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D. Kampik, K. Kampik, M. Heß, G. Geerling; Results After Collagen Cross Linking With Riboflavin and Ultraviolet-A Radiation (CXL) for Keratoconus. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4339.
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Photochemical collagen crosslinking with riboflavin and UV-A radiation (CXL) is reported to strengthen the cornea in keratoconus. In a retrospective chart review we report the postoperative follow-up after corneal crosslinking of eyes with keratoconus regarding safety, side effects, visual acuity, and progression of keratectasia.
53 patients with progressive keratoconus confirmed by topography and patient history received CXL treatment. Following corneal abrasion, riboflavin 0,1% solution was applied over 30 minutes and the cornea exposed to UV-A (365 nm) for further 30 minutes (total surface dose 5,4 J/cm2). Follow-up ranged between 6 and 18 months. Outcome was evaluated by slit lamp biomicroscopy, best spectacle-corrected visual acuity (BSCVA), Placido based topography and Scheimpflug image tomography (Oculus Keratograph and Pentacam, Oculus, Germany), endothelial cell count and central corneal pachymetry.
All patients showed initial haze (maximum 1+) and increase of epithelial surface irregularity resulting in a temporary loss of vision, resolving within 2 months. Even in patients with atopic dermatitis epithelial healing was not delayed. BSCVA remained unchanged (+/- 1 line) in 36 patients (68%) or improved (2 or more lines) in 17 patients (32%), no patient lost 2 or more lines. Maximum K readings decreased from 50.1 to 49.2 D 6 months postoperatively and showed a tendency to further decrease. The maximum radius of curvature measured at the keratoconus apex initially increased for the first 2 months postoperatively by 4,5 D on average. This was followed by a decrease below the preoperative value at the 6 months postop visit (preop 55,4 D vs. 54,1 D postop). Central pachymetry and endothelial cell count did not show a statistically significant change. Corneal crosslinking showed no complications within follow-up time. Only one case showed a progression of keratoconus after crosslinking.
The data confirm CXL as a safe procedure capable of preventing progression of keratoconus. Despite transitory visual loss for 1-2 months after crosslinking, a return or slight increase of visual acuity can be expected. A longer follow-up time and a double-blind, randomized controlled trial are crucial for further assessment of this method.
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