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Correlation of Demarcation Line Depth With Medium-Term Efficacy of Different Corneal Collagen Cross-Linking Protocols in Keratoconus

Mesen, Ali, MD; Bozkurt, Banu, MD; Kamis, Umit, MD; Okudan, Suleyman, MD

doi: 10.1097/ICO.0000000000001733
Clinical Science

Purpose: To compare demarcation line depth (DD) and topographic changes among different corneal collagen cross-linking (CXL) protocols and to evaluate the relation of DD with medium-term efficacy of CXL in halting progression of keratoconus.

Methods: The study included 124 patients (mean age 19 ± 4.8 years) with progressive keratoconus who underwent conventional (3 mW/cm2/30 min), accelerated (18 mW/cm2/5 min), or transepithelial (TE) CXL (3 mW/cm2/30 min) and followed up for at least 2 years. Baseline and final corneal topographic parameters and DD determined with anterior segment optical coherence tomography 1 month after CXL were compared among the protocols and the correlation between DD and topographic changes at the end of 24 months was analyzed. P < 0.05 was considered as statistically significant.

Results: Mean DD was significantly higher in the conventional and accelerated groups (335.19 ± 71.13 μm and 304.97 ± 94.45 μm, respectively) compared with the TE group (239.92 ± 71.37 μm) (P < 0.001). After conventional and TE CXL, keratometric parameters improved remarkably, whereas accelerated CXL only lowered K1 and Kmax (P < 0.05). No correlation was found between DD and topographic changes (P > 0.05). Progression was detected in 3 eyes in the conventional group (4.1%), 3 in the accelerated group (7.7%), and none in the TE group. The use of either riboflavin D or M made no differences in terms of DD and topographic parameters (P > 0.05).

Conclusions: In conventional and accelerated protocols, corneal stromal demarcation line is deeper compared with TE CXL; however, the DD has no correlation with topographic changes, which means that DD is not a direct measure for the efficacy of CXL.

Department of Ophthalmology, Selcuk University Faculty of Medicine, Konya, Turkey.

Correspondence: Banu Bozkurt, MD, Department of Ophthalmology, Selcuk University Faculty of Medicine, Konya, Turkey, Alaaddin Keykubat Kampüsü, Selçuklu, Konya, Türkiye 42075 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received March 25, 2018

Received in revised form July 03, 2018

Accepted July 13, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.