Abstract

FR.22.04

Corneal cross-linking: Complications and Riskfactors

Tobias Koller1, Michael Mrochen1,2, Hans Peter Iseli1,3, Theo Seiler1,4
1IROC – Institut für Refraktive und Ophthalmochirurgie, Zürich, Schweiz, 2Eidgenössische Technische Hochschule, Zürich, Schweiz; 3Augenklinik, Universitätsklinikum Leipzig, Leipzig, Deutschland; 4Universitätsklinik Zürich, Zürich, Schweiz

Objective
To enumerate the complication rate of corneal cross-linking (CXL) for primary keratectasia and to find recommendations to avoid complications.
Methods
In a prospective study, 117 eyes of 99 patients with verified progressive keratectasia were enrolled and received standard CXL. Preoperatively, 6 months and 12 months after CXL among others best spectacle-corrected visual acuity (BSCVA), slit-lamp inspection, applanation tonometry, and Scheimpflug imaging (Pentacam) were used to follow the postoperative development. Statistical analysis included ANOVA and U-tests to detect risk-factors for complications.
Results
Approximately 90% completed the 12 month follow-up. The complication rate (percentage of eyes loosing 2 or more Snellen lines) was 2.9% with a 95%-confidence interval of 0.6% to 8.5%. The failure rate of CXL (percentage of eyes with continued progression) was in this study 7.6%. As significant risk factors for complications the parameters “age>35 years” and “preoperative BSCVA>20/25” were identified, preoperative high Kmax-reading was the only significant risk factor for failure. In 7.6% of the eyes sterile infiltrates and in 2.8% central stromal scars were found.
Conclusions
Changing the inclusion parameters may significantly reduce complications and failures of CXL: preoperative Kmax-readings of less than 58D may reduce the failure rate of CXL to less than 3% and restriction of the age of the patient to less than 35 years may reduce the complication rate to 1%.
Synopsis
Corneal crosslinking for primary keratectasia has a low complication rate (1%) and few failures (3%) if adequate inclusion criteria are respected .

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