New customized crosslinking approach shows promise in keratoconus treatment. Photo: Lily Arendt, OD. Click image to enlarge.

Upon evaluating the visual and tomographic results of customized crosslinking using excimer laser-assisted epithelium removal and topography-guided irradiation in the treatment of progressive keratoconus, researchers recently reported that one-year outcomes showed a significant improvement in visual acuity and stabilization of disease progression.

The prospective, non-randomized clinical trial enrolled 37 eyes of 32 patients with documented progressive keratoconus. Following de-epithelization with phototherapeutic keratectomy (PTK), customized UV irradiation was performed, designed as three concentric circular areas centered on the thinnest point. Energy exposure was 5.4J/cm² in the outer circle and then increased centripetally to 7.2 J/cm² and 10 J/cm². Corrected distance visual acuity (CDVA), refractive outcomes and Scheimpflug tomography were assessed at baseline and six and 12 months postoperatively.

Mean diameter for treated areas was 6.17mm, 4.45mm and 2.58mm for the outer, medium and inner circle, respectively. At the one-year follow-up, mean CDVA improved significantly from 0.38logMAR to 0.20logMAR, with 92% of eyes retaining or improving CDVA. Mean preoperative minimum pachymetry decreased from 449.26µm to 443.26µm. The maximal curvature (Kmax) decreased significantly from 58.50D to 57.05D. After one year, 92% of eyes showed no signs of progression.

“The possibility to have a treatment alternative that is also capable of simultaneously improving the patient’s vision provides us with a new therapeutic option and can help reduce the need for combined procedures for keratoconus,” the study authors wrote in their paper.

Gil JQ, Rosa AM, Costa AE, et al. Customized corneal crosslinking with excimer laser assisted epithelium removal for progressive keratoconus—one year results. J Cataract Refract Surg. February 13, 2023. [Epub ahead of print].