VISUAL IMPROVEMENTS AND CORNEAL STABILIZATION FOLLOWING CORNEAL CROSS-LINKING (CXL) IN PATIENTS WITH KERATOCONUS: AN OBSERVATIONAL PROSPECTIVE STUDY.

Background: Corneal cross-linking (CXL) is a well-established treatment that halts the progression of keratoconus, a disease characterized by an irregular curvature and thinning of the cornea. The method strengthens corneal biomechanical rigidity through a photochemical interaction between riboflavin (vitamin B2) and UV-A light irradiation, thereby stabilizing the corneal structure. Although CXL is primarily used to halt disease progression, many patients also experience improvements in corneal curvature and visual acuity. Objectives: to evaluate the 12-month visual and topographical outcomes in patients with keratoconus treated with corneal cross-linking, by measuring uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal topography, and maximum keratometry (K-max). Study Design: An observational prospective study. Place and Duration of study: Department of Ophthalmology, Gaju Khan Medical College, Sawabi. The study was carried out over one year, from January 2023 to January 2024.   Methods: In this prospective study, 100 patients diagnosed with progressive keratoconus were recruited to evaluate the outcomes of CXL. Postoperative parameters were analyzed at 1, 3, 6, and 12 months, including K-max, corneal topography, UDVA, and CDVA. Topography was performed using a standardized topography system. Quantitative data analysis was performed using paired t-tests, and a p-value <0.05 was considered statistically significant. Results: There were 100 patients (62 men and 38 women), with a mean age of 24.6 ± 4.8 years. Both UDVA and CDVA improved significantly over the 12-month follow-up period. The mean K-max decreased from a preoperative value of 54.2 ± 3.1 D to 52.5 ± 3.0 D postoperatively (p = 0.002). Seventy-two percent of patients showed stabilization or improvement in both keratometric and visual parameters. There were no instances of keratoconus progression and no serious adverse effects. Conclusion: Corneal cross-linking is successful in halting the progression of keratoconus and, for a significant number of patients, yields meaningful improvement in visual function. Corneal flattening and improved vision were observed in most subjects. The procedure demonstrated a favourable safety profile with no significant complications. The most favourable outcomes were seen in patients treated at an early stage of the disease. CXL remains a cornerstone in the management and visual rehabilitation of keratoconus, especially when used in the early phase.