Investigation of the safety and effectiveness of accelerated contact lens-assisted corneal cross-linking (A-CACXL) in thin corneas

Abstract

Purpose To determine the safety and effectiveness of accelerated contact lens-assisted corneal crosslinking (A-CACXL) as an alternative method in progressive keratoconus patients with thin corneas. Methods In our retrospective study, 31 eyes from 25 patients with progressive keratoconus that with a minimum corneal thickness of 400 µm or less after epithelial debridement underwent A-CACXL with a follow-up 6 months or more were included. The main outcome measures were uncorrected distance(UDVA) and corrected distance(CDVA) visual acuities, manifest sphere(D) and manifest cylinder(D) refraction values, K1(D), K2(D), Kmax(D), mean keratometry(D) values, minimum corneal thickness(μm) and endothelial cell count(cells/mm2). These outcome measurements were statistically analyzed at preoperative and postoperative 1 month, 3 months, and 6 months follow-ups. Results 31 eyes from 25 patients with the mean follow-up period of 7.7 ± 2.7 months were included. Data revealed a significant increase in CDVA(p = 0.053). There is no statistically significant change in UDVA, K1, mean keratometry, mean manifest sphere value, minimum corneal thickness and endothelial cell count .(respectively p:0.053, p: 0.333, p: 0,129, p:0.490, p: 0,467, p:0.035, p:0.102). There is a statistically significant decrease in the K2, Kmax and mean manifest cylinder values.(respectively p: 0,030, p < 0,001, p < 0,001). Conclusion A-CACXL method is a safe and effective method to stop keratoconic progression and improve functional vision in patients with thin corneas. However, larger randomised controlled studies are needed to validate these findings.