Effect of the eyelid speculum on pachymetry during corneal collagen crosslinking in keratoconus patients

PurposeTo compare central corneal thickness (CCT) with and without using an eyelid speculum during corneal collagen crosslinking (CXL).SettingUniversity Medical Center Utrecht, Utrecht, the Netherlands.DesignProspective nonrandomized comparative study.MethodsEyes with progressive keratoconus were treated by CXL and consecutively divided into 2 groups. In Group A, an eyelid speculum remained in place throughout the entire CXL procedure. In Group B, the eyelids remained closed during the 30-minute riboflavin instillation. Intraoperative ultrasound pachymetry measurements were performed at different timepoints. The visual acuity, refraction, keratometry, pachymetry, and endothelium were evaluated 6 months after CXL. The main outcome measures were intraoperative CCT measurements and the clinical CXL effect after 6 months.ResultsFifty-two eyes (50 patients) were treated. After riboflavin instillation, a statistically significant difference in CCT reduction was found between the 2 groups (P < .001), with a mean CCT decrease of 62 μm ± 53 (SD) (13% ± 11%) in Group A and 11 ± 35 μm (2% ± 8%) in Group B. No statistically significant between-group differences were found after epithelial removal or ultraviolet-A (UVA) irradiation. Six months after CXL, no statistically significant between-group difference was found in the visual acuity, refraction, keratometry, pachymetry, or endothelium.ConclusionsAvoidance of an eyelid speculum during riboflavin instillation resulted in less CCT reduction during CXL. This finding could increase the chance of attaining the required pachymetry safety margin for applying UVA and thus decrease the chance of premature CXL treatment termination.Financial DisclosureNo author has a financial or proprietary interest in any material or method mentioned.