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266 - Evaluation de la sécurité et de l'efficacité du cross-linking (epi-off) du collagène cornéen pour le traitement du kératocône et des ectasies cornéens

To report the safety and efficacy of conventional epithelium-off corneal crosslinking (CXL) in the treatment of progressive keratoconus and corneal ectasia.

In this retrospective study, the medical charts of consecutive patients with progressive keratoconus or corneal ectasia, who underwent CXL at the Eye and Ear Hospital International, Naccache, Lebanon, from January 2008 to January 2016, were reviewed. Patients with adequate follow-up of 1 year or more were included. Best-corrected visual acuity (BCVA) expressed in logMAR, corneal clarity and topographic indices (flat-K, steep-K and K-max) were recorded preoperatively and at the last visit. Failure of treatment was based on the presence of an increase of 1.00 diopters (D) or more in k-max and/or an increase of more than 0.1 logMAR in BCVA.

156 eyes of 102 patients were enrolled. 6 eyes presented with corneal ectasia. Mean age was 23.85 ± 6.52 years and mean postoperative follow-up was 3.59 ± 2.34 years. At last follow-up, there was a significant decrease in average K-max (52.688 preoperatively and 51.723 postoperatively, p=0.001), flat-K (44.684 preoperatively and 43.989 postoperatively, p=0.001) and steep-K (47.880 preoperatively and 47.425 postoperatively, p=0.002).

Corneal CXL is efficient in stabilizing keratometry on the long run. In our cases, the mean BCVA significantly improved from 0.129 logMAR preoperatively to 0.107 logMAR postoperatively (p=0.033). Failure was noted in 47 cases (30.12%): 12.82% had drop in BCVA of 0.1 logMAR, 17.31% had an increase in K max of 1 D or more. Except for 2 cases of severe corneal haze (1.28%) and 3 cases of corneal scarring (1.92%), no other major complications were observed during follow up.

CXL is an effective and safe method in treating progressive corneal ectasia and keratoconus in term of long-term stabilization of keratometry values and BCVA. Our failure rate was based more on morphological rather than functional changes.