Corneal crosslinking (CXL) with 18-mW/cm 2 irradiance and 5.4-J/cm 2 radiant exposure-early postoperative safety

Graefes Arch Clin Exp Ophthalmol. 2018 Aug;256(8):1521-1525. doi: 10.1007/s00417-018-3978-9. Epub 2018 Apr 17.

Abstract

Purpose: To investigate safety of accelerated corneal crosslinking during the first postoperative month.

Methods: In this retrospective study, 76 eyes of 60 patients with verified progressive keratectasia were enrolled in this study and followed for 1 month after accelerated CXL (18 mW/cm2 for 5 min, radiant exposure 5.4 J/cm2) (A-CXL(5*18)). Preoperatively, objective refraction, slit lamp inspection, and corneal tomography were performed. Early postoperative slit lamp examinations were performed on days 1 and 4. At 1 month, objective refraction, slit lamp inspection, and corneal tomography were performed.

Results: Gender distribution was m:f = 55:21, OD:OS was 40:36, and the average age was 26.5 ± 8.6 years at surgery. Only 71 of the 76 eyes completed the 1-month follow-up, indicating a dropout rate of 6.6%. In 7.0% (n = 5), sterile infiltrates were observed; 5.6% of eyes (n = 4) showed delayed epithelial healing (> 4 days) in 2.8% (n = 2); an infection occurred and in 1 eye (1.4%), a stromal scar was detected; no other complications, neither a loss of two or more Snellen lines at 1 month postoperatively, were observed. As a risk factor for sterile infiltrates, thin preoperative pachymetry could be identified (p = 0.027).

Conclusions: This study revealed no difference in early postoperative safety between CXL using 18 mW/cm2 and standard corneal CXL. Thinner preoperative pachymetry could be identified predicting a higher rate of postoperative sterile infiltrates.

Keywords: 18 mW; Accelerated crosslinking; Corneal crosslinking; Keratectasia; Keratokonus; Sterile infiltrate.

MeSH terms

  • Adolescent
  • Adult
  • Collagen / therapeutic use*
  • Corneal Diseases / diagnosis
  • Corneal Diseases / drug therapy*
  • Corneal Diseases / etiology
  • Corneal Pachymetry
  • Corneal Stroma / drug effects
  • Corneal Stroma / pathology*
  • Corneal Surgery, Laser / adverse effects
  • Corneal Topography
  • Cross-Linking Reagents / therapeutic use*
  • Dilatation, Pathologic / diagnosis
  • Dilatation, Pathologic / drug therapy
  • Dilatation, Pathologic / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Keratoconus / surgery
  • Male
  • Middle Aged
  • Photochemotherapy / methods*
  • Photosensitizing Agents / therapeutic use
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / drug therapy
  • Postoperative Complications* / etiology
  • Retrospective Studies
  • Riboflavin / therapeutic use*
  • Risk Factors
  • Time Factors
  • Tomography, Optical Coherence
  • Ultraviolet Rays
  • Visual Acuity
  • Young Adult

Substances

  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Collagen
  • Riboflavin