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Moritz Pettenkofer, Isaak Raphael Fischinger, Theo G Seiler, Karthiga Santhirasegaram, Daniel Zapp, Chris Lohmann; Early postoperative complications and efficacy of accelerated corneal crosslinking with 18mW/cm2 during the 1st postoperative year. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3016.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate safety and efficacy of accelerated corneal crosslinking with 18mW/cm2 during the 1st postoperative year.
In a retrospective study, 68 eyes of 52 patients which had a verified progressive keratectasia received accelerated CXL (18mW/cm² for 5 min, total energy 5.4 J/cm²) and were followed for at least 1 month up to 2 years. Preoperatively, objective refraction, slit lamp inspection, topography, tomography and AS-OCT were performed. Early postoperative slit lamp examinations were performed at day 1 and 4 as well as at 1 month. 25 eyes completed the 1-year follow up. Objective refraction, slit lamp inspection, corneal topography and tomography were performed. Statistical analysis included U-tests to detect risk-factors for complications and Wilcoxon-test to prove significance in 1-year changes. Significance was assumed if p<0.05.
Gender distribution was m:f = 47:21, OD:OS was 37:31 and the average age was 28 ± 8 years at surgery. 66 of the 68 eyes completed the 1-month follow-up. In 7.6 % (n=5) of the eyes sterile infiltrates were observed and in 4.6% of eyes (n=3) delayed epithelial healing occurred. One eye showed an infection, no other severe complications and no loss of 2 or more Snellen lines at 1 month postoperatively were observed. Of the preoperatively collected parameters the only significant risk factor for complications was a thin preoperative pachymetry which correlated with sterile infiltrates (p=0.03).<br /> AS-OCT showed a demarcation line at a depth of 216 ± 46 µm.<br /> 30 eyes completed the 12-month follow up. An average decrease of Kmax of -0.7 ± 1.3D (p=0.09) was observed. Pachymetry did not change significantly (p=0.11). The difference in Kmax was only correlated to preoperative Kmax (p=0.03) and Qant (p=0.02).
There is no difference regarding early postoperative complication rate compared to standard corneal cross linking. Thin preoperative pachymetry could be identified predicting complications. Efficacy of the analysed 30 eyes is comparable in terms of regression and tomographic changed to conventional CXL. As treatment time is shortened due to the higher energy fluency, it is more convenient for patients and reduces exposure time of the treated eye.
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