Long-term Tomographic, Refractive, and Visual Analysis of Keratoconus Eyes With Extreme Corneal Flattening After Corneal Cross-linking
PURPOSE: To evaluate the long-term tomographic, refractive, and visual characteristics of eyes with extreme corneal flattening after corneal cross-linking (CXL) for progressive keratoconus. METHODS: A retrospective observational study included eyes that underwent corneal CXL with epithelial removal...
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2025
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| author | María A. Henríquez Luis Izquierdo Ignacia Zenteno Rolando Rojas José Chauca Mark J. Mannis |
| author_browse | Ignacia Zenteno José Chauca Luis Izquierdo Mark J. Mannis María A. Henríquez Rolando Rojas |
| author_facet | María A. Henríquez Luis Izquierdo Ignacia Zenteno Rolando Rojas José Chauca Mark J. Mannis |
| author_sort | María A. Henríquez |
| collection | Producción científica |
| description | PURPOSE: To evaluate the long-term tomographic, refractive, and visual characteristics of eyes with extreme corneal flattening after corneal cross-linking (CXL) for progressive keratoconus. METHODS: A retrospective observational study included eyes that underwent corneal CXL with epithelial removal between June 2006 and March 2017 and had extreme keratometric flattening [greater than 5 diopters (D)] and a minimum follow-up of 5 years. Visual, tomographic, pachymetric, and refractive characteristics were evaluated. RESULTS: Mean follow-up time was 7.6 ± 2.6 years (range 5-13 years). Fifteen eyes were included in the study. Mean maximum keratometric (Kmax) flattening was -7.58 ± 2.63 D [range 5.0-12.2 D, ( P <0.001)]. Approximately 56.25% (9/15) of the eyes experienced progressive flattening over the years. And 40% (6/15) presented an improvement of one or more lines of corrected distance visual acuity (CDVA), and 26.6% (5/16) of the eyes showed a worsening of CDVA. Logistic regression analysis revealed that postoperative Kmax flattening greater than 2 D at the first year postop (odds ratio 17.7, 95% confidence interval, 4.4-71.2) and preoperative Kmax greater than 55 D (odds ratio 8.8, 95% confidence interval, 2.7-28.3) were significant risk factors for extreme postop keratometric flattening. CONCLUSIONS: Progressive extreme corneal flattening when accompanied with a decrease of CDVA was a late complication of CXL that may have required corneal transplantation for visual rehabilitation. Preoperative steeper corneas and keratometric flattening greater than 2 D at the first year postoperative period were risk factors associated with long-term extreme postoperative corneal flattening. |
| format | Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/755 |
| institution | UPeU |
| language | English |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
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| spelling | oai:cris.upeu.edu.pe:20.500.15037/7552026-10-30T16:14:49ZLong-term Tomographic, Refractive, and Visual Analysis of Keratoconus Eyes With Extreme Corneal Flattening After Corneal Cross-linkingMaría A. HenríquezLuis IzquierdoIgnacia ZentenoRolando RojasJosé ChaucaMark J. MannisKeratoconusMedicineFlatteningCorneal topographyOphthalmologyOdds ratioConfidence intervalDioptreVisual acuityCorneaInternal medicineMaterials scienceComposite materialKeratoconusMedicineFlatteningCorneal topographyOphthalmologyOdds ratioConfidence intervalDioptreVisual acuityCorneaInternal medicineMaterials scienceCorneal Cross-LinkingCorneal Cross-LinkingCorneal Cross-LinkingAdolescentAdolescentAdolescentAdultAdultAdultCollagen metabolismCollagen metabolismCollagen metabolismCornea pathologyCornea pathologyCornea pathologyCornea physiopathologyCornea physiopathologyCornea physiopathologyCorneal Stroma metabolismCorneal Stroma metabolismCorneal Stroma