Keratopathy After Cross-linking for Keratoconus

Rodríguez-Ausín, P.; Gutiérrez-Ortega, Ramón; Arance-Gil, Ángeles; Romero-Jiménez, Miguel; Fuentes-Páez, Graciana

doi:10.1097/ico.0b013e3182096789

Cited by 22 publications

(14 citation statements)

References 20 publications

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“…Raiskup-Wolf et al 17 found a failure rate of 14% at 12 months, defined as progression of K-max by at least 0.5 D. Wittig-Silva et al 3 had a smaller failure rate of 2.4%, but this was defined as progression by 2 D at 36 months. 3,21,29,30 However, serious microbial keratitis can develop with a range of pathogens, such as Pseudomonas, Escherichia Coli, Staphylococcus aureus, Acanthamoeba, and Fusarium species, having been implicated. To put the failure rates into perspective, we must bear in mind the natural progression history of keratoconus.…”

Section: Safety Conventional Low-fluence Collagen Cross-linkingmentioning

confidence: 99%

Conventional Versus Accelerated Collagen Cross-Linking for Keratoconus

Konstantopoulos

Mehta

2015

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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: Collagen cross-linking (CXL) is a procedure that primarily aims to increase corneal stiffness. Although used for a variety of conditions, it is most commonly applied to the treatment of keratoconus. Collagen cross-linking involves irradiation of the cornea with ultraviolet A (UVA) irradiation after it has been soaked with riboflavin (vitamin B), a photosensitizer. In conventional treatment, based on the Dresden protocol, a minimum corneal thickness threshold of 400 μm is recommended and UVA (370 nm) irradiation of 3 mW/cm irradiance is applied for 30 min, resulting in a cumulative dose of 5.4 J/cm. Evidence presented in this review shows that conventional CXL stabilizes the vision and corneal topographic parameters in the majority of treated patients, with only a small failure rate. It has a good safety profile with no endothelial cell loss and a small risk of corneal infiltration and infection. To reduce the treatment duration, accelerated protocols of similar efficacy have been sought. In accelerated protocols, UVA irradiation of higher irradiance, typically 9 mW/cm, is applied for a shorter time, typically 10 min. The evidence, limited to small studies with short follow-up, shows that they may also stabilize the vision and the ectasia, with no additional safety concerns highlighted. Randomized controlled studies are, however, required to confirm the encouraging results and noninferiority to conventional treatment.

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Section: Safety Conventional Low-fluence Collagen Cross-linkingmentioning

confidence: 99%

Conventional Versus Accelerated Collagen Cross-Linking for Keratoconus

Konstantopoulos

Mehta

2015

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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“…One of the most common complications appears to be the development of sterile corneal infiltrates (Figure ). These have been seen in up to 7.6 per cent of cases and resolve with an increase in topical steroid therapy but sometimes leaving a residual scar .…”

Section: Adverse Effects and Safetymentioning

confidence: 99%

“…With a rapidly increasing number of cross-linking procedures being performed around the world, there is an increasing number of reports 29,32,34,36,45,[70][71][72][73][74][75][76][77][78][79][80][81][82][83] of adverse events, which are outlined in Table 2. While a minor degree of stromal oedema seen on slitlamp examination may be seen in up to 70 per cent of patients in the first month and a temporary haze in 9.8 per cent 32 (Figure 4), more significant stromal haze has been reported in up to 8.6 per cent of treated eyes and may persist for up to six months.…”

Section: Adverse Effects and Safetymentioning

confidence: 99%

“…71 Other reported complications have included recurrent erosion syndrome, 38 corneal oedema, 34,36,70 Desçemets membrane folds, 29 corneal melting and perforation. 81,82 One of the most common complications appears to be the development of sterile corneal infiltrates [72][73][74][75] (Figure 5). These have been seen in up to 7.6 per cent of cases and resolve with an increase in topical steroid therapy but sometimes leaving a residual scar.…”

Section: Adverse Effects and Safetymentioning

confidence: 99%

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Current status of corneal collagen cross‐linking for keratoconus: a review

Chan

Snibson

2013

Clinical and Experimental Optometry

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Over the past decade, corneal collagen cross-linking has become commonplace as a treatment option for individuals with progressive keratoconus. This is based on laboratory data suggesting that cross-linking using riboflavin and ultraviolet-A irradiation increases collagen diameter and the biomechanical strength of the treated cornea. Case series and limited randomised controlled trials support these findings with data demonstrating that cross-linking slows and possibly halts the progression of keratoconus. In some patients cross-linking results in an improvement in maximum corneal curvature, visual acuity, spherical equivalent and higher-order aberrations. The number of reported complications is small. More recently, variations in the treatment protocol have been described, although they have not yet been subject to comparative studies. While the published data indicate cross-linking is effective in modifying the natural history of keratoconus, the long-term impact of this treatment is still unknown. This paper reviews the theoretical basis, pre-clinical research and clinical results of corneal collagen cross-linking in keratoconus.

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“…More recently, 2 cases of keratopathy have been reported after uneventful CXL for grade 3 keratoconus [122]. The pathogenesis in these cases remained unidentified.…”

Section: Complications After CXLmentioning

confidence: 99%

Collagen Cross-Linking: Current Status and Future Directions

Hovakimyan

Guthoff

Stachs

2012

Journal of Ophthalmology

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Collagen cross-linking (CXL) using UVA light and riboflavin (vitamin B2) was introduced as a clinical application to stabilize the cornea by inducing cross-links within and between collagen fibers. CXL has been investigated extensively and has been shown clinically to arrest the progression of keratoconic or post-LASIK ectasia. With its minimal cost, simplicity, and proven positive clinical outcome, CXL can be regarded as a useful approach to reduce the number of penetrating keratoplasties performed. Small case series have also indicated that CXL is beneficial in corneal edema by reducing stromal swelling behavior and in keratitis by inhibiting pathogen growth. Despite these encouraging results, CXL remains a relatively new method that is potentially associated with complications. Aspects such as side effects and recurrence rates have still to be elucidated. In light of the growing interest in CXL, our paper summarizes present knowledge about this promising approach. We have intentionally endeavored to include the more relevant studies from the recent literature to provide an overview of the current status of CXL.

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Keratopathy After Cross-linking for Keratoconus

Abstract: Cross-linking associated with sterile keratitis is an unusual entity of unknown etiology, which can lead to stromal scarring.

Cited by 22 publications

References 20 publications

Conventional Versus Accelerated Collagen Cross-Linking for Keratoconus

Conventional Versus Accelerated Collagen Cross-Linking for Keratoconus

Current status of corneal collagen cross‐linking for keratoconus: a review

Collagen Cross-Linking: Current Status and Future Directions

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