Two-to-three-year effectiveness and safety of nurse-led accelerated corneal crosslinking for progressive keratoconus: The Birmingham and Midland Eye Centre Study
Khan, Murad Sahota, Rashvinder Cabdi, Yasmin Bourlaki, Marianthi Bunce, Catey Aralikatti, Anil Barua, Ankur
Khan, Murad
Sahota, Rashvinder
Cabdi, Yasmin
Bourlaki, Marianthi
Bunce, Catey
Aralikatti, Anil
Barua, Ankur
Abstract
Background/objectives: To examine the two-to-three-year effectiveness and safety of accelerated corneal crosslinking (CXL) treatment performed by ophthalmic nurses for progressive keratoconus and to evaluate the potential prognostic factors for disease progression. Methods: All consecutive eligible patients with progressive keratoconus who underwent nurse-led CXL between February 2019 and December 2021 at the Birmingham and Midland Eye Centre, UK, were included. A standardised accelerated, epithelium-off CXL protocol was employed, using 10 mW/cm2 ultraviolet-A irradiation for 9 min (5.4 J/cm2). Relevant data, including demographics, corrected-distance-visual-acuity (CDVA), corneal tomographic findings, outcomes and adverse event, were analysed. Only patients that had completed at least a 2-year follow-up post-CXL were included. Results: We included 97 patients (n = 97 eyes); mean age was 26.4±6.5 years and 52.6% were female. Most patients had mild (stage I) keratoconus (49.5%). From baseline to 24-month post-CXL (n = 97 eyes), there was a significant improvement in CDVA, (0.30 ± 0.22 logMAR vs. 0.20±0.18 logMAR; p < 0.001) and Kmax (59.1±6.8 D vs. 58.1±6.4 D; p < 0.001), with similar K1, K2 and thinnest corneal pachymetry (all p > 0.05). There were three (3.1%) cases of clinically significant transient corneal haze noted at 1-week post-CXL. No significant adverse events such as corneal infection/melting were observed. At 36-month post-CXL (n = 31 eyes), the CDVA remained stable, with a significant improvement in Kmax (p < 0.001) and K2 measurements (p = 0.038) from baseline. Conclusions: This study highlights the efficacy, safety and feasibility of nurse-led CXL, serving as a valuable initiative in addressing the increased service demand for keratoconus management and preserving the vision of patients with keratoconus.
MIDER Authors
Khan, Murad
Sahota, Rashvinder
Hanson, Joan
Marianthi, Bourlaki
Anil, Aralikatti
Ting, Darren Shu Jeng
Barua, Ankur
Sahota, Rashvinder
Hanson, Joan
Marianthi, Bourlaki
Anil, Aralikatti
Ting, Darren Shu Jeng
Barua, Ankur
Affiliations
Sandwell and West Birmingham NHS Trust; University of Birmingham; London School of Hygiene & Tropical Medicine; University of Nottingham
Date
2026-02-09
Type
Article
Subject
Collections
Citation
Khan M, Sahota R, Hanson J, Cabdi Y, Bourlaki M, Bunce C, Aralikatti A, Barua A, Ting DSJ. Two-to-three-year effectiveness and safety of nurse-led accelerated corneal crosslinking for progressive keratoconus: The Birmingham and Midland Eye Centre Study. Eye Open. 2026;2(1):6. doi: 10.1038/s44440-026-00013-z. Epub 2026 Feb 9