Correlation between corneal stromal demarcation line depth and topographic outcomes after two pulsed-light-accelerated crosslinking protocols.

PURPOSE

To report the visual and topographic outcomes of two pulsed-light-accelerated CXL (A-CXL) protocols at a 12-month follow-up and their correlation with the corneal stromal demarcation line (DL) depth.

PATIENTS AND METHODS

Retrospective comparative cohort of patients with documented progressive keratoconus were included. Two epi-off pulsed-light [1s on-1s off] A-CXL protocols were compared: irradiance 308 and 455:20 (fluence 7.2 J/cm). UDVA, CDVA, spherical equivalent (SE), topographic astigmatism, K, K, K, central corneal thickness (CCT), thinnest pachymetry (TCT) and endothelial cell density (ECD) were measured preoperatively and months 1, 3, 6 and 12 postoperative. Corneal DL was measured 1 month postoperatively using anterior segment optical coherence tomography.

RESULTS

Fifty eyes (27 patients): 22 eyes in group A-CXL (308), 28 eyes in group A-CXL (455:20). Mean age (years) was 19.04±4.71 and 20.32±4.57. DL depth (µm) at month 1 was 200.63±10.01 µm and 184.53±19.68 µm for group A-CXL (308) and group A-CXL (455:20), respectively (<0.001). Significant improvement in CDVA, topographic astigmatism, K, K and K was observed in both groups (no significant difference between groups) and no significant changes were observed in CCT, TCT and ECD with regard to baseline. Over 85% of the eyes in both protocols achieved stabilization or improvement in maximum K at the end of the follow-up. No significant correlations between DL and any visual or topographic outcomes were observed at 12 months.

CONCLUSION

No correlation between DL depth and visual or topographic outcomes was observed on either protocol. Although significant improvement on CDVA, topographic astigmatism, K, K and K was observed in both groups at 12 months, further research is needed to assure safety and effectiveness at stabilizing keratoconus progression.