Long-Term Results With Cross-linking

The lack of standardization and randomized trials—and the relative lack of long-term results—makes it difficult to perform a proper meta-analysis of the outcomes of corneal collagen cross-linking (CXL), said Parag A. Majmudar, MD, at the Refractive Surgery Subspecialty Day on Friday. In assessing study results, “What are we looking for? Stability? Improvement? Contact lens tolerance? Need for retreatment?” he asked.

Despite those limitations, Dr. Majmudar offered an overview of some studies. In particular, he cited one published earlier this year, in which researchers reported 10-year results of CXL in 24 patients (34 eyes) with progressive keratoconus.¹ With mean follow-up of 131.9 ± 20.1 months, the maximum K, minimum K, and K value at the apex of the keratoconus were significantly reduced after treatment. In addition, mean astigmatism was reduced by 5.7 D before treatment to 4.0 D following CXL. However, 2 patients required repeat CXL, one after 5 years and the other after 10 years. No long-term endothelial cell deterioration was noted.

Overall, refractive surgeons may be seeing a reduced need for corneal grafts thanks to CXL, Dr. Majmudar said, although he also acknowledged that other advances, such as the availability of Intacs, may play a role in the lower incidence of grafts. And CXL decreases the lifetime treatment burden, with a concomitant reduction in their economic burden, he noted. “Above all, earlier treatment [of keratoconus] produces better results.”—Jean Shaw

¹ Raiskup F et al. J Cataract Refract Surg. 2015;41(1):41-46.

Financial disclosures. Dr. Majmudar—Alcon Laboratories: C; Allergan: C; Bausch + Lomb: C; CXL Ophthalmics: O; Rapid Pathogen Screening: O; Tear Science: C, S.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.