Long-term complications of corneal cross-linking in patients with progressive keratoconus
Keywords:
complications, crosslinking, keratoconus.Abstract
Introduction: Keratoconus is a progressive disease, which in advanced stages leads to visual disability. Corneal crosslinking stops or slows its progression.Objective: Identify postoperative complications and predictor variables of corneal haze, 10 years after performing corneal crosslinking.
Methods: Retrospective analytical study, carried out between June 2019 and December 2023, in 62 patients with progressive keratoconus, treated in one eye, with corneal crosslinking. The presence/absence of complications, type of complication were identified, the complication rate was calculated and the predictor variable of corneal haze was estimated.
Results: Complications occurred in 41.9% (p= 0.001), versus 58.1% without complications. Haze was the most common complication (19 eyes; 30.6%), predicted by the preoperative keratoconus index; severe flattening occurred in only 2 eyes (3.2%); severe thinning and hyperopic refractive change, in 1 patient (1.6%).
Conclusions: Treatment with corneal crosslinking induces complications in less than half of the cases, corneal haze is the most frequent, predicted by the preoperative keratoconus index.
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References
1. Hashemi H, Heydarian S, Hooshmand E, Saatchi M, Yekta A, Aghamirsalim M, et al. The Prevalence and Risk Factors for Keratoconus: A Systematic Review and Meta-Analysis [Internet]. Cornea. 2020; 39(2):263-70. DOI: 10.1097/ICO.0000000000002150.
2. Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review[Internet]. Cont Lens Anterior Eye. 2022; 45(3):101559. DOI: 10.1016/j.clae.2021.101559.
3. Izquierdo L, Henríquez MA, Mannis MJ. Keratoconus: diagnosis and management. 1st ed. Philadelphia: Elsevier; 2022.
4. Carriazo C, Cosentino MJ. New Frontiers for the Treatment of Keratoconus. 1st ed. Switzerland: Springer Nature; 2021.
5. Lim L, Lim EWL. A Review of Corneal Collagen Crosslinking - Current Trends in Practice Applications [Internet]. Open Ophthalmol J. 2018; 12:181-213. DOI: 10.2174/1874364101812010181
6. Farhat R, Ghannam MK, Azar G, Nehme J, Sahyoun M, Hanna NG, et al. Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus [Internet]. J Ophthalmol. 2020; 2020:7487186. DOI: 10.1155/2020/7487186
7. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus [Internet]. Am J Ophthalmol. 2003; 135(5):620-7. DOI: 10.1016/s0002-9394(02)02220-1
8. Zhu AY, Jun AS, Soiberman US. Combined Protocols for Corneal Collagen Cross-Linking with Photorefractive Surgery for Refractive Management of Keratoconus: Up-date on Techniques and Review of Literature [Internet]. Ophthalmol Ther. 2019; 8(1):15-31. DOI: 10.1007/s40123-019-00210-3
9. Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal cross-linking [Internet]. J Cataract Refract Surg. 2009; 35(8):1358-62. DOI: 10.1016/j.jcrs.2009.03.035
10. Dhawan S, Rao K, Natrajan S. Complications of corneal collagen crosslink-ing [Internet]. J Ophthalmol. 2011; 2011: 869015. DOI: 10.1155/2011/869015
11. Evangelista CB, Hatch KM. Corneal collagen crosslinking complications [Internet]. Seminars in ophthalmology. 2018; 33(1):29-35. DOI: 10.1080/08820538.2017.1353809
12. Agarwal R, Jain P, Arora R. Complications of corneal collagen crosslink-ing [Internet]. Indian J Ophthalmol. 2022; 70(5):1466-74. DOI: 10.4103/ijo.IJO_1595_21
