Accelerated 15 mW pulsed-light crosslinking to treat progressive keratoconus: two-year clinical results

Purpose: To assess the clinical and microstructural results of accelerated 15 mW pulsed-light corneal crosslinking (CXL) to treat progressive keratoconus. Setting: Siena Crosslinking Center, Siena, Italy. Design: Prospective case series. Methods: After epithelium removal (with Epi-Clear) and 10 minutes stromal soaking with riboflavin 0.1% hydroxypropyl methylcellulose solution, all eyes had 15 mW/cm(2) pulsed light epithelium-off accelerated CXL for 6 minutes of ultraviolet-A (UVA) irradiation (1 second on/1 second off), maintaining a total UVA exposure of 12 minutes at a fluence of 5.4 J/cm(2). The 2-year follow-up examination included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, Scheimpflug tomography, in vivo confocal microscopy (IVCM), and spectral domain optical coherence tomography (SD-OCT). Results: The study comprised 132 eyes of 96 patients (mean age 23.7 years +/- 4.3 [SD]) with stage II keratoconus. The change in UDVA and CDVA was statistically significant, from 0.51 +/- 0.106 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.309 +/- 0.074 logMAR (P = .0001) and 0.271 +/- 0.144 logMAR at baseline to 0.135 +/- 0.100 logMAR (P = .0023), respectively. Coma values measured by Scheimpflug analysis showed a statistically significant improvement beginning with the first postoperative month (P = .0004). The IVCM scans documented basal epithelial healing occurring 72 hours after treatment associated with the presence of subepithelial nerves. The SD-OCT scans performed in the central 6.0 mm of corneal diameter documented a demarcation line at a mean depth of 280 32 gm. Conclusion: The 15 mW/cm(2) pulsed-light epithelium-off accelerated CXL was effective and safe, stabilizing keratoconus progression through 2 years of follow-up. (c) 2017 ASCRS and ESCRS