TABLE 1.
Clinical practice in CXL for progressive keratoconus in Scandinavia
| Assessment of progression prior to CXL | n (%) | Topographic/tomographic measurements | n (%) |
|---|---|---|---|
| Adults | 18 (94.7) | One measurement on each occasion | 11 (57.9) |
| Children and adolescents (<18 years) | 8 (42.1) | Mean of two or more measurements | 8 (42.1) |
| Progression detection by number of parameters | Instrument used to define progressiom | ||
| Combination of 2 or more? | 18 (94.7) | Scheimpflug‐based | 17 (89.5) |
| Most difficult keratoconus subgroup to diagnose | Placido‐based | 3 (15.8) | |
| Subclinical keratoconus | 2 (10.5) | Schweimpflug‐Placido based | 1 (5.3) |
| Moderate keratoconus | 1 (5.3) | Other | 3 (15.8) |
| Advanced keratoconus | 12 (63.2) | ||
| CXL protocol UVA fluence rate | CXL Protocol | ||
| 3 mW/cm2 (30 min) | 8 (42.1) | Epi‐off | 19 (100) |
| 9 mW/cm2 (10 min) | 12 (63.2) | Epi‐on | 3 (15.8) |
| 18 mW/cm2 (5 min) | 3 (15.8) | Iontophoresis | 0 (0) |
| 30–45 mW/cm2 (16 min and 40 s) | 1 (5.3) | Other | 4 (21.1) |
| UVA irradiation | Type of riboflavin used in epi‐off protocols | ||
| Continuous | 16 (84.2) | Iso‐osmolar | 7 (38.9) |
| Pulsed | 2 (10.5) | Hypo‐osmolar | 10 (55.6) |
| Both types | 1 (5.3) | HPMC | 8 (44.4) |
| Corneal thickness measurement | Approach with thin corneas | ||
| After epithelial debridement | 11 (57.9) | Hypo‐osmolar riboflavin | 8 (42.1) |
| Immediately prior to UVA irradiation | 12 (63.2) | Sterile water | 6 (31.6) |
| Repeated during UVA irradiation | 3 (15.8) | Other | 5 (26.3) |
| Standard post‐CXL treatment | Complications | ||
| Antibiotics | 19 (100) | Delayed epithelial healing | 14 (73.7) |
| Oral analgesics | 17 (89.5) | Infectious keratitis | 11 (57.9) |
| Steroids | 13 (68.4) | Treatment abandoned due to pachymetry | 10 (52.6) |
| Contact lens after treatment | 9 (47.7) | Corneal melting | 5 (26.3) |
| Topical anaesthetics | 9 (47.4) | Haze warranting treatment | 5 (26.3) |
| Topical cycloplegics | 5 (26.3) | Corneal herpes infection | 1 (5.3) |
| Non‐steroidal anti‐inflammatory drugs | 4 (21.1) | Other | 3 (15.8) |
| Other | 2 (10.5) | Evaluation of the need for re‐treatment | |
| CXL for treatment of other diseases | Same as for untreated patients | 18 (94.7) | |
| Infectious keratitis | 15 (78.9) | Other | 1 (5.3) |
| Bullous keratopathy | 2 (10.5) | Aspects in greatest need of improvement | |
| Other corneal ectasias | 4 (21.1) | Individual adaptation of treatment protocols | 5 (26.3) |
| After CXL | Development of effective epi‐on protocols | 4 (21.1) | |
| Follow‐up | 19 (100) | Methods of performing CXL in thin corneas | 4 (21.1) |
| Need for re‐treatment after CXL | 13 (72.2) | Definition of progression | 2 (10.5) |
| Approach if progression after treatment | Diagnosis of the need for re‐treatment | 2 (10.5) | |
| Re‐treatment with the same CXL protocol | 12 (63.2) | Pain management | 1 (5.3) |
| Re‐treatment with different CXL protocol | 5 (26.3) | Awareness and earlier referral | 1 (5.3) |
| Other | 2 (10.5) | ||