Rate of Corneal Collagen Crosslinking Redo in Private Practice: Risk Factors and Safety

Abstract

Objective. To report the rate of progression of keratectasia after primary crosslinking (CXL) and evaluate the safety and efficiency of CXL redo. Materials and Methods. We conducted a retrospective analysis of the patients who underwent CXL between 2010 and 2013 at the Beirut Eye Specialist Hospital, Lebanon. Progression of keratectasia was based on the presence of an increase in maximum keratometry of 1.00 D, a change in the map difference between two consecutive topographies of 1.00 D, a deterioration of visual acuity, or any change in the refraction. Primary and redo CXL were done using the same protocol. Results. Among the 221 eyes of 130 patients who underwent CXL, 7 eyes (3.17%) of five patients met the criteria of progression. All patients reported a history of allergic conjunctivitis and eye rubbing and progressed within 9 to 48 months. No complications were noted and all patients were stable 1 year after CXL redo. Conclusion. Allergic conjunctivitis and eye rubbing were the only risk factors associated with keratoconus progression after CXL. A close followup is thus mandatory, even years after the procedure. CXL redo seems to be a safe and efficient technique to halt the progression after a primary CXL.

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

“…The failure rates ranged from 0%12 to 16.5% 36. While the recorded postoperative period for documentation of KC progression following SCXL varied from early postoperative months34 to several postoperative years32,35 and even reached 10 years in Raiskup et al37 Our study recorded 4.1% failure rate at 5 years which is similar to some studies38 and lower than others 34,36…”

The 7-Year Outcomes of Epithelium-Off Corneal Cross-linking in Progressive Keratoconus

“…11 Good levels of efficacy and safety have been reported for CXL retreatments in eyes with previous CXL, but showing signs of keratoconus progression associated to allergic conjunctivitis and eye rubbing. 12 The aim of the current study was to evaluate the clinical results of epi-off CXL during a 7-year follow-up, evaluating not only visual, refractive, corneal curvature and pachymetric changes, but also potential corneal elevation and anterior segment alterations.…”

Analysis of pseudoprogression after corneal cross‐linking in children with progressive keratoconus

“…Other studies have shown an increase in keratometry readings related to allergic conjunctivitis necessitating a second CXL (Antoun et al. ). However, we show that such progression can be reversed with anti‐inflammatory treatment using adequate topical and systemic treatment including antihistamines, corticosteroids or cyclosporin.…”