Progression of Keratoconus in Patients While Awaiting Corneal Cross-linking: A Prospective Clinical Study

PURPOSE: To assess topographical changes in patients with keratoconus while awaiting corneal cross-linking (CXL) treatment. METHODS: In this prospective, double-center, observational clinical study, patients with keratoconus were enrolled. Progression was defined as a change in the curvature within the cone area of at least 1.00 diopter (D) on tangential map and a thinning of 20 mu m at the thinnest point after measurements taken at least 3 months apart. Morphological parameters were assessed at baseline (day of listing for CXL) and on the day of CXL treatment, including slit-lamp biomicroscopy, keratometry (maximum, minimum, and mean), and thinnest corneal thickness using corneal tomography (Pentacam; Oculus Optikgerate GmbH, Wetzlar, Germany). RESULTS: One hundred four eyes of 104 patients were included. The waiting time was 84.8 +/- 62.9 days. Twenty-five percent of patients showed evidence of progression while waiting for treatment. Patients who progressed while waiting for treatment were younger (22.2 +/- 6.79 years) compared to those who did not show evidence of progression (25.4 +/- 5.62 years) (P = .02). Stratification by age groups showed a significant worsening of maximum keratometry of 1.18 +/- 1.37 D in patients younger than 18 years compared to those 18 to 26 years of age and those older than 26 years (P = .002 and .042, respectively). The multivariate model confirmed that the progression steepening of the maximum keratometry while waiting for treatment was associated with age (P = .028). CONCLUSIONS: The results suggest that stratification of waiting time according to the patient's age is required to reduce the risk of further progression of keratoconus.