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Paolo Vinciguerra, MD; Elena Albè, MD; Silvia Trazza, BS; Theo Seiler, MD; Daniel Epstein, MD, PhD

Arch Ophthalmol. 2009;127(10):1258-1265.

Objectives  To report intraoperative and 24-month refractive, topographic, tomographic, and aberrometric outcomes after corneal collagen cross-linking in progressive advanced keratoconus.

Methods  Prospective, nonrandomized single-center clinical study involving 28 eyes. Main outcome measures included uncorrected and best spectacle-corrected visual acuities, sphere and cylinder refraction, topography, tomography, aberrometry, and endothelial cell count evaluated at baseline and follow-up at 1, 3, 6, 12, and 24 months after treatment. Topography was also recorded intraoperatively.

Results  Two years after treatment, mean baseline uncorrected and best spectacle-corrected visual acuities improved significantly (P = .048 and <.001, respectively) and mean spherical equivalent refraction decreased significantly (P = .03). Mean baseline flattest and steepest meridians on simulated keratometry, simulated keratometry average, mean average pupillary power, and apical keratometry all decreased significantly (P < .03). Deterioration of the Klyce indices was observed in the untreated contralateral eyes but not in treated eyes. Total corneal wavefront aberrations Z₀ (piston), Z₂ (defocus), and Z₇ (III coma) decreased significantly (P  .046). Mean 12-month baseline pupil center pachymetry and total corneal volume decreased significantly (P = .045). Endothelial cell counts did not change significantly (P = .13).

Conclusions  Two years postoperatively, corneal collagen cross-linking appears to be effective in improving uncorrected and best spectacle-corrected visual acuities in eyes with progressive keratoconus by significantly reducing corneal average pupillary power, apical keratometry, and total corneal wavefront aberrations.

Author Affiliations: Department of Ophthalmology, Istituto Clinico Humanitas, Milano, Italy (Drs Vinciguerra and Albè and Ms Trazza); and IROC (Institute for Refractive and Ophthalmic Surgery) (Dr Seiler) and Department of Ophthalmology, University Hospital Zurich (Dr Epstein), Zurich, Switzerland.

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