Stromal haze after combined riboflavin‐UVA corneal collagen cross‐linking in keratoconus: in vivo confocal microscopic evaluation

Abstract

The technique of corneal collagen cross-linking consists of photopolymerization of stromal fibres by the combined action of a photosensitizing substance (riboflavin or vitamin B2) and ultraviolet light from a solid state UVA source. Photopolymerization increases the rigidity of corneal collagen and its resistance to keratectasia. In this report we present two cases, studied through in vivo confocal microscopy, with stage III keratoconus that developed stromal haze after the cross-linking treatment.

Effects and adverse events after CXL for keratoconus are independent of age: a 1-year follow-up study

“…Despite the overall enthusiasm for offering CXL to KC patients, adverse events have been incompletely assessed in the literature. 13,14 Koller et al 9 reported an overall adverse event rate of 2.9% in 105 eyes, and identified age Z35 years as the most important independent risk factor for adverse events after CXL. However, this findings needs to be interpreted cautiously, because, given the figures provided in the paper, the estimated number of eyes in patients aged 435 years enrolled in the Koller study was only 15 with 2 failures, corresponding to a mean probability of 0.13 and a binomial exact 95% CI of 0.02-0.40.…”

Corneal Collagen Crosslinking with Riboflavin and Ultraviolet - A Irradiation in the Management of Progressive Ectatic Corneal Disorders. Review Article

“…All trials have indicated a time-dependence of the effects of CXL, both in terms of transient haze 54 and edema in the early stages, as well as in refractive outcome, which seems to improve over the first year or more following treatment 26,30,31,[51][52] .…”

Etiology and Clinical Presentation of Astigmatism

“…Despite the fact that no sight-threatening complications were recorded in the large prospective studies, there are some sporadic reports of stromal haze resistant to topical steroid treatment (Mazzota et al, 2007), diffuse lamellar keratitis in post-LASIK ectasia, herpetic keratitis and iritis , Acanthamoeba keratitis with corneal perforation (Rama et al, 2009), and microbial keratitis (Pollhammer & Cursiefen, 2009;Zamora & Males, 2009). Other potential complications include delay in reepithelization, sterile infiltrates, potential for induction of herpes simples virus and dendritic ulcer, and ocular surface disorders and tear dysfunction (Corkin, 2009).…”