Marked deep structural changes with an absence of keratocytes occurred when CXL was used with conventional or accelerated UVA irradiation; however, the changes were more pronounced with the use of conventional UVA irradiation. The use of methylcellulose-riboflavin might explain the deep alterations and raises a long-term safety concern.
Purpose To estimate the national prevalence and incidence of keratoconus in Norway. Methods In this epidemiologic study, data were obtained from the Norwegian Patient Registry, which provides information from all publicly funded specialist care in Norway. Prevalence of keratoconus was estimated from the total number of patients registered with this diagnosis and incidence from the annual frequency of first‐time registrations of patients up to 40 years of age in the period 2010–2018. Data on age and gender of the keratoconus patients were also gathered. Results A total of 9832 keratoconus patients were registered. The estimated prevalence in the general population was 192.1 per 100 000 (95% confidence interval (CI): 188.3–195.9), and the estimated annual incidence was 19.8 per 100 000 (95% CI: 18.1–21.5). There was a predominance of males (73%), and mean age for all patients was 37.5 years at first registration in this period. Conclusion This study reports the frequency of keratoconus from a national patient register during a time period with available modern diagnostic tools. The estimated prevalence and incidence were higher than most previous estimates and show that keratoconus is not a rare condition. As screening was not part of the study, the true prevalence in the general population may be even higher.
Purpose: To compare the clinical outcome 2 years after corneal collagen cross-linking (CXL) with conventional and accelerated ultraviolet A (UVA) irradiation using riboflavin with hydroxypropyl methylcellulose. Methods: Prospective randomized controlled study. Forty patients with keratoconus (40 eyes) were randomized to either CXL using conventional 3 mW/cm2 UVA irradiation for 30 minutes (CXL30 group) or accelerated 9 mW/cm2 UVA irradiation for 10 minutes (CXL10 group). In both groups, a solution of 0.1% riboflavin with 1.1% hydroxypropyl methylcellulose (methylcellulose–riboflavin) was used. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and Scheimpflug tomography were performed at baseline and after 24 months. Results: Both groups had statistically significant improvement in CDVA and maximum keratometric reading compared with baseline; however, with no statistically significant difference in the change between the 2 groups. No significant changes in flattest, steepest and mean keratometry (K1, K2 and K mean) were found in either of the groups. There were no statistically significant changes in ECD in either group after 2 years or in the difference in the change between the 2 groups. A literature review showed comparative clinical outcome after accelerated CXL compared with conventional CXL; however, in several studies, there was a tendency for less pronounced corneal flattening after accelerated CXL. Conclusions: Improvement in visual acuity and maximum keratometric reading 2 years after CXL was found after both conventional and accelerated UVA irradiation using methylcellulose–riboflavin. This suggests that when using riboflavin with methylcellulose, the less time-consuming accelerated protocol is a valuable and effective option in CXL treatment.
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