ISSN : 2146-3123
E-ISSN : 2146-3131

Comparison of Two Different Accelerated Corneal Cross-linking Procedures Outcomes in Patients with Keratoconus
Kemal Özülken1, Gözde Aksoy Aydemir2, Emre Aydemir2, Hasan Kızıltoprak3, Erdem Yüksel4
1Department of Ophthalmology, TOBB ETU School of Medicine, Ankara, Turkey
2Clinic of Ophthalmology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
3Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
4Department of Ophthalmology, Kastamonu University School of Medicine, Kastamanonu, Turkey
DOI : 10.4274/balkanmedj.galenos.2019.8.45

Background: Corneal Cross-linking (CXL) treatment is the unique treatment method that can cease the progression of keratoconus disease. Due to the long duration of conventional treatment, accelerated crosslinking treatment methods are being developed.
Aims: To compare two different accelerated CXL protocols in terms of postoperative visual acuity and topographic findings (Higher-order aberrations and keratometry values).
Study Design: Retrospective comparative study
Methods: Sixty-five eyes of 43 patients (30 males, 13 females) who underwent 2 different accelerated CXL protocols (10 minutes, 9 mW / cm2 or 5 minutes, 18 mW / cm2) for progressive keratoconus were retrospectively analyzed. Patients were divided into two groups as group 1 (10 min, 9 mW / cm2, 32 eyes of 21 patients) and group 2 (5 min, 18 mW / cm2, 33 eyes of 22 patients) according to the accelerated CXL treatment protocol. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) values and topographic findings (central corneal thickness, flat and steep keratometry values) were recorded preoperatively and 6 months after CXL treatment. Higher-order aberration values measured with pentacam preoperatively and 6 months after CXL were also recorded.
Results: In both groups, a significant improvement was detected in UCVA and BCVA levels between the preoperative and postoperative sixth month (Group 1; p=0.001, p=0.001 and Group 2; p=0.001, p=0.001 respectively). In addition, central corneal thickness (CCT) values decreased significantly in both groups (p=0.006, p=0.001). Trefoil values showed no significant difference between preoperative and postoperative 6th month in group 1 (p = 0.160 and p = 0.620, respectively). In group 1 and group 2, coma values were found to decrease significantly in the sixth postoperative month compared to preoperative values (p = 0.001, p = 0.020 respectively). There was no significant difference between preoperative and postoperative 6th month horizontal and vertical trefoil values in both groups. (p = 0.850 and p = 0.140, respectively). There was no significant difference between the two groups in terms of preoperative and postoperative 6th month Higher-order aberrations (HOAs), refractive errors, keratometry values, UCVA and BCVA levels.
Conclusion: Both accelerated CXL procedures were found to be able to stop the progression of keratoconus, provide a significant improvement in topography findings and coma values, and lead to an increase in visual acuity.

Keywords : Accelarated Cross-linking; Corneal Cross-linking, CXL, Coma, Keratoconus, Higher order aberations
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