Original articlePersistent Corneal Edema after Collagen Cross-Linking for Keratoconus
Section snippets
Methods
After approval from the Cornea Centre Institutional Review Board, a retrospective chart review of all patients treated with CXL for progressive keratoconus from July 1, 2008, through June 30, 2011, was conducted. These charts were reviewed for any complications of the treatment. Patients who were treated for persistent stromal haze were excluded from the study. Patients in whom corneal edema developed that persisted for more than 3 weeks were included in the study.
Data acquisition included
Results
Of the 520 charts of patients with progressive keratoconus that were reviewed, 350 consecutive patients received CXL from a referring ophthalmologist. Of these, postoperative corneal edema developed in 10 (10/350; 2.9%). Three patients (3/350; 0.9%) were excluded: 1 because of stromal haze, 1 because of infectious keratitis without corneal edema, and 1 because of corneal melt. No intraoperative complications were noted at the time of CXL treatment. The average age was 22 ± 5 years (range, 16 to
Discussion
CXL has been reported to be a safe and effective treatment to increase the biomechanical strength of the cornea in keratoconus patients.18, 19 The combined use of ultraviolet A irradiation with riboflavin decreases the cytotoxic irradiance level to 10 times lower than that of ultraviolet A irradiation alone.20 Studies have shown that the standard surface ultraviolet A irradiance of 3 mW/cm2 penetrates human keratocytes up to a depth of 300 μm.20 At the endothelial level, the irradiance is
Ashok Sharma is the Director of Cornea Centre in Chandigarh, India, where he has served on the faculty for 11 years. He is also the founder and honorary secretary of Eye Bank Society, Chandigarh, India, and has over 80 peer-reviewed publications. Dr Sharma also received the Achievement Award and the International Ophthalmologist Education Award from the American Academy of Ophthalmology. His research interests include cornea and external diseases.
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Paediatric cornea crosslinking current strategies: A review
2023, Advances in Ophthalmology Practice and ResearchAcute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus
2022, American Journal of Ophthalmology Case ReportsCitation Excerpt :In such chases an anterior segment OCT can be helpful to reveal stromal thinning. Preoperative pachymetry lower than 400 μm was suspected as a potential risk factor by Sharma et al.20 Thus both of our cases were imbibed with hypoosmolar riboflavin to induce swelling prior to UV-A-irradiation, as described to be safe in a series of 20 patients by Hafezi et al. Thinnest pachymetries in their cases were between 362 and 448 μm.21
Ruthenium-induced corneal collagen crosslinking under visible light
2022, Acta BiomaterialiaEpithelium-Off vs. transepithelial corneal collagen crosslinking in progressive keratoconus: 3 years of follow-up
2021, Journal of OptometryCitation Excerpt :In our study, no significant differences were found in terms of astigmatism, posterior elevation, or corneal volume. Even though the most frequent postoperative complications after the epi-off CXL technique are infection,34 persistent corneal edema35 and the need for keratoplasty,36 our study did not reveal a difference between the group treated with epi-off CXL and treatment with transepithelial CXL, as in other works.8,25 This may be due to the fact that patients were treated in the early stages of keratoconus and the sample size was not too big, which suggests that a larger number of subjects may be needed to be able to compare the rate of postoperative complications between CXL techniques
Corneal crosslinking: Current protocols and clinical approach
2019, Journal of Cataract and Refractive SurgeryCitation Excerpt :Other possible causative factors include the delivery of excessive energy resulting from incorrect UVA light focus or calibration, a lack of or error in pachymetry reading during surgery, acute hydrops, and preexisting Fuchs endothelial dystrophy.82,84 Corneal crosslinking can also reactivate viral infections, such as herpes simplex, zoster, and cytomegalovirus and/or activate the host immune response, starting an endothelial inflammatory process.83 Patients with progressive keratoconus might have a reduced quality of life and require corneal transplantation to restore vision.
Ashok Sharma is the Director of Cornea Centre in Chandigarh, India, where he has served on the faculty for 11 years. He is also the founder and honorary secretary of Eye Bank Society, Chandigarh, India, and has over 80 peer-reviewed publications. Dr Sharma also received the Achievement Award and the International Ophthalmologist Education Award from the American Academy of Ophthalmology. His research interests include cornea and external diseases.