Does Corneal Collagen Cross-linking Reduce the Need for Keratoplasties in Patients With Keratoconus?

Abstract

The frequency of keratoplasty for keratoconus has been more than halved in our department over the last decade. There is reason to believe that this reduction is for a great part caused by the introduction of CXL treatment.

Nationwide reduction in the number of corneal transplantations for keratoconus following the implementation of cross‐linking

“…The ability to minimize the need for corneal transplantation is highly relevant, as this procedure is invasive and carries a significant risk of postoperative complications, including graft rejection, graft failure, secondary glaucoma, and cataract (Borderie et al 2012). Our results at the nationwide level are consistent with a recent report by Sandvik et al (2015), who described a similar correlation between CXL and corneal transplantation, albeit on a local scale.…”

“…In a recent study performed on a local scale, Sandvik et al (2015) suggested that the introduction of CXL was the principal underlying factor responsible for the recent reduction in keratoplasties for treating keratoconus. This finding prompted us to investigate whether the introduction of CXL has reduced the number of corneal transplantation surgeries performed in patients with keratoconus throughout the Netherlands.…”

Establishing Corneal Cross-Linking With Riboflavin and UV-A in the Mouse Cornea In Vivo: Biomechanical Analysis

“…7 A few years only after successful introduction of CXL into clinical ophthalmology, 8 the frequency of penetrating keratoplasties has been considerably reduced. 9 Although already used extensively in clinical practice, CXL remains a relatively new technique needing further optimization. A number of new clinical treatment protocols have emerged in the past few years and have rapidly been used clinically without proper laboratory validation.…”

Corneal Cross-Linking for Pediatric Keratoconus

“…One of the principal advantages of CXL is that it minimizes the need for corneal transplantation. Indeed, the link between cross-linking and the reduced need for keratoplasty was reported recently by Sandvik et al 30 Hersh et al performed a randomized trial and reported that only 10% of patients (5/49) had progressive keratoconic disease (ie, Kmax progression $1.0 D) despite treatment. 9 Furthermore, Wittig-Silva et al 10 reported that only 2% of patients (1/46) had disease progression after undergoing cross-linking; it is worth noting, however, that their definition of progression was $2.0 D. The prevalence of progression was much higher in our pediatric cohort than in the aforementioned studies in adults, which suggests *Indicates statistical significance (P , 0.05).…”