Dramatic Reduction in Corneal Transplants for Keratoconus 15 Years After the Introduction of Corneal Collagen Crosslinking

Abstract

Purpose: The aim of this study was to investigate the effect of the implementation of corneal collagen crosslinking (CXL) on the frequency of corneal transplants among patients with keratoconus (KC) in the same region. Methods: Before the introduction of CXL in 2007, 55 primary corneal transplants had been conducted in patients with KC (2005 and 2006) at the Department of Ophthalmology, Oslo University Hospital, Norway. We collected data from our corneal transplant registry for 2021 and 2022. The primary outcome was the number of corneal transplants performed in patients with KC. Age, sex, visual acuity (logarithm of the minimal angle of resolution), KC stage according to the Amsler–Krumeich classification system, and steepest keratometry reading (maximum keratometry, Pentacam, HR) were recorded. Furthermore, we registered the annual number of CXL treatments conducted from 2007 to 2022. Results: A total of 352 corneal transplants were performed in 2021 and 2022. Among them, 11 (3.1%) were transplants for patients with KC. All included patients were male; further, 90.1% and 9.1% of the patients were graded stages 4 and 3, respectively. The mean maximum keratometry was 79.0 diopter (range 61.0–109). The mean best-corrected visual acuity (logarithm of the minimal angle of resolution) was 1.3 (range 0.2–3.0). In 2021 to 2022, 431 CXL treatments were performed. Conclusions: There was a significant decrease in the number of corneal transplants performed in patients with KC 15 years after the introduction of CXL. This indicates that the availability of CXL treatment over many years may considerably reduce the need for keratoplasties in this group of patients.

Prevalence of Keratoconus in the Young Eastern Population of Saudi Arabia

“…In 2003, a novel treatment known as corneal collagen crosslinking was introduced, effectively strengthening the cornea and stabilizing the disease [ 8 ]. This treatment has globally reduced the need for corneal transplantation, as recent data indicates [ 9 - 10 ]. Early diagnosis, especially with the availability of cross-linking treatment, is critical to preventing further vision impairment.…”

A Safe and Effective New Method for Thin Cornea Cross-linking

“…Therefore, induction of cross-links in corneal tissue by riboflavin/ultraviolet A (UVA) is used as a conservative treatment to increase the stiffness of the cornea with ectasia diseases [4][5][6]. Although the introduction of corneal cross-linking (CXL) significantly decreases the incidence of corneal transplantation [7], multiple complications limit its implementation in patients. One primary concern is the usage of high-energy UVA for CXL, which could potentially damage limbal stem cells and corneal endothelium [6] and thus cause corneal edema, haze, and scarring.…”