metabolismCross-Linking Reagents therapeutic useCross-Linking Reagents therapeutic useCross-Linking Reagents therapeutic useFemaleFemaleFemaleFollow-Up StudiesFollow-Up StudiesFollow-Up StudiesHumansHumansHumansKeratoconus diagnosisKeratoconus diagnosisKeratoconus diagnosisKeratoconus drug therapyKeratoconus drug therapyKeratoconus drug therapyKeratoconus metabolismKeratoconus metabolismKeratoconus metabolismKeratoconus physiopathologyKeratoconus physiopathologyKeratoconus physiopathologyMaleMaleMaleMiddle AgedMiddle AgedMiddle AgedPhotochemotherapy methodsPhotochemotherapy methodsPhotochemotherapy methodsRefraction, Ocular physiologyRefraction, Ocular physiologyRefraction, Ocular physiologyRetrospective StudiesRetrospective StudiesRetrospective StudiesRiboflavin therapeutic useRiboflavin therapeutic useRiboflavin therapeutic useUltraviolet RaysUltraviolet RaysUltraviolet RaysVisual Acuity physiologyVisual Acuity physiologyVisual Acuity physiologyPhotosensitizing Agents therapeutic usePhotosensitizing Agents therapeutic usePhotosensitizing Agents therapeutic useCorneal TopographyCorneal TopographyCorneal TopographyYoung AdultYoung AdultYoung AdultCorneal PachymetryCorneal PachymetryCorneal PachymetryHealth Sciences Medicine Radiology, Nuclear Medicine and Imaging Corneal surgery and disordersHealth Sciences Medicine Epidemiology Ophthalmology and Visual Impairment StudiesHealth Sciences Medicine Public Health, Environmental and Occupational Health Ocular Surface and Contact LensPURPOSE: To evaluate the long-term tomographic, refractive, and visual characteristics of eyes with extreme corneal flattening after corneal cross-linking (CXL) for progressive keratoconus. METHODS: A retrospective observational study included eyes that underwent corneal CXL with epithelial removal between June 2006 and March 2017 and had extreme keratometric flattening [greater than 5 diopters (D)] and a minimum follow-up of 5 years. Visual, tomographic, pachymetric, and refractive characteristics were evaluated. RESULTS: Mean follow-up time was 7.6 ± 2.6 years (range 5-13 years). Fifteen eyes were included in the study. Mean maximum keratometric (Kmax) flattening was -7.58 ± 2.63 D [range 5.0-12.2 D, ( P <0.001)]. Approximately 56.25% (9/15) of the eyes experienced progressive flattening over the years. And 40% (6/15) presented an improvement of one or more lines of corrected distance visual acuity (CDVA), and 26.6% (5/16) of the eyes showed a worsening of CDVA. Logistic regression analysis revealed that postoperative Kmax flattening greater than 2 D at the first year postop (odds ratio 17.7, 95% confidence interval, 4.4-71.2) and preoperative Kmax greater than 55 D (odds ratio 8.8, 95% confidence interval, 2.7-28.3) were significant risk factors for extreme postop keratometric flattening. CONCLUSIONS: Progressive extreme corneal flattening when accompanied with a decrease of CDVA was a late complication of CXL that may have required corneal transplantation for visual rehabilitation. Preoperative steeper corneas and keratometric flattening greater than 2 D at the first year postoperative period were risk factors associated with long-term extreme postoperative corneal flattening.Articlehttps://pubmed.ncbi.nlm.nih.gov/4013208910.1097/ico.0000000000003861https://hdl.handle.net/20.500.15037/755W4408884290enCornea0277-37401536-47982025-03-252026-06-13T09:34:11Z2026-06-13T09:34:11Z |
