Purpose: To compare the outcomes of epithelium-on versus epithelium-off pulsed-accelerated crosslinking (Avedro-KXL) in keratoconus at 12 months. Method: A retrospective review of 61 patients, 30 males and 31 females (mean age 25.8 ± 6.2), with progressive keratoconus who underwent pulsed-accelerated crosslinking at the Princess Alexandra Hospital, Brisbane. At three months, six months and 12 months parameters collected included unaided visual acuity, best-spectacle corrected visual acuity, central corneal thickness, thinnest corneal thickness and keratometry using the Galilei G4 tomographer. Keratometric parameters included steep, flat, mean simulated and maximum simulated keratometry. Results: Thirty-four patients with progressive keratoconus underwent epithelium-on and 27 patients underwent epithelium-off crosslinking. At baseline, there were no significant differences in visual and tomographic characteristics (p > 0.05). At three months, six months and 12 months follow-up, there were no significant changes in best-spectacle corrected visual acuity, keratometric parameters or corneal thickness in either group. When the outcomes were compared between the two groups, there were no statistically significant differences (p > 0.05). Conclusion: The Avedro-KXL pulsed-accelerated crosslinking protocol offered stabilisation of keratometric parameters and visual acuity in eyes with progressive keratoconus at 12 months follow-up. There were no significant differences in outcomes between eyes that underwent epithelium-off crosslinking compared to eyes that underwent epithelium-on crosslinking.
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