5%) the
corneal curvature– and increasing BSCVA (at least 1 line in 41% of eyes)
• ORA failed to demonstrate any statistically significant difference after CXL