title: Long-term Results of an Accelerated Corneal Cross-linking Protocol (18 mW/cm2) for the Treatment of Progressive Keratoconus.
abstract: OBJECTIVE
  To compare the long-term outcomes of accelerated and standard corneal cross-linking protocols in the treatment of progressive keratoconus.
  
  
  METHODS
  Prospective randomized clinical trial.
  
  
  METHODS
  Thirty-one eyes with keratoconus were treated with an accelerated protocol (18 mW/cm(2), 5 min) and all contralateral eyes were treated with the standard method (3 mW/cm(2), 30 min) using the same overall fluence of 5.4 J/cm(2).
  
  
  RESULTS
  At 18 months after the procedure, the standard group showed significant improvement in spherical equivalent (P < .05), K-readings (P < .05), Q value (P < .05), index of surface variance (P < .05), and keratoconus index (P = .008) and decline in central corneal thickness (P < .05), but no significant change in visual acuity, corneal hysteresis, corneal resistance factor, P2 area, or endothelial cell density. In the accelerated group, central corneal thickness was the only parameter with statistically significant change. However, neither of these parameters showed significant differences between the standard and the 18 mW/cm(2) accelerated protocol, except K-reading (P = .059) and index surface variance (P = .034).
  
  
  CONCLUSIONS
  An accelerated cross-linking protocol, using 18 mW/cm(2) for 5 minutes, shows a comparable outcome and safety profile when compared to the standard protocol, but better corneal flattening is achieved with the standard method than the accelerated method. Overall, both methods stop the disease progression similarly. This study will continue to examine more long-term results.
authors: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
authors: Hassan
authors: H
authors: Hashemi
authors: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
authors: Mohammad
authors: M
authors: Miraftab
authors: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
authors: Mohammad Amin
authors: MA
authors: Seyedian
authors: Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland; Medical Faculty, University of Geneva, Geneva, Switzerland; Eye Care & Laboratory Research - Zurich Associates, Zurich, Switzerland; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors: Farhad
authors: F
authors: Hafezi
authors: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
authors: Hooman
authors: H
authors: Bahrmandy
authors: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
authors: Shahab
authors: S
authors: Heidarian
authors: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
authors: Kazem
authors: K
authors: Amanzadeh
authors: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
authors: Hamidreza
authors: H
authors: Nikbin
authors: Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors: Akbar
authors: A
authors: Fotouhi
authors: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran. Electronic address: soheilaasgari@gmail.com.
authors: Soheila
authors: S
authors: Asgari
mesh_terms: D000293:Adolescent; D000328:Adult; D003315:Cornea / Q000473:pathology*; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use*; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D012256:Riboflavin