Effects of customized corneal cross-linking on higher-order aberrations in progressive keratoconus and low-grade myopia

IF 2.8 3区医学 Q1 OPHTHALMOLOGY Acta Ophthalmologica Pub Date : 2024-12-19 DOI:10.1111/aos.17432

Jad Hayek, Andreas Viberg, Sofie Elving, Anneli Fredriksson, Anders Behndig

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Abstract

Objective

To evaluate the effects of customized corneal collagen cross-linking (CXL) on higher-order aberrations (HOAs) in keratoconus (KC): vertical coma (VC), horizontal coma (HC), spherical aberration (SA), trefoil (TF) and astigmatism, compared with the same effects in healthy eyes undergoing CXL for low-grade myopia.

Methods

This mixed-designed study included 38 eyes of 38 patients with KC, treated and followed prospectively, who received customized epi-on CXL in high oxygen, and a retrospective control group of 23 eyes from 23 patients who underwent central 4-mm CXL treatment for low-grade myopia. VC, HC, SA, TF and keratometry values were obtained from Pentacam HR® measurements at baseline and at 1, 6, 12 and 24 months post-treatment. Statistical analyses included paired T-tests for changes over time and Pearson correlation tests to assess relationships between aberrations, best spectacle-corrected and low-contrast visual acuities (BSCVA and LCVA, respectively) and CXL parameters.

Results

Reduced HOAs and improved visual acuities were observed in KC. A 20% reduction in VC was observed at 24 months (from −1.82 ± 1.15 μm to −1.46 ± 1.01 μm; 95% CI: [0.155, 0.629], p = 0.002), while a 17% reduction in HC was observed at 12 months (from −0.35 ± 0.56 μm to −0.29 ± 0.62 μm; 95% CI: [0.003, 0.096], p = 0.037). A positive correlation was found between baseline VC and the level of improvement in VC at 24 months (R² = 0.200, p = 0.015). SA increased by 126% at 24 months (from −0.21 ± 0.62 μm to 0.054 ± 0.52 μm; 95% CI: [0.143, 0.347], p ≤ 0.001). TF and astigmatism did not alter from the treatment. In myopia, the natural positive SA increased by 57% post-treatment (from 0.14 ± 0.061 μm to 0.22 ± 0.076 μm at 24 months; 95% CI: [0.067, 0.098], p ≤ 0.001), while changes in VC and HC were minor and BSCVA remained stable.

Conclusion

Customized CXL effectively reduces HOAs in KC. For VC the improvement is larger in cases with higher preoperative VC, indicating that the concept of customization has its intended effect. Accordingly, SA and visual acuities improve in KC whereas CXL for low-grade myopia tends to increase corneal SA unfavourably.

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定制角膜交联对进行性圆锥角膜和低度近视高阶像差的影响。

目的：评价自定义角膜胶原交联（CXL）对圆锥角膜（KC）高阶像差（HOAs）：垂直昏迷（VC）、水平昏迷（HC）、球差（SA）、三叶草（TF）和散光的影响，并与健康眼接受CXL治疗低度数近视的效果进行比较。方法：本混合设计研究纳入38例KC患者的38只眼，接受高氧下定制epi-on CXL治疗和前瞻性随访，以及23例接受中心性4-mm CXL治疗的低度近视患者的23只眼作为回顾性对照组。在基线和治疗后1、6、12和24个月，通过Pentacam HR®测量获得VC、HC、SA、TF和角膜测量值。统计分析包括随时间变化的配对t检验和Pearson相关检验，以评估像差、最佳眼镜矫正视力和低对比度视力（分别为BSCVA和LCVA）和CXL参数之间的关系。结果：KC患者HOAs降低，视力改善，24个月时VC降低20%(从-1.82±1.15 μm降至-1.46±1.01 μm；95% CI: [0.155, 0.629], p = 0.002)，而在12个月时观察到HC降低17%(从-0.35±0.56 μm降至-0.29±0.62 μm；95% CI: [0.003, 0.096], p = 0.037)。基线VC与24个月时VC改善水平呈正相关（R2 = 0.200, p = 0.015）。24个月时SA增加126%(从-0.21±0.62 μm增加到0.054±0.52 μm；95% CI: [0.143, 0.347], p≤0.001)。TF和散光未因处理而改变。在近视组，治疗后自然SA阳性增加57%(24个月时从0.14±0.061 μm增加到0.22±0.076 μm；95% CI: [0.067, 0.098], p≤0.001)，而VC和HC变化较小，BSCVA保持稳定。结论：定制CXL可有效降低KC的hoa，术前VC越高，对VC的改善效果越大，说明定制概念达到了预期效果。因此，KC患者的角膜SA和视力得到改善，而低度数近视的CXL往往不利于角膜SA的增加。

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来源期刊

Acta Ophthalmologica 医学-眼科学

CiteScore

7.60

自引率

5.90%

发文量

433

审稿时长

6 months

期刊介绍： Acta Ophthalmologica is published on behalf of the Acta Ophthalmologica Scandinavica Foundation and is the official scientific publication of the following societies: The Danish Ophthalmological Society, The Finnish Ophthalmological Society, The Icelandic Ophthalmological Society, The Norwegian Ophthalmological Society and The Swedish Ophthalmological Society, and also the European Association for Vision and Eye Research (EVER). Acta Ophthalmologica publishes clinical and experimental original articles, reviews, editorials, educational photo essays (Diagnosis and Therapy in Ophthalmology), case reports and case series, letters to the editor and doctoral theses.