Few studies have evaluated corneal crosslinking in a prospective, randomised fashion. This study aimed to determine the efficacy and safety of corneal crosslinking to reduce the progression of keratoconus.
Prospective, unmasked, randomised, contralateral eye controlled trial at a tertiary eye centre.
Individuals with bilateral progressive keratoconus. One eye from each subject was randomised to corneal crosslinking and the contralateral, untreated eye acted as the control.
change in maximum keratometry.
uncorrected distance visual acuity, spectacle corrected distance visual acuity, spherical equivalent refraction, simulated keratometry, corneal astigmatism, minimum pachymetry, and complications.
Thirty-eight individuals (mean age 21.1 ± 6.7 years) were enrolled with one eye treated with corneal crosslinking. At 5 years, there was a mean decrease in maximum keratometry of treated eyes (-1.45 ± 2.25 D) compared to an increase among the controls (1.71 ± 2.46 D; p < 0.001). There were significant differences between the treated and control groups in the mean change of Steep SimK (-1.07 ± 1.22 vs. 0.96 ± 1.97 D; p < 0.001), Flat SimK (-0.61 ± 1.34 vs. 0.43 ± 1.12 D; p < 0.001), corneal astigmatism (-0.45 ± 1.31 vs. 0.63 ± 1.52 D; p < 0.01), and minimum pachymetry (-32.49 ± 26.32 vs. -13.57 ± 24.11 μm; p < 0.01). Complications included sterile infiltrates (n = 2), microbial keratitis (n = 1), persistent corneal haze/scarring at 5 years (n = 4), and loss of ≥2 lines of corrected distance visual acuity (n = 3).
Corneal crosslinking is an effective and relatively safe intervention to halt or reduce the progression of keratoconus in the majority of eyes for at least 5 years.

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