CXL in Patients With Keratoconus

Corneal collagen crosslinking (CXL) is the only FDA-approved treatment to halt the progression of keratoconus. But the procedure can produce variable outcomes. At the Cornea Subspecialty Day on Saturday, Vishal Jhanji, MD, presented tips for maximizing the effects of CXL on corneal topography.

Several factors predict CXL success. They include:

• Amount of corneal flattening: steep corneas tend to flatten more
• Keratometry (K) >54 D
• Age <40 years
• Central cone
• Severity: An original study suggested that crosslinking is likely to fail in patients with K values <58, but all subsequent studies have suggested otherwise.

What about accelerated CXL? Compared with the conventional Dresden protocol, accelerated CXL:

• Delivers the same amount of energy in less time
• May enhance patient comfort while decreasing postoperative corneal haze
• Offers similar safety
• Has a shallower demarcation line
• May have a lower efficacy according to laboratory studies, but Dr. Jhanji’s clinical experience has shown no difference

Should you leave the corneal epithelium intact? Compared with epi-off CXL, transepithelial CXL leads to:

• Reduced pain, faster visual recovery
• Lower risk of keratitis
• Different effects on collagen fibrils
• Reduced effect on corneal rigidity

As crosslinking protocols continue to be tweaked, the field will further maximize efficacy while maintaining patient comfort. —Anni Delfaro, PhD

Financial interests: Dr. Jhanji: None.

Read more news from AAO 2019 and the Subspecialty Day meetings.