Abstract
ABSTRACT
Background
Keratoconus is a progressive corneal ectatic disorder. Accelerated transepithelial corneal cross‐linking (ATE‐CXL) aims to halt progression while preserving the epithelium, but evidence on its 12‐month efficacy requires further evaluation.
Purpose
To evaluate the 12‐month topographic, visual, biomechanical, and safety outcomes of ATE‐CXL in eyes with progressive keratoconus.
Method
This prospective interventional study included 126 eyes from 63 patients with documented progressive keratoconus. Both eyes of each patient were included when the eligibility criteria were met. Progression before treatment was defined as at least one of the following during the preceding 12 months: an increase in maximum keratometry (Kmax) of ≥ 1.0 diopter (D), a decrease in minimum corneal thickness of > 10 μm, or a loss of more than two lines of corrected distance visual acuity (CDVA). All eyes underwent epithelium‐on ATE‐CXL using a two‐step transepithelial riboflavin protocol followed by pulsed ultraviolet‐A irradiation at 45 mW/cm
2
for 320 s, delivering 7.2 J/cm
2
. Outcomes included Kmax, flat keratometry (K1), steep keratometry (K2), uncorrected distance visual acuity (UDVA), CDVA, corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), progression, and adverse events. Outcomes were summarized descriptively using aggregate values.
Results
Kmax decreased from 52.3 ± 1.8 D at baseline to 49.7 ± 1.5 D at 12 months. CDVA improved from 0.35 ± 0.10 logMAR to 0.20 ± 0.08 logMAR, and UDVA improved by 30.9% from baseline. CH increased from 8.4 ± 1.0 mmHg to 9.1 ± 1.2 mmHg, and CRF increased from 8.0 ± 1.1 mmHg to 8.8 ± 1.3 mmHg. Disease progression, defined as Kmax increase ≥ 1.0 D at 12 months, occurred in 8 of 126 eyes (6.3%). Accordingly, 118 of 126 eyes (93.7%) remained stable by the prespecified Kmax criterion. No severe adverse events were documented.
Conclusion
ATE‐CXL was associated with 12‐month improvements in corneal topography, visual acuity, and ocular‐response‐analyzer biomechanical parameters in this prospective cohort of eyes with progressive keratoconus. These findings should be interpreted cautiously because the study lacked an epithelium‐off or untreated control group, had only 12 months of follow‐up, and included both eyes from each patient. Longer‐term controlled studies with paired‐eye‐adjusted statistical analysis are needed to confirm durability and comparative efficacy.