13. Eguía FM, Río MT, Capote AC. Manual de diagnóstico y tratamiento en Oftalmología. 1st ed. La Habana: ECIMED; 2009.
14. Hersh PS, Stulting RD, Muller D, Durrie DS, Rajpal RK. United States Multicenter Clinical Trial of Corneal Collagen Crosslinking for Keratoconus Treatment [Internet]. Ophthalmology. 2017; 124(9):1259-70. DOI: 10.1016/j.ophtha.2017.03.052
15. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results [Internet]. J Cataract Refract Surg. 2008; 34(5):796-801. DOI: 10.1016/j.jcrs.2007.12.039
16. Mazzotta C, Traversi C, Baiocchi S, Bagaglia S, Caporossi O, Villano A, et al. Corne-al Collagen Crosslinking with Riboflavin and Ultraviolet A Light for Pediatric Kera-toconus: Ten-Year Results [Internet]. Cornea. 2018; 37(5):560-6. DOI: 10.1097/ICO.0000000000001505
17. Nicula C, Pop R, Rednik A, Nicula D. 10-Year Results of Standard Crosslinking in Patients with Progressive Keratoconus in Romania [Internet]. J Ophthalmol. 2019; 2019:8285649. DOI: 10.1155/2019/8285649
18. Henríquez MA, Pérez L, Hernández-Sahagun G, Rojas RP, Stulting RD, Izquierdo L, Jr. Long Term Corneal Flattening After Corneal Crosslinking in Patients with Progressive Keratoconus [Internet]. Clinical ophthalmology (Auckland, NZ). 2023; 17:1865-75. DOI: 10.2147/OPTH.S40900950
19. Padmanabhan P, Belin MW, Padmanaban V, Sudhir RR. Extreme corneal flattening following collagen crosslinking for progressive keratoconus [Internet]. Eur J Oph-thalmol. 2021; 31(4):1546-52. DOI: 10.1177/1120672120947664
20. Asamblea Nacional del Poder Popular. Ley de la Salud Pública [Internet]. La Habana: ANPP; 2023. [acceso: 17/07/2023]. Disponible en: https://www.parlamentocubano.gob.cu/sites/default/files/documento/2023-11/proyecto-de-ley-de-salud-publica_0.pdf
21. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects [Internet]. JAMA. 2013; 310(20):2191-4. DOI: 10.1001/jama.2013.281053
22. Raiskup F, Hoyer A, Spoerl E. Permanent corneal haze after riboflavin-UVA-induced cross-linking in keratoconus [Internet]. J Refract Surg. 2009; 25(9): S824-8. DOI: 10.3928/1081597X-20090813-12
23. Raiskup F, Theuring A, Pillunat LE, Spoerl E. Corneal collagen crosslinking with riboflavin and ultraviolet-A light in progressive keratoconus: ten-year results [Internet]. J Cataract Refract Surg. 2015; 41(1): 41-6. DOI: 10.1016/j.jcrs.2014.09.033
24. Elmassry A, Said Ahmed OI, Abdalla MF, Gaballah K. Ten years' experience of corneal collagen crosslinking: an observational study of 6120 cases [Internet]. Eur J Ophthalmol. 2021; 31(3):951-8. DOI: 10.1177/1120672120928921
25. Salman A, Ali A, Rafea S, Omran R, Kubaisi B, Ghabra M, et al. Long-term visual, anterior and posterior corneal changes after crosslinking for progressive keratoconus [Internet]. Eur J Ophthalmol. 2022; 32(1):50-8. DOI: 10.1177/11206721211052878
26. Noor IH, Seiler TG, Noor K, Seiler T. Continued Long-term Flattening After Corne-al Cross-linking for Keratoconus [Internet]. J Refract Surg. 2018; 34(8):567-70. DOI: 10.3928/1081597X-20180607-01
27. Voulgari N, Mikropoulos D, Kontadakis GA, Safi A, Tabibian D, Kymionis GD. Corneal Scarring and Hyperopic Shift After Corneal Cross-linking for Corneal Ectasia After SMILE [Internet]. J Refract Surg. 2018; 34(11):779-82. DOI: 10.3928/1081597X-20180921-01
28. Kasai K, Kato N, Konomi K, Shinzawa M, Shimazaki J. Flattening effect of corneal cross-linking depends on the preoperative severity of keratoconus [Internet]. Medicine (Baltimore). 2017; 96(40): e8160. DOI: 10.1097/MD.0000000000008160
2. Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review[Internet]. Cont Lens Anterior Eye. 2022; 45(3):101559. DOI: 10.1016/j.clae.2021.101559.
3. Izquierdo L, Henríquez MA, Mannis MJ. Keratoconus: diagnosis and management. 1st ed. Philadelphia: Elsevier; 2022.
4. Carriazo C, Cosentino MJ. New Frontiers for the Treatment of Keratoconus. 1st ed. Switzerland: Springer Nature; 2021.
5. Lim L, Lim EWL. A Review of Corneal Collagen Crosslinking - Current Trends in Practice Applications [Internet]. Open Ophthalmol J. 2018; 12:181-213. DOI: 10.2174/1874364101812010181
6. Farhat R, Ghannam MK, Azar G, Nehme J, Sahyoun M, Hanna NG, et al. Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus [Internet]. J Ophthalmol. 2020; 2020:7487186. DOI: 10.1155/2020/7487186
7. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus [Internet]. Am J Ophthalmol. 2003; 135(5):620-7. DOI: 10.1016/s0002-9394(02)02220-1
8. Zhu AY, Jun AS, Soiberman US. Combined Protocols for Corneal Collagen Cross-Linking with Photorefractive Surgery for Refractive Management of Keratoconus: Up-date on Techniques and Review of Literature [Internet]. Ophthalmol Ther. 2019; 8(1):15-31. DOI: 10.1007/s40123-019-00210-3
9. Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal cross-linking [Internet]. J Cataract Refract Surg. 2009; 35(8):1358-62. DOI: 10.1016/j.jcrs.2009.03.035
10. Dhawan S, Rao K, Natrajan S. Complications of corneal collagen crosslink-ing [Internet]. J Ophthalmol. 2011; 2011: 869015. DOI: 10.1155/2011/869015
11. Evangelista CB, Hatch KM. Corneal collagen crosslinking complications [Internet]. Seminars in ophthalmology. 2018; 33(1):29-35. DOI: 10.1080/08820538.2017.1353809
12. Agarwal R, Jain P, Arora R. Complications of corneal collagen crosslink-ing [Internet]. Indian J Ophthalmol. 2022; 70(5):1466-74. DOI: 10.4103/ijo.IJO_1595_21