| spellingShingle | Keratoconus Medicine Flattening Corneal topography Ophthalmology Odds ratio Confidence interval Dioptre Visual acuity Cornea Internal medicine Materials science Composite material Keratoconus Medicine Flattening Corneal topography Ophthalmology Odds ratio Confidence interval Dioptre Visual acuity Cornea Internal medicine Materials science Corneal Cross-Linking Corneal Cross-Linking Corneal Cross-Linking Adolescent Adolescent Adolescent Adult Adult Adult Collagen metabolism Collagen metabolism Collagen metabolism Cornea pathology Cornea pathology Cornea pathology Cornea physiopathology Cornea physiopathology Cornea physiopathology Corneal Stroma metabolism Corneal Stroma metabolism Corneal Stroma metabolism Cross-Linking Reagents therapeutic use Cross-Linking Reagents therapeutic use Cross-Linking Reagents therapeutic use Female Female Female Follow-Up Studies Follow-Up Studies Follow-Up Studies Humans Humans Humans Keratoconus diagnosis Keratoconus diagnosis Keratoconus diagnosis Keratoconus drug therapy Keratoconus drug therapy Keratoconus drug therapy Keratoconus metabolism Keratoconus metabolism Keratoconus metabolism Keratoconus physiopathology Keratoconus physiopathology Keratoconus physiopathology Male Male Male Middle Aged Middle Aged Middle Aged Photochemotherapy methods Photochemotherapy methods Photochemotherapy methods Refraction, Ocular physiology Refraction, Ocular physiology Refraction, Ocular physiology Retrospective Studies Retrospective Studies Retrospective Studies Riboflavin therapeutic use Riboflavin therapeutic use Riboflavin therapeutic use Ultraviolet Rays Ultraviolet Rays Ultraviolet Rays Visual Acuity physiology Visual Acuity physiology Visual Acuity physiology Photosensitizing Agents therapeutic use Photosensitizing Agents therapeutic use Photosensitizing Agents therapeutic use Corneal Topography Corneal Topography Corneal Topography Young Adult Young Adult Young Adult Corneal Pachymetry Corneal Pachymetry Corneal Pachymetry Health Sciences Medicine Radiology, Nuclear Medicine and Imaging Corneal surgery and disorders Health Sciences Medicine Epidemiology Ophthalmology and Visual Impairment Studies Health Sciences Medicine Public Health, Environmental and Occupational Health Ocular Surface and Contact Lens María A. Henríquez Luis Izquierdo Ignacia Zenteno Rolando Rojas José Chauca Mark J. Mannis Long-term Tomographic, Refractive, and Visual Analysis of Keratoconus Eyes With Extreme Corneal Flattening After Corneal Cross-linking |
| title | Long-term Tomographic, Refractive, and Visual Analysis of Keratoconus Eyes With Extreme Corneal Flattening After Corneal Cross-linking |
| title_full | Long-term Tomographic, Refractive, and Visual Analysis of Keratoconus Eyes With Extreme Corneal Flattening After Corneal Cross-linking |
| title_fullStr | Long-term Tomographic, Refractive, and Visual Analysis of Keratoconus Eyes With Extreme Corneal Flattening After Corneal Cross-linking |
| title_full_unstemmed | Long-term Tomographic, Refractive, and Visual Analysis of Keratoconus Eyes With Extreme Corneal Flattening After Corneal Cross-linking |
| title_short | Long-term Tomographic, Refractive, and Visual Analysis of Keratoconus Eyes With Extreme Corneal Flattening After Corneal Cross-linking |
| title_sort | long term tomographic refractive and visual analysis of keratoconus eyes with extreme corneal flattening after corneal cross linking |
| topic | Keratoconus Medicine Flattening Corneal topography Ophthalmology Odds ratio Confidence interval Dioptre Visual acuity Cornea Internal medicine Materials science Composite material Keratoconus Medicine Flattening Corneal topography Ophthalmology Odds ratio Confidence interval Dioptre Visual acuity Cornea Internal medicine Materials science Corneal Cross-Linking Corneal Cross-Linking Corneal Cross-Linking Adolescent Adolescent Adolescent Adult Adult Adult Collagen metabolism Collagen metabolism Collagen metabolism Cornea pathology Cornea pathology Cornea pathology Cornea physiopathology Cornea physiopathology Cornea physiopathology Corneal Stroma metabolism Corneal Stroma metabolism Corneal Stroma metabolism Cross-Linking Reagents therapeutic use Cross-Linking Reagents therapeutic use Cross-Linking Reagents therapeutic use Female Female Female