Evaluating the efficacy and safety of iontophoresis-assisted corneal cross-linking compared to standard CXL in the treatment of keratoconus.

PURPOSE: To compare the outcomes of standard corneal cross-linking (S-CXL) and iontophoresis-assisted CXL (I-CXL) in Jordanian keratoconus patients over a 12-month follow-up period.

DESIGN

This retrospective, observational cohort study included 107 keratoconus patients who underwent either S-CXL (n = 53) or I-CXL (n = 54) between January 2015 and December 2019.

METHODS

Data collected included demographic information, clinical history, and ophthalmic examinations. The primary outcome was the change in best-corrected visual acuity (BCVA) from baseline to 12 months post-procedure. Secondary outcomes included changes in spherical equivalent, cylindrical values, corneal curvature (K 1 , K 2 , K mean , K max ), and thinnest corneal location. Postoperative complications, such as corneal haze, keratitis, and the need for penetrating keratoplasty, were also assessed. Statistical analysis was performed using R statistical software.

RESULTS

The mean age of patients was 25.0 years, with a male predominance (60%). Decreased vision was the most common symptom (63%). BCVA improvement was similar in both groups at all intervals. At 12 months, the mean BCVA change was 0.05 in the S-CXL group and 0.04 in the I-CXL group. No significant differences were observed in spherical equivalent values. Corneal curvature values (K 1 , K 2 , K mean , K max ) were significantly higher in the I-CXL group. Postoperative complications were minimal, with 40% of S-CXL patients and 93% of I-CXL patients experiencing no complications. Mild haze was more common in the S-CXL group (54%).

CONCLUSIONS

S-CXL demonstrated superiority in improving corneal curvature at 6 and 12 months. Postoperative complications were minimal, with higher incidence of mild haze in the S-CXL group. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these results.