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Purpose <p>To evaluate the long-term efficacy of corneal crosslinking using the standard protocol (S-CXL) and the accelerated protocol (A-CXL) over a period of 8&#xa0;years.</p> Methods <p>This retrospective cohort study included 61 eyes from 61 patients with progressive keratoconus (KC). They were treated with either the S-CXL (3*30, N = 16) or the A-CXL (9*10, N = 45). Visual acuity and corneal parameters, including higher-order aberrations (HOAs), corneal tomography, and corneal densitometry, were recorded prior to the intervention and at four follow-up visits using Scheimpflug tomography. A linear mixed model with Bonferroni correction was used to analyze the longitudinal data.</p> Results <p>Anterior corneal curvature parameters were significantly reduced in both groups at 3 and 8&#xa0;years (all <i>p</i> ≤ 0.019). Central and thinnest corneal thickness decreased significantly after 12 and 36&#xa0;months (<i>p</i> &lt; 0.001). Surface variance and vertical asymmetry indices remained unchanged postoperatively, despite the significant reduction at 8&#xa0;years in the A-CXL group (<i>p</i> &lt; 0.001). The greatest increase in corneal optical density was observed in both groups at 6&#xa0;months in the anterior layer up to a diameter of 10&#xa0;mm, which roughly normalized at 12&#xa0;months. HOA coma was reduced in both groups at 36 and 96&#xa0;months (all <i>p</i> ≤ 0.012). In contrast, only the S-CXL group showed a borderline significant improvement in visual acuity after 96&#xa0;months (<i>p</i> = 0.049) which should be interpreted cautiously due to differences in sample size and baseline characteristics. The rate of postoperative complications was comparable in both protocols.</p> Conclusion <p>In an 8-year long-term follow-up, both S-CXL and A-CXL successfully halted KC progression. Non-inferiority of the accelerated protocol was demonstrated.</p>

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Comparison of conventional corneal crosslinking with the accelerated procedure in progressive keratoconus

  • 期刊论文

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  • 发表日期：

    2025年12月24日

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  • Lisa Ramm,
  • Dominik Thomas Trojan,
  • Dierk Wittig,
  • Frederik Raiskup,
  • Ramin Khoramnia,
  • Robert Herber

摘要

Purpose

To evaluate the long-term efficacy of corneal crosslinking using the standard protocol (S-CXL) and the accelerated protocol (A-CXL) over a period of 8 years.

Methods

This retrospective cohort study included 61 eyes from 61 patients with progressive keratoconus (KC). They were treated with either the S-CXL (3*30, N = 16) or the A-CXL (9*10, N = 45). Visual acuity and corneal parameters, including higher-order aberrations (HOAs), corneal tomography, and corneal densitometry, were recorded prior to the intervention and at four follow-up visits using Scheimpflug tomography. A linear mixed model with Bonferroni correction was used to analyze the longitudinal data.

Results

Anterior corneal curvature parameters were significantly reduced in both groups at 3 and 8 years (all p ≤ 0.019). Central and thinnest corneal thickness decreased significantly after 12 and 36 months (p < 0.001). Surface variance and vertical asymmetry indices remained unchanged postoperatively, despite the significant reduction at 8 years in the A-CXL group (p < 0.001). The greatest increase in corneal optical density was observed in both groups at 6 months in the anterior layer up to a diameter of 10 mm, which roughly normalized at 12 months. HOA coma was reduced in both groups at 36 and 96 months (all p ≤ 0.012). In contrast, only the S-CXL group showed a borderline significant improvement in visual acuity after 96 months (p = 0.049) which should be interpreted cautiously due to differences in sample size and baseline characteristics. The rate of postoperative complications was comparable in both protocols.

Conclusion

In an 8-year long-term follow-up, both S-CXL and A-CXL successfully halted KC progression. Non-inferiority of the accelerated protocol was demonstrated.