Five‐year corneal cross‐linking outcomes: A Save Sight Keratoconus Registry Study

Ferdi, Alex; Kandel, Himal; Nguyen, Vuong; Tan, Jeremy; Arnalich‐Montiel, Francisco; Abbondanza, Marco; Watson, Stephanie

doi:10.1111/ceo.14177

Cited by 8 publications

(7 citation statements)

References 43 publications

(90 reference statements)

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“…project that tracks real-world treatment outcomes of keratoconus. [11][12][13][14] This study included patients from 24 sites in Australia, New Zealand, and Italy.…”

Section: Study Design and Settingmentioning

confidence: 99%

Comparative Efficacy and Safety of Standard Versus Accelerated Corneal Crosslinking for Keratoconus: 1-Year Outcomes From the Save Sight Keratoconus Registry Study

Kandel

Nguyen

Ferdi

et al. 2021

Cornea

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The aim of this study was to compare the efficacy and safety of standard [Ultraviolet (UV) light power: 3 mW/cm 2 , duration: 30 minutes] versus accelerated (UV power: 9 mW/cm 2 , duration: 10 minutes) corneal crosslinking (CXL) for stabilizing keratoconus.Methods: A total of 684 eyes (555 patients; mean age 6 SD, 25.0 6 7.9 years; women, 30.6%) from 24 international sites with epithelium-off CXL for keratoconus had follow-up data at 1-year and met the inclusion criteria. Two hundred sixty-six eyes (228 patients) had undergone standard CXL, and 418 eyes (327 patients) had undergone accelerated CXL. The outcome measures included changes in visual acuity, keratometry, minimum corneal thickness, and frequency of adverse events. The outcomes were compared using mixed-effects regression models adjusted for age, sex, visual acuity, keratometry, pachymetry, doctor, practice, and eye laterality. Results:The adjusted mean changes (95% confidence interval) in outcomes were similar in standard and accelerated CXL in visual acuity [6.5 (2.0, 11.1) versus 5.5 (0.4, 10.6) logMAR letters, respectively], Kmax [20.9 (21.4,20.3) D versus 21.2 (21.9, 20.4) D, respectively], K2 [20.4 (20.9, 0.2) D versus 20.4 (21.1, 0.3), D respectively], or minimum corneal thickness [213.3 (220.3, 26.3) mm versus 216.6 (224.5, 28.6) mm, respectively] (all P . 0.05). The frequency of adverse events at the 12-month visit was also similar between the CXL groups (standard, 8.3% vs. accelerated, 5.5%; P = 0.21). Conclusions:This real-world observational study found that both standard and accelerated CXL were similarly safe and effective in stabilizing keratoconus at 1-year postsurgery in the real-world setting. The findings support the adoption of accelerated CXL for time and convenience.

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“…project that tracks real-world treatment outcomes of keratoconus. [11][12][13][14] This study included patients from 24 sites in Australia, New Zealand, and Italy.…”

Section: Study Design and Settingmentioning

confidence: 99%

Comparative Efficacy and Safety of Standard Versus Accelerated Corneal Crosslinking for Keratoconus: 1-Year Outcomes From the Save Sight Keratoconus Registry Study

Kandel

Nguyen

Ferdi

et al. 2021

Cornea

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“…Cross-linking is an effective procedure for stabilizing corneal ectasia. 2,3 However, there is a risk of scarring and haze in a small population of patients, which increases its risk in this particular subgroup. Treating clinically significant haze remains a challenge for physicians as there is a lack of noninvasive treatment options.…”

Section: Discussionmentioning

confidence: 99%

“…1 Epithelium-off corneal cross-linking (CXL) is the gold standard treatment to halt the progression of keratoconus through biomechanical stabilization of the cornea. 2,3 Clinically significant haze is a potential complication of CXL and occurs in 8.6% to 15.1% of patients who undergo CXL for progressive keratoconus. 2,4 This clinically significant haze differs from the mild transient haze associated with the normal healing process of CXL.…”

mentioning

confidence: 99%

Topical Losartan for Treating Corneal Haze After Ultraviolet-A/Riboflavin Collagen Cross-Linking

