Table A7: Impact of CXL on Corneal Curvature in Keratoconus − Higher Order Topographic Findings in Treated and Untreated Fellow-Eyes*.
| Author Year | Patients (P) Mean Age | Keratometric (K-Value) Outcome | Treated Eye Diopters Mean ± SD | Untreated Eye Diopters Mean ± SD | Pre-post change Treated Vs Untreated Eye | |
|---|---|---|---|---|---|---|
| Caporossi A, 2010 (41) | 44 P (44 e) Range 10 to 40 years | K- Average at 12-monthsCorneal topography (CSO Eye Top, | Pre-post change −1.96 ± 0.63 D (R, 0.92 to −3.24) | Pre-post change +1.2 ± 0.96 | ||
| Surface aberrometry (CSO Eye Top) | Pre-post change Total wavefront higher order aberrations significantly reduced (P<0.00001) |
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| Corneal symmetry- Inferior-Superior-inferior index (SI) | Pre-post SI asymmetry index significantly improved (P< 0.0001) Spherical aberration remained unchanged |
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| Henriquez M, 2011 (44) | 10 P (10 e) and 10 control P (10 e) 29.7 (R, 15 to 43) years |
K-Max K-Min At 12-months Corneal typography Topcon |
Pre-post reduction K-Max 2.66 D p =.04 K-Min 1.61 D (P= 0.03) 80% (8/10) decreased K-Max 20% (2/10) worsening K-Max |
90% (9/10) had increased K-Max | ||
| Koller T, 2009 (45) | 21 P (21 e) Age NR |
Corneal topography Pentacam system with Scheimpflug camera − progression regression minimum corneal curvature radius (Rmin/mm) At 12-months | Pre-post improvement Rmim/mm 6.14 to 6.21 (P= 0.01) |
Pre-post worsening Rmin/mm 6.94 to 6.86 (P= 0.002) |
Pre-post change Rmin/mm 0.066 ± 0.10 vs −0.08 ± 0.10 (P = 0.0009) Rmin/D |
|
| Rmin/D 55.0 D to 54.3D (P= 0.01) | Rmin/D 48.6 to 49.2 (P= 0.002) | −-0.62 ± 0.9 vs 0.57 ± 0.8 (P= 0.0009) | ||||
| 4 / 7 Pentacam KC indices showed significant improvements towards a more normalized corneal anterior surface | Based on ARmin 0.12 mm ≃ 1 Progressed = 7 untreated Vs 0 treated Unchanged = 14 untreated Vs 13 treated Regressed = 0 untreated Vs 8 treated |
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| Leccisotti A, 2010 (46) | 51 P (51 e) 26.9 ± 6.3 (R 26.9 to 39) years | K-Apex Average Sim-K (averaging flattest and steepest meridian) At 12-months |
Pre-post K-Apex 54.31 ± 8.76 to 54.81 ± 4.86 Mean Δ 0.51 ± 7.79 (P>0.05) Pre-post Sim-K 46.63 ± 2.89 to 46.53 ± 3.18 Mean Δ-0.10 ± 1.44 (P> 0.05) |
Pre-post K-Apex 51.69 ± 6.42 to 53.30 ± 7.71 Mean Δ 1.61 ± 6.28 (P> 0.05) Pre-post Sim-K 44.60 ± 2.19 to 45.48 ± 2.88 Mean Δ 0.88 ± 2.35 (P> 0.05) |
Comparative Pre-post Δ K-Apex (95% CI) −3.98 to 1.87 Comparative Pre-post Δ Sim-K (95% CI) −1.75 to −0.21 |
|
| Corneal surface regularity | Pre-post | Pre-post | Comparative Pre-post Δ | |||
| index (ISV) -deviation of individual corneal radii from mean values (abnormal >37) At 12-months Tangential video keratography (Keratograph |
ISV 76.4 ± 28.2 to 77.3 ± 28.8 Mean Δ 0.9 ± 4.69 (P> 0.05) |
ISV 48.2 ± 14.3 to 53.5 ± 19.5 Mean Δ 5.3 ± 7.30 (P> 0.05) |
ISV (95% CI) 1.99 to 6.81 |
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| Vinciguerra P, 2009 (48) | 28 P (28 e) Range 24 to 52 years |
K-Min K-Max Sim-K |
Pre-post K-Min 46.10 to 40.22 (P= 0.0003) |
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| Corneal topography with CSO Eye Top Topographer and 21-Klyce indices | K-Max 50.37 to 44.21 (P= 0.0011) Sim-K 48.08 to 42.01 (P= 0.0004) |
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| Total (corneal and internal) wavefront analysis performed with Nidek OPD-Scan - 21-Klyce Indices | Pre-Post Sim-K1 50.53 to 50.13 (P < 0.05) |
Pre-Post Sim-K1 45.81 to 46.21 (P< 0.05) |
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| Sim-K2 45.89 to 45.76 (P < 0.05) |
Sim-K2 43.29 to 43.57 (P < 0.05) |
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| K-Min 41.18 to 41.32 (P > 0.05) |
K-Min 40.83 to 40.92 (P > 0.05) |
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| Wollensak G, 2003 (7) | 22 P (23 e) 31.7 ±11.9 (R 13 to 58) years |
K-max At 12-months Videokeratoscope (C-scan) |
Pre-post K-Max Mean regression of 2.01 ± 1.74 D (p =.03) |
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| K-Max Regression in 70% (16/23) with average reduction 2.01 D (95% CI; 1.23 to 3.07) | K-Max progression on average 1.48 D in 22% (5/22) | |||||
| Stable in 22% (5/23) Increase in 1 patient of 0.28 D | ||||||
| Hersh P, 2011 (47) | 58 p (71 e) 41 KC and e | K-Max K-Average K-Min (Flat) K-Max (Steep) At 12-months Topography Scheimpflug camera (Pentacam) | Pre-post Treated Eye K-Max 60.4 ± 9.99 to 58.4 ± 8.41 (p <.05) K-Max Mean Δ 1.5 D (p<.001) K-Average 50.4 ± 7.06 to 48.9 ± 5.48 (p<.05) K-Steep 52.9 ± 7.45 to 51.5 ± 5.94 (p<.05) Δ K-Max Decrease > 2 D(N=22), 1−2 D (N = 14), No change (N=28), Increase 1−2 D (N = 4), lncrease>2 D |
Pre-post Sham Group K-Max, K-Average, K-Steep - No statistically significant changes Pre-post Fellow-eye Δ K-Max +0.29 ± 1.19 D (p =.19) Δ K-average +0.20 ± 0.79 (p =. 18) |
Comparative pre-post Δ Treatment Vs Sham Group Only 3 month comparison as all crossed over No significant differences in kerotometry Comparative pre-post Δ Treatment Vs Untreated Fellow-eye Δ K-Max p <.001 Δ K-Average p <.001 |
*
CI indicates confidence interval; E indicates eye, K indicates keratometry; Max indicates maximum; Min indicates minimum; NR indicates not reported; P indicates people; Sim indicates simulated; SD indicates standard deviation.