Stephanie Watson1,2, Mark Daniell3,4, Elsie Chan3,4, Yves Keardraon1,2, John Males1,2, Nigel Morlet5, Peter Beckingsale6, Richard Mills7, Chris Go1, Daniel Barthelmes8, Martina Knecht-Bosch9, Amparo Herrera-Bond1, Vuong Nguyen1, Amanda Dinh1, Courtney Weston1, Marco Garcia1, Mark Gillies1,2
Purpose: To report the 12 month outcomes of 169 eyes undergoing corneal cross-linking for keratoconus performed in routine clinical practice across Australia and New Zealand.
Methods: Index visit characteristics, such as visual acuity (VA, in Logarithm of the Minimal Angle of Resolution [logMAR] letters), maximum keratometry [Kmax], pachymetry, as well as treatment parameters (epithelial status, riboflavin type, UV duration), outcomes (VA, Kmax, pachymetry) and ocular adverse events were recorded in a prospectively designed electronic database. Index visit characteristics associated with the 12-month VA outcome were identified using mixed effects linear regression.
Results: Mean change in VA in the cohort after 12 months was +1.8 logMAR letters (95% confidence interval [CI]: -0.5, 4.1); Kmax +0.1 D (95% CI: -0.4, 0.6) and pachymetry -15.9 microns (95% CI: -23.2, -8.7). There was no significant difference in change in VA (p = 0.126) or Kmax (p = 0.649); a significant reduction in pachymetry was found at 12 months (p < 0.001). VA at the index visit was the strongest predictor for the 12-month VA outcomes (p < 0.001). Treatments were epithelial-off (n=169) with UV exposure that was accelerated (n= 113) or according to the Dresden protocol (n=51). Adverse events episodes occurred in 14 eyes and included clinically significant haze (n=21), microbial keratitis (n=1), persistent epithelial defect (n=2), scarring (n=6) and sterile infiltrates (n=2) from a total of 169 eyes within the first 12 months of follow-up.
Conclusions: Corneal cross-linking can stabilize visual acuity and corneal parameters when used in routine clinical practice.