Treatment of bullous keratopathy with corneal collagen cross-linking in two dogs

Vet Ophthalmol. 2015 Mar;18(2):168-73. doi: 10.1111/vop.12137. Epub 2013 Dec 30.


Objective: Corneal collagen cross-linking with riboflavin and UV-A (CXL) decreases corneal oedema and increases visual acuity in human patients with bullous keratopathy. Presumed mechanisms are an increase in collagen packing density and a reduction in stromal swelling pressure. We present two cases in which CXL was used to treat bullous keratopathy in dogs.

Procedures: Four eyes of two dogs with painful bullous keratopathy-induced corneal erosions that were resistant to prior therapy were treated with CXL. Both corneas of the second patient were dehydrated to ± 400 μm corneal thickness using topical 70% glycerol solution immediately prior to CXL. Follow-up included slit-lamp examination, fluorescein staining and photographic documentation in both cases and high-resolution ultrasound examination in the second patient.

Results: All four eyes were comfortable and fluorescein negative at 1-week post-CXL and remained so for the rest of the follow-up period (17.5 months for case 1 and 6 months for case 2). The owner of the first patient reported a less oedematous cornea and improvement in vision that lasted for 6 months. Despite a reported lack of improvement in vision in the second patient, corneal thickness initially decreased, but was back at baseline thickness at the 4-month recheck.

Conclusions: Similar to humans, CXL might become a useful treatment option for bullous keratopathy-induced therapy-resistant corneal erosions in dogs. Patient comfort was greatly improved, but corneal thickness decrease was not as long-lasting as reported for humans. The presently used protocols might need modification to fit the dog cornea.

Keywords: bullous keratopathy; cornea; corneal collagen cross-linking; dog; endothelial decompensation; oedema.

Publication types

  • Case Reports

MeSH terms

  • Animals
  • Blister / therapy
  • Blister / veterinary*
  • Collagen*
  • Corneal Diseases / therapy
  • Corneal Diseases / veterinary*
  • Dog Diseases / therapy*
  • Dogs
  • Female
  • Male
  • Riboflavin / administration & dosage
  • Riboflavin / pharmacology*
  • Ultraviolet Therapy / veterinary*


  • Collagen
  • Riboflavin