Management of Tomographically Suspicious Fellow Eyes of Young Patients With Unilateral Clinically Evident Keratoconus: Accelerated Epithelium-On Corneal Crosslinking Versus Observation.

Purpose: To investigate the effectiveness and safety of accelerated epithelium-on crosslinking to stabilize tomographically suspicious fellow eyes of young patients with unilateral clinically evident keratoconus (KC) compared with observation alone.

Methods: This retrospective observational study included 43 fellow eyes of 43 young patients with unilateral clinically evident KC who completed a 24-month follow-up. Twenty-four eyes underwent accelerated epithelium-on crosslinking [epi-on corneal crosslinking (CXL) group] and 19 eyes were observed (observation group). A third healthy control group was added for comparison. The primary outcome measures were tomographic parameters and topometric indices assessed by pentacam. Secondary outcome measures included corneal ectatic progression defined as 1-diopter or more increase in maximum or steep keratometry (Kmax or K2), visual & refractive outcomes, and complications.

Results: Baseline demographic and tomographic characteristics were similar between the epi-on CXL and observation groups (P > 0.05). Almost all mean tomographic parameters and topometric indices showed insignificant differences between baseline and after 24 months in the epi-on CXL and control groups (P > 0.05), whereas a significant progression was documented in the observation group (P < 0.05). At the end of the follow-up, progression was documented in 1 eye (4.2%) and in 8 eyes (42.1%) in the epi-on CXL and observation groups, respectively. Visual and refractive outcomes were more favorable in the epi-on CXL group. No significant complications were reported after accelerated epi-on CXL.

Conclusions: Accelerated epithelium-on CXL was safe and achieved better tomographic stability and less corneal ectatic progression in tomographically suspicious fellow eyes of young patients with unilateral clinically evident keratoconus compared with observation alone.