Biomechanical Changes Following Corneal Crosslinking in Keratoconus Patients.
Graefe's archive for clinical and experimental ophthalmology(2024)
摘要
To evaluate the biomechanical and tomographic outcomes of keratoconus patients up to four years after corneal crosslinking (CXL). In this longitudinal retrospective-prospective single-center case series, the preoperative tomographic and biomechanical results from 200 keratoconus eyes of 161 patients undergoing CXL were compared to follow-up examinations at three-months, six-months, one-year, two-years, three-years, and four-years after CXL. Primary outcomes included the Corvis Biomechanical Factor (CBiF) and five biomechanical response parameters obtained from the Corvis ST. Tomographically, the Belin-Ambrósio deviation index (BAD-D) and the maximal keratometry (Kmax) measured by the Pentacam were analyzed. Additionally, Corvis E-staging, the thinnest corneal thickness (TCT), and the best-corrected visual acuity (BCVA) were obtained. Primary outcomes were compared using a paired t-test. The CBiF decreased significantly at the six-month (p < 0.001) and one-year (p < 0.001) follow-ups when compared to preoperative values. E-staging behaved accordingly to the CBiF. Within the two- to four-year follow-ups, the biomechanical outcomes showed no significant differences when compared to preoperative. Tomographically, the BAD-D increased significantly during the first year after CXL with a maximum at six-months (p < 0.001), while Kmax decreased significantly (p < 0.001) and continuously up to four years after CXL. The TCT was lower at all postoperative follow-up visits compared to preoperative, and the BCVA improved. In the first year after CXL, there was a temporary progression in both the biomechanical CBiF and E-staging, as well as in the tomographic analysis. CXL contributes to the stabilization of both the tomographic and biomechanical properties of the cornea up to four years postoperatively. What is known: • While corneal crosslinking (CXL) is an effective procedure for halting disease progression in keratoconus patients, biomechanical in vivo measurements following CXL have shown conflicting results. What is new: • Biomechanical and tomographic severity indices CBiF, E-staging, and BAD-D show a temporary worsening within the first year after CXL. • Post-CXL biomechanical stabilization can be observed up to four years postoperatively when analyzing the corneal response parameters and severity indices. • Due to corneal thinning following standard protocol CXL, thickness-dependent parameters may not be optimal for the biomechanical and tomographic evaluation after CXL.
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关键词
Keratoconus,Cornea,Biomechanical analysis,Crosslinking,Corvis ST
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