A recent study found that corneal crosslinking (CXL) is able to stop keratoconus progression in the majority of young patients. Rigid contact lenses can help affected eyes, but more advanced disease may devolve into opacification requiring a transplant. CXL, on the other hand, strengthens the cornea by increasing the biomechanical rigidity.

The study aimed to examine the efficacy and safety of CXL for stabilizing progressive keratoconus in young patients. The observer-masked, randomized, controlled, parallel group superiority trial included one eye of each of the 60 patients, who were 10 to 16 years old. Patients were randomized to receive CXL + standard care (n=30) or standard care alone (n=30), with spectacle or contact lens correction as necessary. Keratoconus progression was defined as 1.50D increase in K2.

The researchers analyzed 30 patients in the CXL group and 28 patients in the standard care group. They found the mean K2 in the study eye at 18 months was 49.70D in the CXL group and 53.40D in the standard care groups. The adjusted mean difference significantly favored CXL, with a K2 of -3.00D.

Eyes that received CXL achieved better uncorrected and corrected vision than standard care at 18 months. Differences between the two groups were significant, at -0.31logMAR and -0.30logMAR, respectively.

The researchers reported keratoconus progressions in two patients (7%) in the CXL group and in 12 patients (43%) in the standard care group. Based on the adjusted odds ratio, the researchers found that patients in the CXL group had a 90% lower chance of progression than in the standard care group. They reported that quality of life outcomes were similar.

 “On average at 18 months post-randomization, patients receiving CXL in the study eye had corneal power in the steepest meridian 3.00D lower than those receiving standard care, a statistically significant difference,” they wrote. “We found no adverse events associated with CXL, suggesting that this is a relatively safe intervention.

“These data suggest that CXL should be considered as a first-line treatment in progressive disease,” the researchers concluded. “If the arrest of keratoconus progression induced by CXL is sustained in longer follow-up, there may be particular benefit in avoiding a later requirement for contact lens wear or corneal transplant.”

Larkin DFP, Chowdhury K, Burr JM, et al. Effect of corneal cross-linking vs. standard care on keratoconus progression in young patients: The Keralink randomized controlled trial. Ophthalmology. April 20, 2021. [Epub ahead of print].