Evaluating the safety and effectiveness of the sub-400 corneal cross-linking protocol: initial clinical and morphological findings
International Ophthalmology, cilt.45, sa.1, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 45 Sayı: 1
- Basım Tarihi: 2025
- Doi Numarası: 10.1007/s10792-024-03371-8
- Dergi Adı: International Ophthalmology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE
- Anahtar Kelimeler: The Sub-400 protocol, Keratoconus, Ultrathin corneas, Corneal collagen crosslinking
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Purpose: To assess the safety and the efficacy of the “Sub-400 corneal cross-linking (CXL) protocol” for progressive keratoconus (KC) in ultrathin corneas. Methods: The study included thirty four patients with progressive KC, who underwent CXL using the “Sub-400” protocol due to intraoperative thinnest corneal pachymetry ranging from 295 to 398 μm after epithelial removal. After the epithelium was removed, the following ultraviolet A irradiation was applied at a fluence of 3 mW/cm2 and the duration was adjusted based on the specific corneal stromal thickness. In addition to slit-lamp microscopy and visual acuity assessment, our evaluation included measurements of the maximal anterior keratometry value (Kmax), mean anterior and posterior K values (Kmean), thinnest corneal thickness (TCT), central corneal thickness, intraoperative pachymetry, and corneal endothelial cell density (ECD) preoperatively and 1 year postoperatively. Stromal demarcation line depth (DL) was measured in the first postoperative month. Results: At the first year postoperative follow-up visit, 88% (30 eyes) exhibited tomographic stability, with average values of change in Kmax (ΔKmax) 0.61 ± 6.45 D after CXL. None of the eyes showed signs of endothelial decompensation. The mean DL depth was 250.76 ± 44.05 μm. Moderate positive correlations were observed between DL and ultraviolet A irradiation time, DL, and intraoperative stromal thickness (r = 0.473, p = 0.005 and r = 0.517, p = 0.002, respectively). ΔKmax was negatively correlated with preoperative Kmax (r = − 0.559, P = 0.001) and positively correlated with preoperative TCT (r = 0.373, P = 0.030). Conclusion: The “Sub-400 protocol” for CXL has a broad application possibility for ultrathin corneas with KC and has shown promising results.