VISUAL IMPROVEMENTS AND CORNEAL STABILIZATION FOLLOWING CORNEAL CROSS-LINKING (CXL) IN PATIENTS WITH KERATOCONUS: AN OBSERVATIONAL PROSPECTIVE STUDY.
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Keywords
Keratoconus, Cross-linking, Visual acuity, Corneal topography
Abstract
Background: Corneal cross-linking (CXL) is a well-established treatment that halts the progression of keratoconus, a disease characterized by an irregular curvature and thinning of the cornea. The method strengthens corneal biomechanical rigidity through a photochemical interaction between riboflavin (vitamin B2) and UV-A light irradiation, thereby stabilizing the corneal structure. Although CXL is primarily used to halt disease progression, many patients also experience improvements in corneal curvature and visual acuity.
Objectives: to evaluate the 12-month visual and topographical outcomes in patients with keratoconus treated with corneal cross-linking, by measuring uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal topography, and maximum keratometry (K-max).
Study Design: An observational prospective study.
Place and Duration of study: Department of Ophthalmology, Gaju Khan Medical College, Sawabi. The study was carried out over one year, from January 2023 to January 2024.
Methods: In this prospective study, 100 patients diagnosed with progressive keratoconus were recruited to evaluate the outcomes of CXL. Postoperative parameters were analyzed at 1, 3, 6, and 12 months, including K-max, corneal topography, UDVA, and CDVA. Topography was performed using a standardized topography system. Quantitative data analysis was performed using paired t-tests, and a p-value <0.05 was considered statistically significant.
Results: There were 100 patients (62 men and 38 women), with a mean age of 24.6 ± 4.8 years. Both UDVA and CDVA improved significantly over the 12-month follow-up period. The mean K-max decreased from a preoperative value of 54.2 ± 3.1 D to 52.5 ± 3.0 D postoperatively (p = 0.002). Seventy-two percent of patients showed stabilization or improvement in both keratometric and visual parameters. There were no instances of keratoconus progression and no serious adverse effects.
Conclusion: Corneal cross-linking is successful in halting the progression of keratoconus and, for a significant number of patients, yields meaningful improvement in visual function. Corneal flattening and improved vision were observed in most subjects. The procedure demonstrated a favourable safety profile with no significant complications. The most favourable outcomes were seen in patients treated at an early stage of the disease. CXL remains a cornerstone in the management and visual rehabilitation of keratoconus, especially when used in the early phase.
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Muhammad Waseem
Associate Professor Ophthalmology Jinnah Medical College Peshawar
Syed Amir Hamza
Assistant Professor Ophthalmology Lady Reading Hospital Peshawar
Jehanzeb Khan
Associate professor Ophthalmology, Gajju Khan Medical College Swabi.
Muhammad Rafiq
Associate professor ophthalmology Rehman medical institute Peshawar
Maria Sultan
Assistant Professor Ophthalmology KMU Hospital and Research Centre Peshawar
Javed Rasul
Associate Professor, Department of Ophthalmology, Pak International Medical College Peshawar