Accelerated corneal crosslinking with 20′-soaking hydroxypropyl methyl cellulose/riboflavin vs conventional crosslinking with 30′-soaking dextran/riboflavin

Abstract

Purpose: To evaluate and compare functional and structural outcomes of accelerated cross-linking (A-CXL) using riboflavin with hydroxypropyl methyl cellulose (HPMC) versus conventional cross-linking (C-CXL) using Riboflavin with Dextran. Setting: American University of Beirut Medical-Center, Lebanon Design: Retrospective Analysis Methods: Retrospective Analysis of 83 eyes of 73 patients with mild to moderate keratoconus. First group (n=44 eyes) underwent C-CXL using 30 minutes Riboflavin/Dextran soaking between June 2014 & March 2016. Second group (n=39 eyes) underwent A-CXL using 20 minutes Riboflavin/HPMC soaking, between April 2016& December 2017. Patients were evaluated preoperatively and at 1, 3 and 12 months postoperatively. Main outcome measures were simulated keratometry (SimK), maximum axial keratometry (Kmax), demarcation-line depth and haze intensity measured by an OCT-based image analysis software. Results: DL was 298.30±64.60 µm and 335.61±99.76 µm for C-CXL and A-CXL groups, respectively (p=0.04). Haze profile was similar for both groups. Mean SimK values were reduced from 46.93±3.50 and 46.44±2.93 preoperatively to 46.18±3.65 and 45.54±2.78 at 12 months postoperatively, for C-CXL and A-CXL, respectively (p=0.003 for both groups). Mean Kmax decreased from 52.46±4.82 and 51.50±3.87 preoperatively to 51.30±4.42 and 50.30 ± 3.52 postoperatively, for the C-CXL and A-CXL, respectively (p<0.001 for both groups). There was no difference in the SimK and Kmax changes between the C-CXL and A-CXL groups (p=0.814 and p=0.913), visual acuity, and refraction between the two groups (p> 0.05). Conclusion: A-CXL with 20 minutes Riboflavin/HPMC soaking produced deeper DL and similar corneal haze, topographic, refractive, and visual results to C-CXL with 30 minutes Riboflavin/Dextran soaking.