Rodgers,

Al-Mohtaseb,

Chen

2024

Cornea

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Purpose: The purpose of this study was to report our first clinical experience using topical losartan for the treatment of severe corneal haze after epithelium-off corneal cross-linking (CXL). Methods: A 20-year-old man presented with clinically significant corneal haze in the right eye 1 month following Ultraviolet-A/Riboflavin Epithelium-off Collagen CXL. Haze progressed to a deep stromal scar, and vision was 20/150 with no improvement on refraction, 60 days after CXL. After unsuccessful treatment with topical corticosteroids, the patient elected to start off-label treatment with topical losartan 0.8 mg/mL, administered 6 times per day. Results: After 3 months of initiating topical losartan, the right eye vision improved to preoperative vision of 20/40-1. Corneal haze was significantly reduced as observed on slitlamp examination and on Scheimpflug corneal tomography (Pentacam; OCULUS, Inc. Arlington, WA). Conclusions: Topical losartan, a transforming growth factor-β inhibitor, is a potential treatment in clinically significant corneal haze following epithelium-off corneal CXL. This clinical experience highlights the potential efficacy of topical losartan as a novel therapeutic option in such cases, but further clinical studies are needed.

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“…It has been demonstrated that outcomes can continue to change over time in CXL such that future studies should include medium to long-term outcomes. Recently, the five-year CXL outcomes were published from the Save Sight Keratoconus Registry which showed CXL was effective in stabilizing keratoconus up to 5 years in most patients [ 60 ]. This systematic review and meta-analysis were limited by the quality of the studies included, heterogeneity, biases, small sample size, and short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Epithelium-on versus epithelium-off corneal collagen crosslinking for keratoconus: a systematic review and meta-analysis

Borchert,

Kandel,

Watson

2023

Graefes Arch Clin Exp Ophthalmol

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Purpose Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to compare the efficacy and safety of epithelium-on versus epithelium-off CXL to treat keratoconus. Methods We searched PubMed, Medline, Embase, Web of Science, and Scopus databases. We included studies that compared standard epithelium-off with epithelium-on CXL. The primary outcome measures were changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax), and the secondary outcomes were uncorrected distance visual acuity (UDVA), central corneal thickness (CCT), and adverse events. A meta-analysis was performed on the primary and secondary outcomes based on the weighted mean differences between baseline to 12-month follow-up. Results The search retrieved 887 publications with 27 included in the systematic review. A total of 1622 eyes (1399 patients; age 25.51 ± 4.02 years) were included in comparisons of epithelium-off to epithelium-on CXL in keratoconus. Epithelium-off CXL treated 800 eyes and epithelium-on CXL for 822 eyes. At 12-month follow-up, CDVA and Kmax showed no significant difference between the epithelium-off and epithelium-on CXL. The secondary outcomes showed that UDVA was better in epithelium-off CXL (− 0.11D, 95% CI − 0.12, − 0.1; p < 0.001) and there was more thinning in CCT in epithelium-off CXL (− 3.23 μm, 95% CI − 4.64, − 1.81; p <0.001). Conclusion Epithelium-off and epithelium-on CXL were both effective to treat progressive keratoconus. Further research is needed to compare the long-term outcomes and safety of both CXL protocols for adaptation into clinical practice.

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Five‐year corneal cross‐linking outcomes: A Save Sight Keratoconus Registry Study

Cited by 8 publications

References 43 publications

Comparative Efficacy and Safety of Standard Versus Accelerated Corneal Crosslinking for Keratoconus: 1-Year Outcomes From the Save Sight Keratoconus Registry Study

Comparative Efficacy and Safety of Standard Versus Accelerated Corneal Crosslinking for Keratoconus: 1-Year Outcomes From the Save Sight Keratoconus Registry Study

Topical Losartan for Treating Corneal Haze After Ultraviolet-A/Riboflavin Collagen Cross-Linking

Epithelium-on versus epithelium-off corneal collagen crosslinking for keratoconus: a systematic review and meta-analysis

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