Safety and efficacy of transepithelial crosslinking (C3-R/CXL)

Abstract

We appreciate having another chance to point out that corneal CXL is a clinical procedure with complications and failures, and we are grateful that Kymionis et al. drew attention to more infrequent complications that were not mentioned in our discussion.We fully agree that an impact on the cornea such as CXL may initiate a recurrence of herpes keratitis and in cases with an ocular herpes history, systemic antimetabolite therapy is clearly indicated. Stimulation of an inflammatory reaction such as diffuse lamellar keratitis after LASIK by CXL is also not a surprising side effect, and we agree that topical steroids should precede CXL in cases of iatrogenic keratectasia.Please keep in mind: CXL is a technically easy procedure but represents a significant impact on the eye treated.dTobias Koller, MD, Theo Seiler, MD, PhD LETTERS

Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus

“…3 Complications such as severe bacterial keratitis, viral reactivation of herpes keratitis, and sterile infiltrates have been reported. [4][5][6] To avoid such complications, Boxer Wachler et al 7 suggested modifying the technique by keeping the epithelium intact (epithelium-on or transepithelial CXL).…”

Refractive and topographic results of benzalkonium chloride–assisted transepithelial crosslinking

“…Boxer Wachler et al 13 argue that the use of preservative-based anesthetic drops is a decisive feature for the success of transepithelial CXL. Benzalkonium chloride (BAC) can loosen the tight junctions of the corneal epithelial cells, increasing permeability for riboflavin and allowing CXL without removal of the epithelium.…”

Transepithelial crosslinking

“…5 The collection of large amounts of data and their critical evaluation are needed, as the future of many young patients will be affected. Collaboration, or at least reciprocal recognition, between research groups is essential.…”