Corneal crosslinking (CXL) with 18-mW/cm2 irradiance and 5.4-J/cm2 radiant exposure—early postoperative safety

Abstract

Purpose

To investigate safety of accelerated corneal crosslinking during the first postoperative month.

Methods

In this retrospective study, 76 eyes of 60 patients with verified progressive keratectasia were enrolled in this study and followed for 1 month after accelerated CXL (18 mW/cm2 for 5 min, radiant exposure 5.4 J/cm2) (A-CXL(5*18)). Preoperatively, objective refraction, slit lamp inspection, and corneal tomography were performed. Early postoperative slit lamp examinations were performed on days 1 and 4. At 1 month, objective refraction, slit lamp inspection, and corneal tomography were performed.

Results

Gender distribution was m:f = 55:21, OD:OS was 40:36, and the average age was 26.5 ± 8.6 years at surgery. Only 71 of the 76 eyes completed the 1-month follow-up, indicating a dropout rate of 6.6%. In 7.0% (n = 5), sterile infiltrates were observed; 5.6% of eyes (n = 4) showed delayed epithelial healing (> 4 days) in 2.8% (n = 2); an infection occurred and in 1 eye (1.4%), a stromal scar was detected; no other complications, neither a loss of two or more Snellen lines at 1 month postoperatively, were observed. As a risk factor for sterile infiltrates, thin preoperative pachymetry could be identified (p = 0.027).

Conclusions

This study revealed no difference in early postoperative safety between CXL using 18 mW/cm2 and standard corneal CXL. Thinner preoperative pachymetry could be identified predicting a higher rate of postoperative sterile infiltrates.

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Correspondence to Isaak Fischinger.

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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.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name the institution/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Fischinger, I., Seiler, T.G., Santhirasegaram, K. et al. Corneal crosslinking (CXL) with 18-mW/cm2 irradiance and 5.4-J/cm2 radiant exposure—early postoperative safety. Graefes Arch Clin Exp Ophthalmol 256, 1521–1525 (2018). https://doi.org/10.1007/s00417-018-3978-9

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Keywords

  • Corneal crosslinking
  • Keratokonus
  • Keratectasia
  • Accelerated crosslinking
  • 18 mW
  • Sterile infiltrate