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Effect of corneal collagen crosslinking on subsequent deep anterior lamellar keratoplasty (DALK) in keratoconus

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Abstract

Purpose

The purpose was to investigate the impact of ultraviolet light corneal collagen crosslinking (UV-CXL) on the success rate and clinical outcome of subsequent deep anterior lamellar keratoplasty (DALK) in eyes with keratoconus (KC).

Methods

Medical records of 101 consecutive eyes with KC scheduled for big-bubble DALK surgery were screened retrospectively for details of previously performed UV-CXL, as well as intra- and postoperative complications of DALK surgery. Main outcome measures were intraoperative success rates (big-bubble formation, conversion to penetrating keratoplasty (PK)), postoperative complications, best corrected visual acuity (BCVA), endothelial cell density (ECD), and central corneal thickness (CCT) within 18 months of follow-up.

Results

Out of the 101 KC eyes, eight eyes (7.9%) had a history of previous UV-CXL. Surgical failure, defined as conversion to PK due to macroperforation, occurred in 17 eyes (16.8%) of 93 eyes without and in none with previous UV-CXL (P < .001). Failure to achieve a big-bubble occurred in 37 eyes (40.2%) without previous UV-CXL and in two eyes (25%) with previous UV-CXL. Microperforations of Descemet’s membrane were observed in ten eyes (20.7%) without and in 14 eyes (15.2%) with previous UV-CXL (P = .16). No significant differences could be detected for either the postoperative complication rate (P ≥ .18) or the clinical outcome parameters at 18 months follow-up, including BCVA, ECD and CCT (P ≥ .08) for eyes with or without UV-CXL.

Conclusions

In DALK surgery, prior UV-CXL does not seem to affect the rate of intra- or postoperative complications, the success rate, or its clinical outcome.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany

    Friederike Schaub, Philip Enders, Björn O. Bachmann, Ludwig M. Heindl & Claus Cursiefen

Authors
  1. Friederike Schaub
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  2. Philip Enders
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  3. Björn O. Bachmann
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  4. Ludwig M. Heindl
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  5. Claus Cursiefen
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Corresponding author

Correspondence to Friederike Schaub.

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Funding

The German Research Foundation provided financial support in the form of the grant FOR 2240 “(Lymph) Angiogenesis And Cellular Immunity In Inflammatory Diseases Of The Eye” to C.C. and L.M.H. (www.for2240.de). The European Cooperation of Science and Technology (EU COST) provided financial support in the form of the grant BM1302 “Joining Forces in Corneal Regeneration” to B.O.B and C.C. (www.biocornea.eu). The sponsor had no role in design, conduct, or analysis of the study.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Schaub, F., Enders, P., Bachmann, B.O. et al. Effect of corneal collagen crosslinking on subsequent deep anterior lamellar keratoplasty (DALK) in keratoconus. Graefes Arch Clin Exp Ophthalmol 255, 811–816 (2017). https://doi.org/10.1007/s00417-017-3592-2

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  • DOI: https://doi.org/10.1007/s00417-017-3592-2

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