DOI: 10.4103/jcos.jcos_7_26 ISSN: 2950-2810

Clinical, Tomographic, and Quality-of-Life Outcomes Following Corneal Collagen Cross-Linking in Keratoconus: A Prospective Observational Study

Venugopal Anitha, Titu Devaraj, Meenakshi Ravindran, Mohammed Sithiq Uduman
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Abstract

Purpose:

To assess the early outcomes of corneal collagen cross-linking (CXL) on visual acuity, corneal tomographic parameters, quality of life (QoL), and associated risk factors in patients with keratoconus.

Materials and Methods:

This is a prospective interventional study that included 70 patients with keratoconus who underwent standard Dresden protocol CXL at a tertiary eye care center in South India. Patients aged ≥10 years with tomographic diagnosis of keratoconus were included. Visual acuity (uncorrected visual acuity [UCVA], best-corrected visual acuity [BCVA]), corneal tomography (Pentacam parameters), QoL using the Keratoconus Outcomes Research Questionnaire (KORQ), and systemic/risk factor profiles were assessed preoperatively and at 4 months postoperatively.

Results:

At 4 months, there was no significant improvement in UCVA ( P = 0.185), BCVA ( P = 0.622), or contact lens-corrected visual acuity ( P = 0.678). However, significant reductions were observed in K mean ( P = 0.018), K max ( P = 0.004), and K steep ( P = 0.003), indicating corneal flattening. Anterior elevation decreased ( P = 0.009), whereas posterior elevation remained unchanged. The thinnest pachymetry reduced significantly ( P < 0.001). KORQ activity limitation scores improved significantly ( P = 0.003), whereas symptom scores did not. Eye rubbing (55.7%) and ocular allergy (52.9%) were common risk factors. The I-S value showed a significant correlation with the final visual acuity after Bonferroni correction ( P = 0.004). Symptom scores correlated significantly with visual acuity ( r = 0.52, P = 0.002).

Conclusion:

CXL produces measurable early corneal structural improvements without immediate visual acuity gains. Crucially, patients experience improvements in functional QoL before objective visual improvement, highlighting the inadequacy of traditional outcome measures for early-stage assessment. Corneal asymmetry is confirmed as a critical determinant of visual outcomes, supporting its role in guiding prognosis and management strategies.

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