Complication and failure rates after corneal crosslinking.
OBJECTIVE
To evaluate the complication rate of corneal crosslinking (CXL) for primary keratectasia and to develop recommendations for avoiding complications.


METHODS
Institut für Refraktive und Ophthalmo-Chirurgie, Zurich, Switzerland.


METHODS
In a prospective study, eyes with verified progressive keratectasia had standard CXL. Preoperative and 6- and 12-month postoperative examinations included corrected distance visual acuity (CDVA), slitlamp evaluation, applanation tonometry, and Scheimpflug imaging (Pentacam). Statistical analysis included analysis of variance and the Mann-Whitney U test to detect risk factors for complications.


RESULTS
The study evaluated 117 eyes of 99 patients; approximately 90% completed the 12-month follow-up. The complication rate (percentage of eyes losing 2 or more Snellen lines) was 2.9% (95% confidence interval, 0.6%-8.5%). The failure rate of CXL (percentage of eyes with continued progression) was 7.6%. Age older than 35 years and a preoperative CDVA better than 20/25 were identified as significant risk factors for complications. A high preoperative maximum keratometry (K) reading was a significant risk factor for failure. Sterile infiltrates were seen in 7.6% of eyes and central stromal scars, in 2.8%.


CONCLUSIONS
Results indicate that changing the inclusion criteria may significantly reduce the complications and failures of CXL. A preoperative maximum K reading less than 58.00 diopters may reduce the failure rate to less than 3%, and restricting patient age to younger than 35 years may reduce the complication rate to 1%.
Koller
Tobias
T
From Institut für Refraktive und Ophthalmo-Chirurgie, Zürich, Switzerland.
Mrochen
Michael
M
Seiler
Theo
T
D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism* / Q000503:physiopathology; D019781:Corneal Topography; D004108:Dilatation, Pathologic / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use; D012307:Risk Factors; D017211:Treatment Failure; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology
D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin