Repeated CXL safe and effective for progressive keratoconus

Epithelial-off CXL can stabilize keratoconus, but the disease can continue to progress. (Image credit: Adobe Stock/mik_cz)

Israeli investigators reported that after the initial collagen crosslinking (CXL) for progressive keratoconus fails, the procedure can be repeated because it is safe and efficacious,¹ according to lead author Ofri Vorobichik Berar, MD, and colleagues from the Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.

Epithelial-off CXL can stabilize keratoconus, but the disease can continue to progress. Because the disease is vision-threatening, the investigators retrospectively reviewed the demographic, clinical, and surgical data from the cases of patients who required additional CXL.

The researchers identified 9 patients (10 eyes) with progressive keratoconus after an initial CXL procedure. The mean patient age when keratoconus was diagnosed was 20.2 years. The patients underwent a repeat CXL procedure and were followed for a mean of 2.1 years.

The data showed the mean best-corrected visual acuity remained stable during follow-up.

They reported that the mean baseline Kmax was 60.4 diopters (D). Before the second CXL procedure, the, Kmax had progressed significantly (P = 0.018) to 62.2 D; at the last follow-up, examination, the Kmax decreased significantly (P = 0.037) to 60.3 D. The mean baseline minimal pachymetry was 464.0 microns. Before the repeated CXL, the minimal pachymetry was significantly lower (P = 0.018), and after the repeated CXL procedure, the minimal pachymetry was stable (P = 0.2). No intraoperative or postoperative complications were noted.

The study concluded, “Repeated CXL is a safe and effective treatment option when failure of the initial CXL is diagnosed, even in young patients. This procedure may prevent visual deterioration and a potential need for keratoplasty.”

Reference

1. Vorobichik Berar O, Rotenberg M, Berger Y, et al. Safety and efficacy of repeated corneal collagen crosslinking in progressive keratoconus. Cornea. 2023;42:423-8; DOI: 10.1097/ICO.0000000000003165