Complications of accelerated corneal collagen cross-linking: review of 2025 eyes

Çakmak, Semih; Sucu, Mehmet Emin; Yıldırım, Yusuf; Yıldız, Burçin Kepez; Kirgiz, Ahmet; Bektasoglu, Damla; Demirok, Ahmet

doi:10.1007/s10792-020-01512-3

Cited by 23 publications

(27 citation statements)

References 37 publications

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“…Over the years, several authors h potheses. According to the literature, 87 people with this procedure have been described so far [7][8][9][10][11][14][15][16][17][18][19][20][21][22][23]. Compar procedures performed in the world, it is a rare complicatio derestimated, and-according to the authors of this article pact on the method of treatment and possible late complic scribed in 2009 by Angunawela et al [7].…”

Section: Discussionmentioning

confidence: 91%

“…Few papers describing this complication have been published over the years. It is suspected that the following factors contribute to the formation of sterile infiltrates: increased response to staphylococcal antigens that accumulate in tears at the eye shield contact, causing an increased immune response [7], epithelial damage, vernal keratoconjunctivitis [8], phototoxicity of the procedure [9], thinner and steeper cornea before the procedure [10], and postoperative use of NSAIDs [11,12]. Recent studies indicate increased incidence in people with Down's syndrome [8].…”

Section: Of 10mentioning

confidence: 99%

“…It is suspected that the following factors contribute to the formation of sterile infiltrates: increased response to staphylococcal antigens that accumulate in tears at the eye shield contact, causing an increased immune response [7], epithelial damage, vernal keratoconjunctivitis [8], phototoxicity of the procedure [9], thinner and steeper cornea before the procedure [10], and postoperative use of NSAIDs [11,12]. Recent studies indicate increased incidence in people with Down's syndrome [8]. Clarification of what may be the cause of this complication will reduce the number of patients with this condition and allow for faster diagnosis and implementation of the appropriate treatment, which is different in infectious keratitis.…”

Section: Of 10mentioning

confidence: 99%

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Retrospective Analysis of Sterile Corneal Infiltrates in Patients with Keratoconus after Cross-Linking Procedure

Krok

Wróblewska‐Czajka

Kokot

et al. 2022

JCM

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Background: This paper’s objective is to analyze patients with keratoconus who developed sterile infiltrate after corneal collagen cross-linking (CXL), and to evaluate possible risk factors for their occurrence. Methods: 543 medical histories of patients after cross-linking (Epi-off, Epi-on) procedure performed according to the Dresden protocol were analyzed retrospectively. Results: Sterile corneal infiltrates occurred in four men (0.7%) in the age range (16–28) years, the average age being 20.3. The average time from procedure to onset of symptoms was 3.5 days (2–5 days). Inflammatory infiltration resolved in all patients, leaving scars on corneal stroma in two patients. Corneal healing time ranged from 4–12 weeks. In vivo confocal microscopy (IVCM), round inflammatory cells, and Langerhans cells in the epithelium and Bowman’s layer were observed at the site of infiltration. The Optical coherence tomography (OCT) shows hyperreflective lesions of various sizes which decreased over time. The corneal topographic parameters and Best-corrected visual acuity (BCVA) improved after the CXL procedure in all of the described cases. Conclusions: Most likely, damage to the epithelium and the phototoxic effect of the procedure is of significant importance in the formation of sterile corneal infiltrates. Appropriate classification and selection of CXL procedures in combination with protective measures in people at risk may have an overwhelming impact on the incidence of this complication.

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Section: Discussionmentioning

confidence: 91%

Section: Of 10mentioning

confidence: 99%

Section: Of 10mentioning

confidence: 99%

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Retrospective Analysis of Sterile Corneal Infiltrates in Patients with Keratoconus after Cross-Linking Procedure

Krok

Wróblewska‐Czajka

Kokot

et al. 2022

JCM

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“…Other complications described after A-CXL are delayed epithelial healing, sterile infiltrates, infectious keratitis, scarring or the loss of visual acuity [14,22].…”

Section: Complications and Side Effects Of A-cxlmentioning

confidence: 99%

Accelerated Crosslinking: The New Epithelium-Off

Raiskup

Herber

2021

Keratoconus

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One major disadvantage of the standard corneal crosslinking (S-CXL) procedure so far is the long total treatment time of 1 hour in case of considering only "pure incision-suture" time. Taking into account the time of patient´s preparation before the procedure and follow-up of patient immediately after the crosslinking, is the duration of the actual personnel engagement in only one case even longer than one hour. Therefore, in order to increase patient's comfort and the surgeon's workflow in a clinical practice, a shorter CXL procedure would be desirable.

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“…Since hydrophilic riboflavin cannot penetrate the intact hydrophobic corneal epithelium due to its chemical properties, in current standard CXL epithelium-off (Epi-off) techniques, the central corneal epithelium is mechanically debrided to allow sufficient riboflavin stromal imbibition with potential complications [32][33][34].…”

Section: Introductionmentioning

confidence: 99%

Chemically-Boosted Corneal Cross-Linking for the Treatment of Keratoconus through a Riboflavin 0.25% Optimized Solution with High Superoxide Anion Release

Mazzotta

Ferrise

Gabriele

et al. 2021

JCM

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The purpose of this study was to evaluate the effectiveness and safety of a novel buffered riboflavin solution approved for corneal cross-linking (CXL) in progressive keratoconus and secondary corneal ectasia. Following the in vivo preclinical study performed on New Zealand rabbits comparing the novel 0.25% riboflavin solution (Safecross®) containing 1% hydroxypropyl methylcellulose (HPMC) with a 0.25% riboflavin solution containing 0.10% EDTA, accelerated epithelium-off CXL was performed on 10 patients (10 eyes treated, with the contralateral eye used as control) through UV-A at a power setting of 9 mW/cm2 with a total dose of 5.4 J/cm2. Re-epithelialization was evaluated in the postoperative 7 days by fluorescein dye test at biomicroscopy; endothelial cell count and morphology (ECD) were analyzed by specular microscopy at the 1st and 6th month of follow-up and demarcation line depth (DLD) measured by anterior segment optical coherence tomography (AS-OCT) one month after the treatment. We observed complete re-epithelization in all eyes between 72 and 96 h after surgery (88 h on average). ECD and morphology remained unchanged in all eyes. DLD was detected at a mean depth of 362 ± 50 µm, 20% over solutions with equivalent dosage. SafeCross® riboflavin solution chemically-boosted corneal cross-linking seems to optimize CXL oxidative reaction by higher superoxide anion release, improving DLD by a factor of 20%, without adverse events for corneal endothelium.

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Complications of accelerated corneal collagen cross-linking: review of 2025 eyes

Cited by 23 publications

References 37 publications

Retrospective Analysis of Sterile Corneal Infiltrates in Patients with Keratoconus after Cross-Linking Procedure

Retrospective Analysis of Sterile Corneal Infiltrates in Patients with Keratoconus after Cross-Linking Procedure

Accelerated Crosslinking: The New Epithelium-Off

Chemically-Boosted Corneal Cross-Linking for the Treatment of Keratoconus through a Riboflavin 0.25% Optimized Solution with High Superoxide Anion Release

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