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Current clinical practice in corneal crosslinking for treatment of progressive keratoconus in four Nordic countries

Gustafsson, Ingemar LU ; Vicente, André LU ; Bergström, Anders LU ; Stenevi, Ulf ; Ivarsen, Anders and Hjortdal, Jesper Østergaard (2023) In Acta Ophthalmologica 101(1). p.109-116
Abstract

PURPOSE: To evaluate clinical practice in the diagnosis and treatment of progressive keratoconus with corneal crosslinking (CXL) in four Nordic countries.

METHODS: A questionnaire was sent to all centres at which keratoconus patients are evaluated and CXL is performed in Sweden, Denmark, Norway and Iceland. Nineteen of 20 centres participated.

RESULTS: CXL is performed approximately 1300 times per year in these four Nordic countries with a population of around 21.7 million (2019). In most cases, progression is evaluated using the Pentacam HR, and the maximum keratometry reading (Kmax ) is considered the most important parameter. The most frequently used treatment protocol in Scandinavia is the 9 mW/cm2 epi-off protocol,... (More)

PURPOSE: To evaluate clinical practice in the diagnosis and treatment of progressive keratoconus with corneal crosslinking (CXL) in four Nordic countries.

METHODS: A questionnaire was sent to all centres at which keratoconus patients are evaluated and CXL is performed in Sweden, Denmark, Norway and Iceland. Nineteen of 20 centres participated.

RESULTS: CXL is performed approximately 1300 times per year in these four Nordic countries with a population of around 21.7 million (2019). In most cases, progression is evaluated using the Pentacam HR, and the maximum keratometry reading (Kmax ) is considered the most important parameter. The most frequently used treatment protocol in Scandinavia is the 9 mW/cm2 epi-off protocol, using hydroxylpropyl methylcellulose riboflavin (HPMC-riboflavin). The participants deemed the following areas to be in most need of improvement: adaptation of the CXL protocol to individual patients (5/19), the development of effective epi-on treatment protocols (4/19), optimal performance of CXL in thin corneas (4/19), improvement of the definition of progression (2/19), and diagnosis of the need for re-treatment (2/19).

CONCLUSIONS: We concluded that the diagnosis of progressive keratoconus and the diagnostic equipment used are similar. Treatment strategies are also similar but are suitably different to provide an interesting basis for the comparison of treatment outcomes. The high degree of participation in this survey indicates the possibility of future scientific collaboration on CXL focusing on the areas deemed to need improvement. It would also be of interest to evaluate the possibility of creating a Nordic CXL Registry. The high number of CXL treatments performed ensures sufficient statistical power to solve many questions. Such a registry could be an important contribution to evidence-based care and would allow for longitudinal evaluation.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Keratoconus/diagnosis, Photochemotherapy/methods, Photosensitizing Agents/therapeutic use, Visual Acuity, Cross-Linking Reagents/therapeutic use, Riboflavin/therapeutic use, Scandinavian and Nordic Countries/epidemiology, Corneal Topography, Ultraviolet Rays
in
Acta Ophthalmologica
volume
101
issue
1
pages
109 - 116
publisher
Wiley-Blackwell
external identifiers
  • scopus:85133683028
  • pmid:35811357
ISSN
1755-3768
DOI
10.1111/aos.15213
language
English
LU publication?
yes
additional info
© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.
id
576851ce-656b-47ad-bd76-da29a396c3b2
date added to LUP
2023-08-17 10:20:21
date last changed
2024-04-20 00:52:35
@article{576851ce-656b-47ad-bd76-da29a396c3b2,
  abstract     = {{<p>PURPOSE: To evaluate clinical practice in the diagnosis and treatment of progressive keratoconus with corneal crosslinking (CXL) in four Nordic countries.</p><p>METHODS: A questionnaire was sent to all centres at which keratoconus patients are evaluated and CXL is performed in Sweden, Denmark, Norway and Iceland. Nineteen of 20 centres participated.</p><p>RESULTS: CXL is performed approximately 1300 times per year in these four Nordic countries with a population of around 21.7 million (2019). In most cases, progression is evaluated using the Pentacam HR, and the maximum keratometry reading (Kmax ) is considered the most important parameter. The most frequently used treatment protocol in Scandinavia is the 9 mW/cm2 epi-off protocol, using hydroxylpropyl methylcellulose riboflavin (HPMC-riboflavin). The participants deemed the following areas to be in most need of improvement: adaptation of the CXL protocol to individual patients (5/19), the development of effective epi-on treatment protocols (4/19), optimal performance of CXL in thin corneas (4/19), improvement of the definition of progression (2/19), and diagnosis of the need for re-treatment (2/19).</p><p>CONCLUSIONS: We concluded that the diagnosis of progressive keratoconus and the diagnostic equipment used are similar. Treatment strategies are also similar but are suitably different to provide an interesting basis for the comparison of treatment outcomes. The high degree of participation in this survey indicates the possibility of future scientific collaboration on CXL focusing on the areas deemed to need improvement. It would also be of interest to evaluate the possibility of creating a Nordic CXL Registry. The high number of CXL treatments performed ensures sufficient statistical power to solve many questions. Such a registry could be an important contribution to evidence-based care and would allow for longitudinal evaluation.</p>}},
  author       = {{Gustafsson, Ingemar and Vicente, André and Bergström, Anders and Stenevi, Ulf and Ivarsen, Anders and Hjortdal, Jesper Østergaard}},
  issn         = {{1755-3768}},
  keywords     = {{Humans; Keratoconus/diagnosis; Photochemotherapy/methods; Photosensitizing Agents/therapeutic use; Visual Acuity; Cross-Linking Reagents/therapeutic use; Riboflavin/therapeutic use; Scandinavian and Nordic Countries/epidemiology; Corneal Topography; Ultraviolet Rays}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{109--116}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Ophthalmologica}},
  title        = {{Current clinical practice in corneal crosslinking for treatment of progressive keratoconus in four Nordic countries}},
  url          = {{http://dx.doi.org/10.1111/aos.15213}},
  doi          = {{10.1111/aos.15213}},
  volume       = {{101}},
  year         = {{2023}},
}