Accelerated versus Conventional Corneal Collagen Cross-Linking for Progressive Keratoconus

We aimed to compare the effect of accelerated and conventional corneal collagen cross-linking (CXL) on visual, refractive, and topographic parameters in patients with progressive keratoconus. Between December 2014 and February 2016, at Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Iran, we compared 37 eyes of 21 patients treated by conventional CXL (CCXL; 3 mW/cm2 in 30 minutes) with 34 eyes of 18 patients treated by accelerated CXL (ACXL; 18 mW/cm2 in 5 minutes) based on generalizing estimation equation analysis in terms of corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), corneal endothelial cell indices, and topographic parameters before and at 3, 6 and 12 months after the operation. The mean UDVA and spherical equivalent changes were similar in the two groups, but an improvement in CDVA was only observed in the CCXL group (P = 0.003). Keratometry (minimum and maximum) was significantly decreased in the CCXL group (P = 0.043 and P = 0.008, respectively). Indices of keratoconus progression—surface asymmetry index (SAI), keratoconus prediction index (KPI), and keratoconus index (KCI)—were significantly lower in the CCXL group than in the ACXL group (P = 0.002, P < 0.001, and P < 0.001, respectively). The thinnest corneal thickness (TCT) was not significantly different between the two groups (P = 0.15). The reduction of corneal endothelial cell density was also similar between the two groups; however, polymorphism and polymegethism were significantly lower in the ACXL group than in the CCXL group. In conclusion, we showed that although ACXL at 18 mW/cm2 slowed keratoconus progression safely during a 1-year follow-up, CCXL at 3 mW/cm2 may be superior in the prevention of keratoconus progression.