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Early epithelial complications of accelerated trans-epithelial corneal crosslinking in treatment of keratoconus: a case series

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Abstract

Background

To report a case series of early postoperative complications following combined accelerated corneal crosslinking (CXL) and trans-epithelial technique in keratoconus.

Case presentations

Eleven eyes underwent accelerated trans-epithelial CXL (18 mW/cm2 for 5 min). Seven eyes (64%) developed complications in the first week postoperatively. Five eyes had large epithelial defects, and two eyes were complicated with diffuse punctate epithelial erosions. Early transient stromal haze was seen in eyes with epithelial complications. Anterior segment optical coherence tomography showed a faint demarcation line in six eyes (55%) with epithelial complications.

Conclusion

A significant number of eyes developed epithelial complications shortly after combined accelerated trans-epithelial CXL, which defeated the benefits of leaving the epithelium intact.

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References

  1. Wollensak G, Spoerl E, Seiler T (2003) Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 135(5):620–627

    Article  CAS  Google Scholar 

  2. Baiocchi S, Mazzotta C, Cerretani D, Caporossi T, Caporossi A (2009) Corneal crosslinking: riboflavin concentration in corneal stroma exposed with and without epithelium. J Cataract Refract Surg 35(5):893–899

    Article  Google Scholar 

  3. Wittig-Silva C, Chan E, Islam FM, Wu T, Whiting M, Snibson GR (2014) A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. Ophthalmology 121(4):812–821

    Article  Google Scholar 

  4. Hashemian H, Jabbarvand M, Khodaparast M, Ameli K (2014) Evaluation of corneal changes after conventional versus accelerated corneal cross-linking: a randomized controlled trial. J Refract Surg 30(12):837–842

    Article  Google Scholar 

  5. Lombardo M, Pucci G, Barberi R, Lombardo G (2015) Interaction of ultraviolet light with the cornea: clinical implications for corneal crosslinking. J Cataract Refract Surg 41(2):446–459

    Article  Google Scholar 

  6. Koller T, Mrochen M, Seiler T (2009) Complication and failure rates after corneal crosslinking. J Cataract Refract Surg 35(8):1358–1362

    Article  Google Scholar 

  7. Leccisotti A, Islam T (2010) Transepithelial corneal collagen cross-linking in keratoconus. J Refract Surg 26(12):942–948

    Article  Google Scholar 

  8. Filippello M, Stagni E, O’Brart D (2012) Transepithelial corneal collagen crosslinking: bilateral study. J Cataract Refract Surg 38(2):283–291

    Article  Google Scholar 

  9. Yuksel E, Novruzlu S, Ozmen MC, Bilgihan K (2015) A study comparing standard and transepithelial collagen cross-linking riboflavin solutions: epithelial findings and pain scores. J Ocul Pharmacol Ther 31(5):296–302

    Article  CAS  Google Scholar 

  10. Taneri S, Oehler S, Lytle G, Dick HB (2014) Evaluation of epithelial integrity with various transepithelial corneal cross-linking protocols for treatment of keratoconus. J Ophthalmol 2014:614380

    PubMed  PubMed Central  Google Scholar 

  11. Wu MF, Stachon T, Wang J, Song X, Colanesi S, Seitz B et al (2015) Effect of keratocyte supernatant on epithelial cell migration and proliferation after corneal crosslinking (CXL). Curr Eye Res 41:466–473. doi:10.3109/02713683.2015.1050739

    Article  CAS  PubMed  Google Scholar 

  12. Mazzotta C, Hafezi F, Kymionis G, Caragiuli S, Jacob S, Traversi C et al (2015) In vivo confocal microscopy after corneal collagen crosslinking. Ocul Surf 13(4):298–314

    Article  Google Scholar 

  13. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T, Paradiso AL (2012) Transepithelial corneal collagen crosslinking for keratoconus: qualitative investigation by in vivo HRT II confocal analysis. Eur J Ophthalmol 22(Suppl 7):S81–S88

    Article  Google Scholar 

  14. Ng AL, Chan TC, Lai JS, Cheng AC (2015) Comparison of the central and peripheral corneal stromal demarcation line depth in conventional versus accelerated collagen cross-linking. Cornea 34(11):1432–1436

    Article  Google Scholar 

  15. Wollensak G, Iomdina E (2009) Biomechanical and histological changes after corneal crosslinking with and without epithelial debridement. J Cataract Refract Surg 35(3):540–546

    Article  Google Scholar 

  16. Soeters N, Wisse RP, Godefrooij DA, Imhof SM, Tahzib NG (2015) Transepithelial versus epithelium-off corneal cross-linking for the treatment of progressive keratoconus: a randomized controlled trial. Am J Ophthalmol 159(5):821–823

    Article  Google Scholar 

  17. Richoz O, Hammer A, Tabibian D, Gatzioufas Z, Hafezi F (2013) The biomechanical effect of corneal collagen cross-linking (CXL) with riboflavin and UV-A is oxygen dependent. Trans Vis Sci Technol 2(7):6

    Article  Google Scholar 

  18. Gatzioufas Z, Raiskup F, O’Brart D, Spoerl E, Panos GD, Hafezi F (2016) Transepithelial corneal cross-linking using an enhanced riboflavin solution. J Refract Surg 32(6):372–377

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Grantham Hospital, Hong Kong, Hong Kong, SAR

    Sharon S. W. Chow & Michelle C. Y. Fan

  2. Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Shatin, Hong Kong, SAR

    Tommy C. Y. Chan

  3. Department of Ophthalmology, The University of Hong Kong, Room 301, 3/F, Block B, Cyberport 4, Hong Kong, Hong Kong, SAR

    Ian Y. H. Wong, Jimmy S. M. Lai & Alex L. K. Ng

Authors
  1. Sharon S. W. Chow
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  2. Tommy C. Y. Chan
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  3. Ian Y. H. Wong
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  4. Michelle C. Y. Fan
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  5. Jimmy S. M. Lai
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  6. Alex L. K. Ng
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Corresponding author

Correspondence to Alex L. K. Ng.

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All authors have no conflict of interest.

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

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Chow, S.S.W., Chan, T.C.Y., Wong, I.Y.H. et al. Early epithelial complications of accelerated trans-epithelial corneal crosslinking in treatment of keratoconus: a case series. Int Ophthalmol 38, 2635–2638 (2018). https://doi.org/10.1007/s10792-017-0734-9

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  • DOI: https://doi.org/10.1007/s10792-017-0734-9

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