Pulsed accelerated CXL may provide better outcomes
This single-center, the retrospective study compares the outcomes of pulsed and continuous accelerated crosslinking (CXL) for keratoconus. Twenty-five eyes in the pulsed CXL group received 8 minutes of 1 second on/1 second off CXL at 7.2 J/cm2 while 20 eyes in the continuous CXL group received 4 minutes of continuous CXL at 7.2 J/cm2. Outcome measures included change in UDVA, CDVA, spherical equivalent, keratometry, corneal thinness, corneal densitometry, and demarcation line at 1 year.

Neither group showed a change in UDVA or CDVA. The pulsed group demonstrated significant improvement in spherical equivalent while the continuous group remained unchanged. Both groups had statistically significant improvement in keratometry, but the pulsed group's improvement was significantly greater for some values. Similarly, both groups showed significant decreases in corneal thickness, but the pulsed-CXL group had significantly slimmer thinnest corneal thickness. Although data were not available for all subjects, the pulsed group had a significantly greater change in densitometry and deeper demarcation line. Although this study has significant limitations, it is valuable as clinicians continue to determine the best method for crosslinking.