Complication and failure rates after corneal crosslinking

J Cataract Refract Surg. 2009 Aug;35(8):1358-62. doi: 10.1016/j.jcrs.2009.03.035.


Purpose: To evaluate the complication rate of corneal crosslinking (CXL) for primary keratectasia and to develop recommendations for avoiding complications.

Setting: Institut für Refraktive und Ophthalmo-Chirurgie, Zurich, Switzerland.

Methods: In a prospective study, eyes with verified progressive keratectasia had standard CXL. Preoperative and 6- and 12-month postoperative examinations included corrected distance visual acuity (CDVA), slitlamp evaluation, applanation tonometry, and Scheimpflug imaging (Pentacam). Statistical analysis included analysis of variance and the Mann-Whitney U test to detect risk factors for complications.

Results: The study evaluated 117 eyes of 99 patients; approximately 90% completed the 12-month follow-up. The complication rate (percentage of eyes losing 2 or more Snellen lines) was 2.9% (95% confidence interval, 0.6%-8.5%). The failure rate of CXL (percentage of eyes with continued progression) was 7.6%. Age older than 35 years and a preoperative CDVA better than 20/25 were identified as significant risk factors for complications. A high preoperative maximum keratometry (K) reading was a significant risk factor for failure. Sterile infiltrates were seen in 7.6% of eyes and central stromal scars, in 2.8%.

Conclusions: Results indicate that changing the inclusion criteria may significantly reduce the complications and failures of CXL. A preoperative maximum K reading less than 58.00 diopters may reduce the failure rate to less than 3%, and restricting patient age to younger than 35 years may reduce the complication rate to 1%.

MeSH terms

  • Adult
  • Collagen / metabolism*
  • Corneal Stroma / metabolism*
  • Corneal Stroma / physiopathology
  • Corneal Topography
  • Dilatation, Pathologic / drug therapy
  • Dilatation, Pathologic / metabolism
  • Dilatation, Pathologic / physiopathology
  • Disease Progression
  • Female
  • Humans
  • Keratoconus / drug therapy*
  • Keratoconus / metabolism
  • Keratoconus / physiopathology
  • Male
  • Photochemotherapy / adverse effects*
  • Photosensitizing Agents / therapeutic use
  • Postoperative Complications*
  • Prospective Studies
  • Refraction, Ocular / physiology
  • Riboflavin / therapeutic use
  • Risk Factors
  • Treatment Failure
  • Ultraviolet Rays
  • Visual Acuity / physiology


  • Photosensitizing Agents
  • Collagen
  • Riboflavin