Clinical Experience with Scleral Lens Wear After Corneal Cross-Linking in Keratoconus: Longitudinal Keratometric Outcomes

Objectives: To investigate the effectiveness of scleral lenses following corneal cross-linking (CXL) in patients with progressive keratoconus. Methods: This retrospective study analyzed patients with keratoconus who underwent CXL and subsequently used scleral lenses for at least one year. A total of 21 patients (23 eyes) with progressive keratoconus were included. CXL was performed using the epithelium-off cross-linking technique following the Dresden protocol. Corneal astigmatism (CA), white-to-white distance, thinnest corneal thickness, and central corneal thickness (CCT) were assessed using corneal topography and tomography. Data were collected before CXL, at one month postoperatively, at the time of scleral lens prescription, and at 1, 3, 6, and 12 months after scleral lens use. Results: The mean age of the patients was 24.6 ± 4.6 years. The baseline uncorrected visual acuity (logMAR) before CXL was 1.05 ± 0.52. The baseline Kmax and CA were 53.01 ± 6.99 and −5.83 ± 3.23 D, respectively. The mean CCT was 444.09 ± 61.82 µm. The mean interval between CXL and scleral lens prescription was 6.75 ± 8.49 months. Following CXL, the Kmean decreased from 49.61 to 45.79 (p = 0.056), Kmax decreased from 53.01 to 51.32 (p = 0.053), and CA decreased from −5.83 to −4.91 D (p = 0.051), albeit statistically non-significant. At the 12-month follow-up after scleral lens prescription, Kmean and Kmax values remained stable, indicating no disease progression. Compared with baseline values before CXL, Kmean, Kmax, and CA were significantly reduced at the 12-month follow-up after scleral lens prescription (p = 0.047, p = 0.049, and p = 0.042, respectively). Scleral lens-corrected visual acuity was significantly better than habitual corrected visual acuity at all follow-up time points. Conclusions: Scleral lens application following CXL was associated with improved corrected visual acuity, and corneal keratometric values remained stable during lens wear.