title: Safety of high-intensity corneal collagen crosslinking.
abstract: OBJECTIVE
  To evaluate the safety of a new high-intensity corneal collagen crosslinking (CXL) treatment protocol for keratoconus.
  
  
  METHODS
  Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
  
  
  METHODS
  Prospective interventional case series.
  
  
  METHODS
  Patients with progressive keratoconus had CXL using a new treatment protocol with 9 mW/cm(2) irradiance for duration of 10 minutes. The rate of reepithelialization, endothelial cell density (ECD), corrected distance visual acuity (CDVA), and steep and flat keratometry (K) values were evaluated preoperatively and 3 months postoperatively.
  
  
  RESULTS
  Nine patients (10 eyes) were enrolled. No intraoperative or early postoperative complications were observed in any patient. The ECD did not change significantly 3 months postoperatively (P=.169). The CDVA improved from 0.19 logMAR ± 0.20 (SD) preoperatively to 0.10 ± 0.16 logMAR 3 months postoperatively; however, the improvement did not attain significance (P=.141). No eye lost lines of CDVA. The mean steep K readings decreased significantly from 48.04 ± 2.57 diopters (D) preoperatively to 46.51 ± 2.81 D 3 months postoperatively (P=.047); the mean flat K readings did not change significantly postoperatively (P=.285).
  
  
  CONCLUSIONS
  Corneal collagen crosslinking at 9 mW/cm(2) irradiance for 10 minutes did not cause significant changes in ECD or intraoperative or early postoperative complications. None patient lost a line of CDVA 3 months after the procedure.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From Vardinoyiannion Eye Institute of Crete (Kymionis, Grentzelos, Kankariya, Liakopoulos, Portaliou, Tsoulnaras, Karavitaki, Pallikaris), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; the Department of Ophthalmology (Kymionis, Kankariya, Portaliou), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: kymionis@med.uoc.gr.
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.affiliation: From Vardinoyiannion Eye Institute of Crete (Kymionis, Grentzelos, Kankariya, Liakopoulos, Portaliou, Tsoulnaras, Karavitaki, Pallikaris), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; the Department of Ophthalmology (Kymionis, Kankariya, Portaliou), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grentzelos
authors.affiliation: From Vardinoyiannion Eye Institute of Crete (Kymionis, Grentzelos, Kankariya, Liakopoulos, Portaliou, Tsoulnaras, Karavitaki, Pallikaris), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; the Department of Ophthalmology (Kymionis, Kankariya, Portaliou), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Vardhaman P
authors.initials: VP
authors.lastname: Kankariya
authors.affiliation: From Vardinoyiannion Eye Institute of Crete (Kymionis, Grentzelos, Kankariya, Liakopoulos, Portaliou, Tsoulnaras, Karavitaki, Pallikaris), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; the Department of Ophthalmology (Kymionis, Kankariya, Portaliou), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Liakopoulos
authors.affiliation: From Vardinoyiannion Eye Institute of Crete (Kymionis, Grentzelos, Kankariya, Liakopoulos, Portaliou, Tsoulnaras, Karavitaki, Pallikaris), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; the Department of Ophthalmology (Kymionis, Kankariya, Portaliou), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Dimitra M
authors.initials: DM
authors.lastname: Portaliou
authors.affiliation: From Vardinoyiannion Eye Institute of Crete (Kymionis, Grentzelos, Kankariya, Liakopoulos, Portaliou, Tsoulnaras, Karavitaki, Pallikaris), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; the Department of Ophthalmology (Kymionis, Kankariya, Portaliou), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Tsoulnaras
authors.affiliation: From Vardinoyiannion Eye Institute of Crete (Kymionis, Grentzelos, Kankariya, Liakopoulos, Portaliou, Tsoulnaras, Karavitaki, Pallikaris), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; the Department of Ophthalmology (Kymionis, Kankariya, Portaliou), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Karavitaki
authors.affiliation: From Vardinoyiannion Eye Institute of Crete (Kymionis, Grentzelos, Kankariya, Liakopoulos, Portaliou, Tsoulnaras, Karavitaki, Pallikaris), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; the Department of Ophthalmology (Kymionis, Kankariya, Portaliou), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Aristophanis I
authors.initials: AI
authors.lastname: Pallikaris
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism*; D003432:Cross-Linking Reagents / Q000009:adverse effects / Q000627:therapeutic use*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D018613:Microscopy, Confocal; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications; D011446:Prospective Studies; D012256:Riboflavin / Q000009:adverse effects / Q000627:therapeutic use; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin