Orjowan M Shalabi², Yousef Shanti*^1,2, Abd-Alfattah Arafat⁵, Reham H Shehada³, Basel M Shalabi², Alaa I Dweikat², Ibrahim Rabi², Ahmed Meri² and Jamal AS Qaddumi⁴

¹Department of Ophthalmology, An-Najah National University Hospital, Nablus, Palestine
²Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
³Department of Ophthalmology, The Islamic Hospital, Amman, Jordan
⁴Department of Nursing, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
⁵Al-noor Center of Ophthalmology, Al-Arabi Hospital, Nablus, Palestine

*Corresponding Author: Yousef Shanti, Department of Ophthalmology, An-Najah National University Hospital, Nablus, Palestine.

Received: October 17, 2021 ; Published: November 09, 2021

Abstract

Purpose: To compare the 36-month visual acuity, refraction, corneal topography, and corneal pachymetry outcomes of the conventional and accelerated corneal collagen crosslinking in progressive keratoconic eyes.

Methods: A prospective cohort study of 191 eyes of 76 patients. 91 eyes were treated with conventional crosslinking (C-CXL; 3mW/cm² for 30 minutes), while 100 eyes were treated with accelerated crosslinking (A-CXL; 30mW/cm² for 3 minutes). Preoperative and post-operative uncorrected (UCVA) and best corrected visual acuity (BCVA), spherical equivalent (SE), manifest refraction and corneal topography were evaluated and compared at different intervals of 3, 6, 12, 24 and 36 months.

Results: Both groups show significant improvement from baseline at final follow up in terms of uncorrected visual acuity. But the conventional method shows more improvement at final follow up (C-CXL; LogMAR 0.22, A-CXL; LogMAR 0.54, p = 0.03). There was no significant difference in terms of best corrected visual acuity. Both groups show insignificant improvement in spherical equivalent (SE) and cylinder. K1, K2 show comparable improvement in both groups, Kmean and Kmax show insignificant improvement from baseline in both groups. Central corneal thickness shows minimal change from baseline, with significant improvement by C-CXL (416.38 μm) over A-CXL (462.75 μm) (p = 0.028). No complications were detected in both groups.

Conclusion: Both conventional and accelerated CXL improved UCVA with more improvement at long-term follow up with the C-CXL. Entirely, C-CXL, as well as A-CXL, offers productive results in the strengthening of corneal tissue and disease stabilization.

Conclusion: The application of advanced analytic computer software engine allows for better planning of LASIK and provides an opportunity for a more efficient and safe protocol for management of patients. Reduction in overall diagnostics and the use of telemedicine also provided benefits to patients and similar outcomes, as compared to prior to the pandemic. No patients during the treatment period developed COVID-19 to our knowledge.

Keywords: Cross Linking; CXL; Keratoconus; Conventional; Accelerated; Visual; Topographic; Refractive Outcomes

References

1. Edwards M., et al. “The genetics of keratoconus”. Clinical and Experimental Ophthalmology6 (2001): 345-351.
2. Viswanathan D and Males J. “Prospective longitudinal study of corneal collagen cross-linking in progressive keratoconus”. Clinical and Experimental Ophthalmology6 (2013): 531-536.
3. Sorkin N and Varssano D. “Corneal collagen crosslinking: a systematic review”. Ophthalmologica 1 (2014): 10-27.
4. Hashemi H., et al. “The Prevalence and Risk Factors for Keratoconus: A Systematic Review and Meta-Analysis”. Cornea 2 (2020): 263-270.
5. Sarac O., et al. “Accelerated versus standard corneal collagen cross-linking in pediatric keratoconus patients: 24 months follow-up results”. Contact Lens and Anterior Eye : The Journal of the British Contact Lens Association5 (2018): 442-447.
6. Steinberg J and Linke SJ. “Screening for Keratoconus and Related Ectatic Corneal Disorders: A Response”. Cornea11 (2015): e34-35.
7. Konstantopoulos A and Mehta JS. “Conventional versus accelerated collagen cross-linking for keratoconus”. Eye Contact Lens2 (2015): 65-71.
8. McGhee CN., et al. “Contemporary Treatment Paradigms in Keratoconus”. Cornea 10 (2015): S16-23.
9. Shajari M., et al. “Comparison of standard and accelerated corneal cross-linking for the treatment of keratoconus: a meta-analysis”. Acta Ophthalmology1 (2019): e22-e35.
10. Wollensak G., et al. “Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus”. American Journal of Ophthalmology5 (2003): 620-627.
11. Woo JH., et al. “Conventional Versus Accelerated Collagen Cross-Linking for Keratoconus: A Comparison of Visual, Refractive, Topographic and Biomechanical Outcomes”. The Open Ophthalmology Journal 11 (2017): 262-72.
12. Hashemian H., et al. “Evaluation of corneal changes after conventional versus accelerated corneal cross-linking: a randomized controlled trial”. Journal of Refractive Surgery (Thorofare, NJ : 1995)12 (2014): 837-842.
13. Sherif AM. “Accelerated versus conventional corneal collagen cross-linking in the treatment of mild keratoconus: a comparative study”. Clinical Ophthalmology 8 (2014): 1435-1440.
14. Çınar Y., et al. “Accelerated corneal collagen cross-linking for progressive keratoconus”. Cutaneous and Ocular Toxicology2 (2014): 168-171.
15. Krumeich JH and Daniel J. “[Live epikeratophakia and deep lamellar keratoplasty for I-III stage-specific surgical treatment of keratoconus]”. Klinische Monatsblatter fur Augenheilkunde2 (1997): 94-100.
16. Chow VWS., et al. “One-year outcomes of conventional and accelerated collagen crosslinking in progressive keratoconus”. Scientific Reports 1 (2015): 14425.
17. Shetty R., et al. “Current Protocols of Corneal Collagen Cross-Linking: Visual, Refractive, and Tomographic Outcomes”. American Journal of Ophthalmology2 (2015): 243-249.
18. Sadoughi MM., et al. “Accelerated versus conventional corneal collagen cross-linking in patients with keratoconus: an intrapatient comparative study”. International Ophthalmology1 (2018): 67-74.

Citation

Citation: Yousef Shanti., et al. “A Comparative Study: 36 Months Follow up Results of Accelerated Versus Conventional Corneal Collagen Cross-linking in Progressive Keratoconus Patients".Acta Scientific Ophthalmology 4.12 (2021): 02-09.

Copyright

Copyright: © 2021 Yousef Shanti., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.