Refractive Lenticule-Assisted Accelerated Corneal Cross-linking: A Three-Year Clinical Observation in Patients with Thin Keratoconus

Objective Accelerated corneal cross-linking (A-CXL) is unsuitable for thin keratoconus treatment. We developed refractive lenticule-assisted A-CXL by overlaying lenticules during A-CXL to optimize therapy for thin keratoconus. This retrospective study evaluates its 3-year efficacy and safety. Methods This study retrospectively included 63 eyes (42 cases) with progressive keratoconus who underwent A-CXL in our hospital from September 2017 to December 2020. The surgical method is determined based on the patients' corneal thickness. Patients received refractive lens-assisted A-CXL (10 cases with 18 eyes) were designated as Group A, while those undergowent A-CXL alone (32 cases with 45 eyes) were classified as Group B. The follow-up duration for both groups was 3 years. Preoperative and postoperative evaluation (6 months, 12 months, 24 months, and 36 months) included best corrected visual acuity (BCVA), endothelial cell density (ECD), thinnest corneal thickness (TCT), keratoconus vertex back (Kvb) and corneal curvature. Any adverse events like delayed corneal healing, corneal infections, haze, etc that occurred during this period should be record. Results During follow-up, no significant changes were observed in TCT, Kmax, K1, K2, or Kvb in Group A, while BCVA significantly improved at 36 months postoperatively, and ECD significantly increased at 12 months postoperatively ( P <0.016). Over the same period, Group B showed decreases in TCT and ECD compared to baseline ( P  < 0.05), increases in anterior surface K1 and K2 values, and improvements in BCVA and Kmax ( P  < 0.05), with no significant change in Kvb. During the 36-month postoperative period, Group A exhibited more substantial improvements in BCVA and more pronounced elevation in Kvb than Group B. Both groups exhibited uneventful healing with no adverse events. Conclusions Over the 3-year follow-up period, the refractive lenticule-assisted A-CXL and A-CXL showed similar efficacy and safety in controlling the progression of keratoconus.