Corneal crosslinking can safely and effectively stabilize keratoconus long-term

Even 15 years after the initial procedure, corneal crosslinking appears to safely stabilize the cornea without the need for retreatment in most patients with progressive keratoconus.

Study design

This was a long-term, retrospective study of eyes with progressive keratoconus that underwent corneal crosslinking according to the Dresden protocol between 2001 and 2006 at a single center. Forty-two of 47 eyes had 15-year follow-up and were included. Progression after initial treatment was defined as an increase in maximum keratometry of more than 1 D compared to the postoperative steady state at 2 subsequent follow-up visits.

Outcomes

At 15-year follow-up, there was a significant improvement compared to baseline in mean maximum keratometry (55.1 D vs 61.6 D, respectively), mean keratometry (47.5 D vs 50.3 D), and BCVA (difference –0.1 LogMAR); there were no significant changes in these parameters between year 10 and year 15. Retreatment was performed in 6 of 42 eyes (14%), with a mean retreatment time of 9 years. Mild scarring was present in 15 of 42 (36%) eyes, though for most of these eyes visual acuity was not adversely affected.

Limitations

Different devices were used to measure corneal topography and tomography pre- and postoperatively, which may have affected the magnitude of the keratometry changes. Additionally, the relatively large degree of corneal flattening observed in this study may be influenced by the greater proportion of eyes with severe keratoconus at presentation.

Clinical significance

Corneal crosslinking appears to be a safe and effective treatment for stabilizing progressive keratoconus over a 15-year period. However, for a small proportion of eyes, re-progression may occur even many years after initial treatment. Patients should, therefore, continue to be followed for the long term.

Financial Disclosures: Dr. Kevin Ma discloses no financial relationships.