INTRODUCTION:

Keratoconus is a progressive, bilateral, ectatic disease of the cornea. Few studies have explored the effect of

delaying cross-linking services during the COVID-19 pandemic, for this reason this study investigates the effects

of such delays in the delivery of cross-linking services in patients with keratoconus progression.

METHODES:

Retrospective observational study of 46 patients with keratoconus progression, whose cross-linking was delayed

due to the COVID-19 pandemic. Rapid disease progression and patients with thin corneas were given priority.

Corneal topographic data and corrected distance visual acuity on the day of being listed for CXL and on the day

of the CXL treatment were recorded. Keratoconus progression during the time between listing and procedure was

calculated according to the ABCD progression analysis.

RESULTS:

In total, 46 eyes, of 34 patients, were reviewed. All eyes demonstrated evidence of keratoconus progression when

listed for CXL. Of these, 30 males and 16 females. It was noted that 39% had a history of atopy and 25% were

contact lens wearer. The mean age was 25.4 ± 7.5 years. 52% of listings were intended for bilateral CXL. The

average time between being listed and having the procedure done was 182 ± 65 days. Additional delay due to

COVID-19 accounted to 3 months. Atopy was also found to be associated with keratoconus progression, in

contrast, age, gender, CL wear, VA, and thinnest corneal thickness showed no association.

DISCUSSION:

Results from our study suggest that delays due to re-prioritization of ophthalmic services has resulted in further

progression of keratoconus: 70% of cases. These findings are consistent with multiple previous studies. Further

to significant worsening of all keratometric indices analysed, patients lost almost one line of visual acuity, as

keratoconic eyes in which visual acuity cannot be corrected with contact lenses, may need a cornea transplant.

Furthermore, a delay of 3–4 months in a ‘very thin cornea’, however, considering risks associated with CXL in

corneal thicknesses < 400 ?m, this thinning may lead to patient’s becoming ineligible for this treatment option.

CONCLUSION:

We recommend that CXL needs to be considered as a high priority intervention.

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