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Adverse events after riboflavin/UV-A corneal cross-linking: a literature review

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Abstract

Background

Riboflavin/UV-A corneal cross-linking (CXL) for treating keratoconus and iatrogenic corneal ectasia has been well-established as first treatment option to stabilize corneal tissue biomechanical instability. Although the plethora of clinical studies has been published into the field, there is no systematic review assessing the type and frequency of adverse events after CXL.

Methods

A systemic literature review on clinical safety and adverse events after CXL in patients with keratoconus and corneal ectasia was performed using PubMed. A literature search was performed for relevant peer-reviewed publications. The main outcome measures extracted from the articles were adverse events, endothelial cell density, corrected distance visual acuity and maximum simulated keratometry.

Results

The most frequent adverse events after CXL were corneal haze and corneal edema, which were mild and transient. The severe adverse events were infrequent (cumulative incidence: < 1.3%) after CXL. The clinical benefits of CXL highly outweighed the risks for the treatment of keratoconus and corneal ectasia.

Conclusions

The severe adverse events with permanent sequelae are infrequent after CXL and all are associated with corneal de-epithelialization, such as infectious keratitis and corneal scarring.

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Authors and Affiliations

  1. Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy

    Sebastiano Serrao & Marco Lombardo

  2. Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy

    Sebastiano Serrao, Giuseppe Lombardo & Marco Lombardo

  3. CNR-IPCF, Istituto per i processi Chimico-Fisici, Viale F. Stagno D’Alcontres 37, 98158, Messina, Italy

    Giuseppe Lombardo

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All authors whose names appear on the submission made substantial contributions to the design of the work and to the acquisition, analysis and interpretation of data. Giuseppe Lombardo and Marco Lombardo have drafted the manuscript. All authors have approved the final version of the manuscript.

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Correspondence to Sebastiano Serrao.

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Serrao, S., Lombardo, G. & Lombardo, M. Adverse events after riboflavin/UV-A corneal cross-linking: a literature review. Int Ophthalmol 42, 337–348 (2022). https://doi.org/10.1007/s10792-021-02019-1

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