# Two-to-three-year effectiveness and safety of nurse-led accelerated corneal crosslinking for progressive keratoconus: The Birmingham and Midland Eye Centre Study

## TL;DR

This study shows that nurse-led corneal crosslinking is effective and safe for treating progressive keratoconus over two to three years.

## Contribution

It demonstrates the feasibility of nurse-led accelerated corneal crosslinking in managing keratoconus with long-term effectiveness and minimal complications.

## Key findings

- Significant improvement in corrected-distance-visual-acuity and Kmax was observed at 24 months post-treatment.
- Only 3.1% of patients experienced transient corneal haze, with no serious adverse events reported.
- At 36 months, visual acuity remained stable with continued improvement in corneal measurements.

## Abstract

To examine the two-to-three-year effectiveness and safety of accelerated corneal crosslinking (CXL) treatment performed by ophthalmic nurses for progressive keratoconus and to evaluate the potential prognostic factors for disease progression.

All consecutive eligible patients with progressive keratoconus who underwent nurse-led CXL between February 2019 and December 2021 at the Birmingham and Midland Eye Centre, UK, were included. A standardised accelerated, epithelium-off CXL protocol was employed, using 10 mW/cm2 ultraviolet-A irradiation for 9 min (5.4 J/cm2). Relevant data, including demographics, corrected-distance-visual-acuity (CDVA), corneal tomographic findings, outcomes and adverse event, were analysed. Only patients that had completed at least a 2-year follow-up post-CXL were included.

We included 97 patients (n = 97 eyes); mean age was 26.4±6.5 years and 52.6% were female. Most patients had mild (stage I) keratoconus (49.5%). From baseline to 24-month post-CXL (n = 97 eyes), there was a significant improvement in CDVA, (0.30 ± 0.22 logMAR vs. 0.20±0.18 logMAR; p < 0.001) and Kmax (59.1±6.8 D vs. 58.1±6.4 D; p < 0.001), with similar K1, K2 and thinnest corneal pachymetry (all p > 0.05). There were three (3.1%) cases of clinically significant transient corneal haze noted at 1-week post-CXL. No significant adverse events such as corneal infection/melting were observed. At 36-month post-CXL (n = 31 eyes), the CDVA remained stable, with a significant improvement in Kmax (p < 0.001) and K2 measurements (p = 0.038) from baseline.

This study highlights the efficacy, safety and feasibility of nurse-led CXL, serving as a valuable initiative in addressing the increased service demand for keratoconus management and preserving the vision of patients with keratoconus.