Corneal cross-linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases: a prospective single-arm study

Abstract Objective This study aims to evaluate the effects of epithelial-off corneal cross-linking (CXL) on the ocular surface and corneal topographic and optical parameters in progressive keratoconus (KCN) cases. Study design Prospective single-arm interventional study. Methods Thirty eyes of 25 pr...

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Main Authors: Nazli Taheri, Afshin Lotfi Sadigh, Salar Abed Nikmanesh, Amir Tarkavani, Peyman Ghodraty, Amin Arasteh, Tahereh Attar Gharamaleki
Format: Article
Language:English
Published: BMC 2025-03-01
Series:BMC Ophthalmology
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Online Access:https://doi.org/10.1186/s12886-025-03968-2
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author Nazli Taheri
Afshin Lotfi Sadigh
Salar Abed Nikmanesh
Amir Tarkavani
Peyman Ghodraty
Amin Arasteh
Tahereh Attar Gharamaleki
author_facet Nazli Taheri
Afshin Lotfi Sadigh
Salar Abed Nikmanesh
Amir Tarkavani
Peyman Ghodraty
Amin Arasteh
Tahereh Attar Gharamaleki
author_sort Nazli Taheri
collection DOAJ
description Abstract Objective This study aims to evaluate the effects of epithelial-off corneal cross-linking (CXL) on the ocular surface and corneal topographic and optical parameters in progressive keratoconus (KCN) cases. Study design Prospective single-arm interventional study. Methods Thirty eyes of 25 progressive KCN cases needing corneal CXL entered the study. All the included eyes underwent an epi-off corneal CXl procedure following the Dresden protocol. The ocular surface parameters, including tear break-up time (TBUT), Schirmer I test, and Ocular surface disease index (OSDI), were evaluated at baseline, one and 6 months after the procedure. The corneal imaging with Pentacam (Oculus Inc.) was conducted at these visits, measuring topographic parameters (e.g., Kmax, K1, K2, and corneal thickness), indices (e.g., ISV, IVA, KI IHA), and aberrations. Results The median age of the patients was 24.0 (IQR:21.0–26.5) with a baseline BCVA of 0.045 LogMAR (IQR:0.000–0.301). The BCVA had no significant change in the last follow-up (p:1.000). The baseline median values for TBUT, Schirmer test, and OSDI were 11.0s, 13.0mm, and 28.12, demonstrating a significant ocular surface malfunction. These ocular surface parameters showed no significant change 6 months after CXL (p: 0.662, 0.534, and 0.372, respectively). The K1 and K2 values decreased significantly at the last follow-up compared to the baseline (44.4 vs. 45.6 (p:0.019) and 48.0 vs. 48.1 (p:0.008), respectively). The only topographic indices that improved 6 months after CXL was the index of surface variance (ISV) (70.50 vs. 61.70, p:0.036). The corneal front surface higher-order aberrations, including spherical aberration, coma, and trefoil, showed no significant change 6 months after CXL. Conclusion Progressive KCN cases cope with some ocular surface problems, such as dry eye, but the corneal CXL is safe for these cases without causing any deterioration in the ocular surface problems. The corneal CXL might not improve the topographic indices and corneal aberrations 6 months after the procedure. Graphical Abstract
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spelling doaj-art-7b6898ecbf2c44bc8e7a56c380e9b72b2025-08-20T02:51:24ZengBMCBMC Ophthalmology1471-24152025-03-0125111010.1186/s12886-025-03968-2Corneal cross-linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases: a prospective single-arm studyNazli Taheri0Afshin Lotfi Sadigh1Salar Abed Nikmanesh2Amir Tarkavani3Peyman Ghodraty4Amin Arasteh5Tahereh Attar Gharamaleki6Department of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical SciencesDepartment of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical SciencesDepartment of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical SciencesDepartment of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical SciencesDepartment of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical SciencesDepartment of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical SciencesDepartment of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical SciencesAbstract Objective This study aims to evaluate the effects of epithelial-off corneal cross-linking (CXL) on the ocular surface and corneal topographic and optical parameters in progressive keratoconus (KCN) cases. Study design Prospective single-arm interventional study. Methods Thirty eyes of 25 progressive KCN cases needing corneal CXL entered the study. All the included eyes underwent an epi-off corneal CXl procedure following the Dresden protocol. The ocular surface parameters, including tear break-up time (TBUT), Schirmer I test, and Ocular surface disease index (OSDI), were evaluated at baseline, one and 6 months after the procedure. The corneal imaging with Pentacam (Oculus Inc.) was conducted at these visits, measuring topographic parameters (e.g., Kmax, K1, K2, and corneal thickness), indices (e.g., ISV, IVA, KI IHA), and aberrations. Results The median age of the patients was 24.0 (IQR:21.0–26.5) with a baseline BCVA of 0.045 LogMAR (IQR:0.000–0.301). The BCVA had no significant change in the last follow-up (p:1.000). The baseline median values for TBUT, Schirmer test, and OSDI were 11.0s, 13.0mm, and 28.12, demonstrating a significant ocular surface malfunction. These ocular surface parameters showed no significant change 6 months after CXL (p: 0.662, 0.534, and 0.372, respectively). The K1 and K2 values decreased significantly at the last follow-up compared to the baseline (44.4 vs. 45.6 (p:0.019) and 48.0 vs. 48.1 (p:0.008), respectively). The only topographic indices that improved 6 months after CXL was the index of surface variance (ISV) (70.50 vs. 61.70, p:0.036). The corneal front surface higher-order aberrations, including spherical aberration, coma, and trefoil, showed no significant change 6 months after CXL. Conclusion Progressive KCN cases cope with some ocular surface problems, such as dry eye, but the corneal CXL is safe for these cases without causing any deterioration in the ocular surface problems. The corneal CXL might not improve the topographic indices and corneal aberrations 6 months after the procedure. Graphical Abstracthttps://doi.org/10.1186/s12886-025-03968-2KeratoconusCross-linkingCXLOcular surfaceTopographic indicesAberration
spellingShingle Nazli Taheri
Afshin Lotfi Sadigh
Salar Abed Nikmanesh
Amir Tarkavani
Peyman Ghodraty
Amin Arasteh
Tahereh Attar Gharamaleki
Corneal cross-linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases: a prospective single-arm study
BMC Ophthalmology
Keratoconus
Cross-linking
CXL
Ocular surface
Topographic indices
Aberration
title Corneal cross-linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases: a prospective single-arm study
title_full Corneal cross-linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases: a prospective single-arm study
title_fullStr Corneal cross-linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases: a prospective single-arm study
title_full_unstemmed Corneal cross-linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases: a prospective single-arm study
title_short Corneal cross-linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases: a prospective single-arm study
title_sort corneal cross linking effects on ocular surface parameters and corneal topographic and optical characteristics in progressive keratoconus cases a prospective single arm study
topic Keratoconus
Cross-linking
CXL
Ocular surface
Topographic indices
Aberration
url https://doi.org/10.1186/s12886-025-03968-2
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