13. Eguía FM, Río MT, Capote AC. Manual de diagnóstico y tratamiento en Oftalmología. 1st ed. La Habana: ECIMED; 2009.
14. Hersh PS, Stulting RD, Muller D, Durrie DS, Rajpal RK. United States Multicenter Clinical Trial of Corneal Collagen Crosslinking for Keratoconus Treatment [Internet]. Ophthalmology. 2017; 124(9):1259-70. DOI: 10.1016/j.ophtha.2017.03.052
15. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results [Internet]. J Cataract Refract Surg. 2008; 34(5):796-801. DOI: 10.1016/j.jcrs.2007.12.039
16. Mazzotta C, Traversi C, Baiocchi S, Bagaglia S, Caporossi O, Villano A, et al. Corne-al Collagen Crosslinking with Riboflavin and Ultraviolet A Light for Pediatric Kera-toconus: Ten-Year Results [Internet]. Cornea. 2018; 37(5):560-6. DOI: 10.1097/ICO.0000000000001505
17. Nicula C, Pop R, Rednik A, Nicula D. 10-Year Results of Standard Crosslinking in Patients with Progressive Keratoconus in Romania [Internet]. J Ophthalmol. 2019; 2019:8285649. DOI: 10.1155/2019/8285649
18. Henríquez MA, Pérez L, Hernández-Sahagun G, Rojas RP, Stulting RD, Izquierdo L, Jr. Long Term Corneal Flattening After Corneal Crosslinking in Patients with Progressive Keratoconus [Internet]. Clinical ophthalmology (Auckland, NZ). 2023; 17:1865-75. DOI: 10.2147/OPTH.S40900950
19. Padmanabhan P, Belin MW, Padmanaban V, Sudhir RR. Extreme corneal flattening following collagen crosslinking for progressive keratoconus [Internet]. Eur J Oph-thalmol. 2021; 31(4):1546-52. DOI: 10.1177/1120672120947664
20. Asamblea Nacional del Poder Popular. Ley de la Salud Pública [Internet]. La Habana: ANPP; 2023. [acceso: 17/07/2023]. Disponible en: https://www.parlamentocubano.gob.cu/sites/default/files/documento/2023-11/proyecto-de-ley-de-salud-publica_0.pdf
21. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects [Internet]. JAMA. 2013; 310(20):2191-4. DOI: 10.1001/jama.2013.281053
22. Raiskup F, Hoyer A, Spoerl E. Permanent corneal haze after riboflavin-UVA-induced cross-linking in keratoconus [Internet]. J Refract Surg. 2009; 25(9): S824-8. DOI: 10.3928/1081597X-20090813-12
23. Raiskup F, Theuring A, Pillunat LE, Spoerl E. Corneal collagen crosslinking with riboflavin and ultraviolet-A light in progressive keratoconus: ten-year results [Internet]. J Cataract Refract Surg. 2015; 41(1): 41-6. DOI: 10.1016/j.jcrs.2014.09.033
24. Elmassry A, Said Ahmed OI, Abdalla MF, Gaballah K. Ten years' experience of corneal collagen crosslinking: an observational study of 6120 cases [Internet]. Eur J Ophthalmol. 2021; 31(3):951-8. DOI: 10.1177/1120672120928921
25. Salman A, Ali A, Rafea S, Omran R, Kubaisi B, Ghabra M, et al. Long-term visual, anterior and posterior corneal changes after crosslinking for progressive keratoconus [Internet]. Eur J Ophthalmol. 2022; 32(1):50-8. DOI: 10.1177/11206721211052878
26. Noor IH, Seiler TG, Noor K, Seiler T. Continued Long-term Flattening After Corne-al Cross-linking for Keratoconus [Internet]. J Refract Surg. 2018; 34(8):567-70. DOI: 10.3928/1081597X-20180607-01
27. Voulgari N, Mikropoulos D, Kontadakis GA, Safi A, Tabibian D, Kymionis GD. Corneal Scarring and Hyperopic Shift After Corneal Cross-linking for Corneal Ectasia After SMILE [Internet]. J Refract Surg. 2018; 34(11):779-82. DOI: 10.3928/1081597X-20180921-01
28. Kasai K, Kato N, Konomi K, Shinzawa M, Shimazaki J. Flattening effect of corneal cross-linking depends on the preoperative severity of keratoconus [Internet]. Medicine (Baltimore). 2017; 96(40): e8160. DOI: 10.1097/MD.0000000000008160
Published
2024-06-05
How to Cite
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Jareño Ochoa M, Cárdenas Díaz T, Pérez Parra Z, Hernández Fernández Y, Mayea Díaz DY, Castillo Borges YM. Long-term complications of corneal cross-linking in patients with progressive keratoconus. Rev Cubana Med Milit [Internet]. 2024 Jun. 5 [cited 2025 Apr. 3];53(2):e024051258. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/51258
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