Visual outcome after corneal crosslinking in patients with progressive keratoconus at the royal medical services of Jordan

Abstract EN

Objectives: This study was designed to retrospectively evaluate the visual and topographic outcome after corneal crosslinking in patients with progressive keratoconus at the Royal Medical Services of Jordan.

Methods: The study is a retrospective, non-controlled, non-comparative study that was conducted in the LASIK and Refractive Surgery center at King Hussein military hospital, Royal Medical Services of Jordan between November 2015 and February 2018.

All patients with progressive keratoconus who underwent corneal crosslinking (CXL) during that period were enrolled.

Progression of keratoconus was defined as a recent change in the mean keratometry (Km) and/or manifest refraction during the last six months.

An increase of 1.00 diopter (D) in the mean keratometry and/or an increase in manifest refraction (0.5 D spherical equivalent) were considered as a progression.

Km value and corneal thickness were measured topographically by using pentacam.

The extracted data included: age, gender, preoperative unaided vision, preoperative manifest refraction, type of crosslinking (epithelium off-iso CXL, epithelium on- Trans CXL), unaided vision 1 and 6 months after CXL, best corrected visual acuity preoperatively and six months after CXL, manifest refraction six months after CXL, mean keratometry (Km) pre operatively and six months post operatively, corneal thickness before cxl and six months after cxl, anterior and posterior segment examination, associated ocular diseases , complications, and follow up period.

Patients with incomplete data or patients who had other types of keratectasia were excluded.

Results: During 28 months, a total of 46 patients were enrolled in the study, of whom 85 eyes underwent corneal crosslinking (39 patients had both eyes cross-linked, 7 patients had one eye cross-linked).

Twenty-four (52.17%) patients were females and 22(47.83%) patients were males with a male: female ratio of (1: 1.01).

The average age of females at time of surgery was (21.83± 4.32, range from 12 - 28) years which was close to males’ average age (21.95±5.83, range from 12 - 31) years.

The mean follow-up period was 6 months.

Seventy (82.35%) eyes underwent standard corneal crosslinking (iso- CXL), while 15(17.65%) eyes underwent trans- epithelium corneal crosslinking.

At 6 months after iso crosslinking, unaided visual acuity improved one Snellen line or more in 47(67.14%) eyes, and best corrected visual acuity improved one snellen line or more in 48(68.57%) eyes.

Six months after Trans Cxl, unaided visual acuity improved one Snellen line or more in 8(53.3%) eyes, and best corrected visual acuity, improved one snellen line or more in 9(60%) eyes.

Km value showed regression in 55 (78.57%) eyes six months after Iso Cxl and in 11 (73.33%) eyes six months after Trans CXL, none showed progression.

Conclusion: Crosslinking can improve unaided vision and best corrected visual acuity, arrest and even reverse progression of keratoconus in the studied population.