Follow-Up Studies Follow-Up Studies Follow-Up Studies Humans Humans Humans Keratoconus diagnosis Keratoconus diagnosis Keratoconus diagnosis Keratoconus drug therapy Keratoconus drug therapy Keratoconus drug therapy Keratoconus metabolism Keratoconus metabolism Keratoconus metabolism Keratoconus physiopathology Keratoconus physiopathology Keratoconus physiopathology Male Male Male Middle Aged Middle Aged Middle Aged Photochemotherapy methods Photochemotherapy methods Photochemotherapy methods Refraction, Ocular physiology Refraction, Ocular physiology Refraction, Ocular physiology Retrospective Studies Retrospective Studies Retrospective Studies Riboflavin therapeutic use Riboflavin therapeutic use Riboflavin therapeutic use Ultraviolet Rays Ultraviolet Rays Ultraviolet Rays Visual Acuity physiology Visual Acuity physiology Visual Acuity physiology Photosensitizing Agents therapeutic use Photosensitizing Agents therapeutic use Photosensitizing Agents therapeutic use Corneal Topography Corneal Topography Corneal Topography Young Adult Young Adult Young Adult Corneal Pachymetry Corneal Pachymetry Corneal Pachymetry Health Sciences Medicine Radiology, Nuclear Medicine and Imaging Corneal surgery and disorders Health Sciences Medicine Epidemiology Ophthalmology and Visual Impairment Studies Health Sciences Medicine Public Health, Environmental and Occupational Health Ocular Surface and Contact Lens |
| topic_facet | Keratoconus Medicine Flattening Corneal topography Ophthalmology Odds ratio Confidence interval Dioptre Visual acuity Cornea Internal medicine Materials science Composite material Keratoconus Medicine Flattening Corneal topography Ophthalmology Odds ratio Confidence interval Dioptre Visual acuity Cornea Internal medicine Materials science Corneal Cross-Linking Corneal Cross-Linking Corneal Cross-Linking Adolescent Adolescent Adolescent Adult Adult Adult Collagen metabolism Collagen metabolism Collagen metabolism Cornea pathology Cornea pathology Cornea pathology Cornea physiopathology Cornea physiopathology Cornea physiopathology Corneal Stroma metabolism Corneal Stroma metabolism Corneal Stroma metabolism Cross-Linking Reagents therapeutic use Cross-Linking Reagents therapeutic use Cross-Linking Reagents therapeutic use Female Female Female Follow-Up Studies Follow-Up Studies Follow-Up Studies Humans Humans Humans Keratoconus diagnosis Keratoconus diagnosis Keratoconus diagnosis Keratoconus drug therapy Keratoconus drug therapy Keratoconus drug therapy Keratoconus metabolism Keratoconus metabolism Keratoconus metabolism Keratoconus physiopathology Keratoconus physiopathology Keratoconus physiopathology Male Male Male Middle Aged Middle Aged Middle Aged Photochemotherapy methods Photochemotherapy methods Photochemotherapy methods Refraction, Ocular physiology Refraction, Ocular physiology Refraction, Ocular physiology Retrospective Studies Retrospective Studies Retrospective Studies Riboflavin therapeutic use Riboflavin therapeutic use Riboflavin therapeutic use Ultraviolet Rays Ultraviolet Rays Ultraviolet Rays Visual Acuity physiology Visual Acuity physiology Visual Acuity physiology Photosensitizing Agents therapeutic use Photosensitizing Agents therapeutic use Photosensitizing Agents therapeutic use Corneal Topography Corneal Topography Corneal Topography Young Adult Young Adult Young Adult Corneal Pachymetry Corneal Pachymetry Corneal Pachymetry Health Sciences Medicine Radiology, Nuclear Medicine and Imaging Corneal surgery and disorders Health Sciences Medicine Epidemiology Ophthalmology and Visual Impairment Studies Health Sciences Medicine Public Health, Environmental and Occupational Health Ocular Surface and Contact Lens |
| url | https://pubmed.ncbi.nlm.nih.gov/40132089 https://hdl.handle.net/20.500.15037/755 |
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