Severe Complications After Corneal Collagen Cross-Linking (CXL)

Overview

Journal Klin Monbl Augenheilkd

Publisher Thieme

Specialty Ophthalmology

Date 2023 May 10

PMID 37164391

Authors

Frank Blaser

Sandrine Zweifel

Maximilian Robert Justus Wiest

Anahita Bajka

Sadiq Said

Daniel Barthelmes

Daniel Rudolf Muth

Affiliations

Soon will be listed here.

Abstract

Purpose: To present a case series of rare and severe complications after corneal collagen cross-linking (CXL) of keratoconus patients.

Methods: Single-center descriptive case series covering the period of 2012 to 2022 at the Department of Ophthalmology at the University Hospital, Zurich, Switzerland.

Results: We present four eyes of four patients that showed severe unusual complications within the first month after CXL. Three patients had been treated with the classical epithelium-off "Dresden" protocol. One patient had been treated with the accelerated epithelium-off protocol. One patient presented with extensive corneal edema due to rubbing the eye after treatment. Two patients showed a bacterial infectious keratitis: one due to and the other due to , and . The latter of the two patients exhibited extensive infectious crystalline keratopathy. The fourth patient showed a severe ulcerative lesion where no infectious cause could be found. Therefore, an autoimmune keratolytic process had to be suspected. Apart from the corneal edema, which resolved , the other complications resulted in permanent corneal scarring and thinning. One patient needed an emergency amniotic transplant.

Conclusion: Severe complications after CXL remain rare. Most common causes are complications that are not directly associated with the treatment as such. Those indirect complications occur after the treatment during the healing course of the epithelium. Associations with bandage contact lenses, topical steroids, atopic disease, and inappropriate patient behavior are often suspected. Correctly performed corneal scrapings with repeated microbiological analysis and a detailed patient history are essential for establishing the correct diagnosis, especially in complicated cases that do not respond to a standard therapeutic regimen. This case series supports the efforts that are currently taken to improve the CXL technique in a way that postoperative complications are further reduced. A more efficient epithelium-on technique might be a step in that direction.

Citing Articles

Herpes Simplex Keratitis Following Corneal Crosslinking for Keratoconus: A One-Year Case Series Follow-Up.

Bagatin F, Radman I, Randelovic K, Petric Vickovic I, Lacmanovic Loncar V, Ivekovic R Diagnostics (Basel). 2024; 14(20).

PMID: 39451590 PMC: 11506186. DOI: 10.3390/diagnostics14202267.

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