Comparison of accelerated collagen cross linking & conventional collagen cross linking in management of keratoconus: An interventional study
Abstract
Keratoconus is a disease of corneal and is a growing disease in the young population of today and in recent years many new modalities of treatment have come up to try and stop its progression in the early stages. Corneal collagen cross linking (CXL) is one of those modality. there are two type of CXL surgeries one is conventional other one is accelerated one. This intervention study was conducted on 40 patients and 60 eyes compare the outcome of conventional CXL (30 eyes) and accelerated CXL(30 eyes) in treatment of Keratoconus. It was found that there was no significant difference in change in various parameters like Log MAR best corrected visual acuity (BCVA) on Snellen’s Chart, Spherical Equivalent (SEQ), Kmax (D) and Central Corneal Thickness (CCT) after 3 months as well as after 6 months in both the type of modalities. It was conclude from this study that accelerated CXL shows comparable results with conventional CXL in arresting the progression of mild KC, but long-term follow-up evaluation is warranted to delineate any difference in the clinical and topographical effect between the conventional and accelerated protocols.
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Introduction
Keratoconus (KC) is a common ectasia of the cornea [1,2]. Keratoconus is a progressive asymmetrical, bilateral, non-inflammatory corneal ectasia which is characterized by corneal thinning and irregular astigmatism. It is aggravated by puberty, pregnancy, vernal kerato-conjunctivitis and lid rubbing. It occurs due to enzyme imbalance, stromal keratocyte apoptosis. Its reported incidence ranges between 50-230 per 100,000 and the estimated prevalence is 54.5:100,000. 1,2 In India incidence is 2300 per 100,000(0.0003-2.3%). 3
Keratoconus(from Greek: kerato-horn, cornea; konos-cone) is a growing disease in the young population of today and in recent years many new modalities of treatment have come up to try and stop its progression in the early stages.Natural progression of the disease usually led to vision threatening complications like hydrops, severe corneal thinning with astigmatism. Surgical intervention was the usual end stage of the progression. The results of keratoplasty, though good, but requires lifelong follow-up and management of rejection. Post keratoplasty astigmatism is also a leading cause of visual morbidity. Hence a technique for halting the progression of thinning and ectasia was investigated. One such modality is collagen cross linking with riboflavin and UV-A.
Corneal collagen cross linking is a procedure to strengthen the cornea by formation of inters and intrafibrilar covalent bond in collagen fibers of corneal stroma with the help of photo-sensitizer Riboflavin and UVA rays.C3R was developed in 1998 by Theo Seiler. 4,5
Conclusion
It can be concluded from this present study that accelerated CXL shows comparable results with conventional CXL in arresting the progression of mild KC, but long-term follow-up evaluation is warranted to delineate any difference in the clinical and topographical effect between the conventional and accelerated protocols.