May 2008
Volume 49, Issue 13
ARVO Annual Meeting Abstract  |   May 2008
Results After Collagen Cross Linking With Riboflavin and Ultraviolet-A Radiation (CXL) for Keratoconus
Author Affiliations & Notes
  • D. Kampik
    University Eye Hospital Wurzburg, Wurzburg, Germany
  • K. Kampik
    University Eye Hospital Wurzburg, Wurzburg, Germany
  • M. Heß
    University Eye Hospital Wurzburg, Wurzburg, Germany
  • G. Geerling
    University Eye Hospital Wurzburg, Wurzburg, Germany
  • Footnotes
    Commercial Relationships  D. Kampik, None; K. Kampik, None; M. Heß, None; G. Geerling, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 4339. doi:
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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. doi:

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : 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.

Methods: : 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.

Results: : 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.

Conclusions: : 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.

Keywords: cornea: clinical science • keratoconus • cornea: stroma and keratocytes 

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