A Randomised Prospective Study Investigating The Efficacy Of Corneal Collagen Cross-Linkage In Halting Keratoconus Progression

1. Anish N Shah¹
2. David P S O'Brart¹
3. Elsie Chan¹
4. Parul Patel¹
5. Kostas Samaras¹

¹St Thomas' Hospital, London, United Kingdom

PURPOSE: A blind, randomised, prospective, bilateral study to investigate the efficacy of riboflavin/ultraviolet A corneal collagen cross-linkage (CXL) to halt the progression of keratoconus.

METHODS: 24 patients with early/moderate bilateral keratoconus with recent progression were recruited. One eye was randomly assigned to undergo CXL following epithelial removal with Riboflavin 0.1% and Ultraviolet A (370nm at 3mW/cm2). The other remained untreated as a control. Follow up was 18 months in 22 patients.

RESULTS: At 18 months Orbscan II 3mm-, 5mm- keratometry and simulated astigmatism and cone apex power and wave-front measurements (Keraton Scout), including root mean square (RMS), coma and pentafoil showed significant reductions from baseline in treated compared to untreated eyes (p=0.04). In treated eyes at 18 months, best spectacle corrected acuity improved (p=0.01) and Orbscan II simulated keratometry (p<0.001), 3mm keratometry (p=0.008), simulated astigmatism (p=0.007), cone apex power (p=0.002), RMS, coma, spherical aberration, secondary astigmatism and pentafoil (p=0.05) decreased from baseline. One treated eye experienced transient recurrent corneal erosions otherwise there were no complications attributable to the treatment.