Complications of corneal collagen cross-linking

Shikha Dhawan, Kavita Rao, Sundaram Natrajan, Shikha Dhawan, Kavita Rao, Sundaram Natrajan

Abstract

Cross-linking of corneal collagen (CXL) is a promising approach for the treatment of keratoconus and secondary ectasia. Several long-term and short-term complications of CXL have been studied and documented. The possibility of a secondary infection after the procedure exists because the patient is subjected to epithelial debridement and the application of a soft contact lens. Formation of temporary corneal haze, permanent scars, endothelial damage, treatment failure, sterile infiltrates, and herpes reactivation are the other reported complications of this procedure. Cross-linking is a low-invasive procedure with low complication and failure rate but it may have direct or primary complications due to incorrect technique application or incorrect patient's inclusion and indirect or secondary complications related to therapeutic soft contact lens, patient's poor hygiene, and undiagnosed concomitant ocular surface diseases.

References

    1. Rabinowitz YS. Keratoconus. Survey of Ophthalmology. 1998;42(4):297–319.
    1. Spörl E, Huhle M, Kasper M, Seiler T. Artificial stiffening of the cornea by induction of intrastromal cross-links. Ophthalmologe. 1997;94(12):902–906.
    1. Iseli HP, Thiel MA, Hafezi F, Kampmeier J, Seiler T. Ultraviolet a/riboflavin corneal cross-linking for infectious keratitis associated with corneal melts. Cornea. 2008;27(5):590–594.
    1. Wollensak G, Aurich H, Wirbelauer C, Pham DT. Potential use of riboflavin/UVA cross-linking in bullous keratopathy. Ophthalmic Research. 2009;41(2):114–117.
    1. Ehlers N, Hjortdal J. Riboflavin-ultraviolet light induced cross-linking in endothelial decompensation. Acta Ophthalmologica. 2008;86(5):549–551.
    1. Kanellopoulos AJ, Binder PS. Collagen cross-linking (CCL) with sequential topography-guided PRK: a temporizing alternative for keratoconus to penetrating keratoplasty. Cornea. 2007;26(7):891–895.
    1. Caporossi A, Baiocchi S, Mazzotta C, Traversi C, Caporossi T. Parasurgical therapy for keratoconus by riboflavin-ultraviolet type A rays induced cross-linking of corneal collagen. Preliminary refractive results in an Italian study. Journal of Cataract and Refractive Surgery. 2006;32(5):837–845.
    1. Spoerl E, Mrochen M, Sliney D, Trokel S, Seiler T. Safety of UVA-riboflavin cross-linking of the cornea. Cornea. 2007;26(4):385–389.
    1. Vinciguerra P, Albè E, Mahmoud AM, Trazza S, Hafezi F, Roberts CJ. Intra- and postoperative variation in ocular response analyzer parameters in keratoconic eyes after corneal cross-linking. Journal of Refractive Surgery. 2010;26(9):669–676.
    1. Wollensak G, Spoerl E, Wilsch M, Seiler T. Endothelial cell damage after riboflavin-ultraviolet-A treatment in the rabbit. Journal of Cataract and Refractive Surgery. 2003;29(9):1786–1790.
    1. Wollensak G. Crosslinking treatment of progressive keratoconus: new hope. Current Opinion in Ophthalmology. 2006;17(4):356–360.
    1. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus. American Journal of Ophthalmology. 2003;135(5):620–627.
    1. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. Journal of Cataract and Refractive Surgery. 2008;34(5):796–801.
    1. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena Eye Cross Study. American Journal of Ophthalmology. 2010;149(4):585–593.
    1. Pollhammer M, Cursiefen C. Bacterial keratitis early after corneal crosslinking with riboflavin and ultraviolet-A. Journal of Cataract and Refractive Surgery. 2009;35(3):588–589.
    1. Rama P, Di Matteo F, Matuska S, Paganoni G, Spinelli A. Acanthamoeba keratitis with perforation after corneal crosslinking and bandage contact lens use. Journal of Cataract and Refractive Surgery. 2009;35(4):788–791.
    1. Zamora KV, Males JJ. Polymicrobial keratitis after a collagen cross-linking procedure with postoperative use of a contact lens. Cornea. 2009;28(4):474–476.
    1. Kymionis GD, Portaliou DM, Bouzoukis DI, et al. Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus. Journal of Cataract and Refractive Surgery. 2007;33(11):1982–1984.
    1. Pérez-Santonja JJ, Artola A, Javaloy J, Alió JL, Abad JL. Microbial keratitis after corneal collagen crosslinking. Journal of Cataract and Refractive Surgery. 2009;35(6):1138–1140.
    1. Kymionis GD, Bouzoukis DI, Diakonis VF, Portaliou DM, Pallikaris AI, Yoo SH. Diffuse lamellar keratitis after corneal crosslinking in a patient with post-laser in situ keratomileusis corneal ectasia. Journal of Cataract and Refractive Surgery. 2007;33(12):2135–2137.
    1. Sharma N, Maharana P, Singh G, Titiyal JS. Pseudomonas keratitis after collagen crosslinking for keratoconus: case report and review of literature. Journal of Cataract and Refractive Surgery. 2010;36(3):517–520.
    1. Coskunseven E, Jankov MR, Hafezi F. Contralateral eye study of corneal collagen cross-Linking with riboflavin and UVA irradiation in patients with keratoconus. Journal of Refractive Surgery. 2009;25(4):371–376.
    1. Koppen C, Vryghem JC, Gobin L, Tassignon MJ. Keratitis and corneal scarring after UVA/riboflavin cross-linking for keratoconus. Journal of Refractive Surgery. 2009;25(9):S819–S823.
    1. Raiskup F, Hoyer A, Spoerl E. Permanent corneal haze after riboflavin-UVA-induced cross-linking in keratoconus. Journal of Refractive Surgery. 2009;25(9):S824–S828.
    1. Wollensak G, Herbst H. Significance of the lacunar hydration pattern after corneal cross linking. Cornea. 2010;29(8):899–903.
    1. Mazzotta C, Balestrazzi A, Baiocchi S, Traversi C, Caporossi A. Stromal haze after combined riboflavin-UVA corneal collagen cross-linking in keratoconus: in vivo confocal microscopic evaluation. Clinical and Experimental Ophthalmology. 2007;35(6):580–582.
    1. Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal crosslinking. Journal of Cataract and Refractive Surgery. 2009;35(8):1358–1362.
    1. Hanna KD, Pouliquen YM, Waring GO, Savoldelli M, Fantes F, Thompson KP. Corneal wound healing in monkeys after repeated excimer laser photorefractive keratectomy. Archives of Ophthalmology. 1992;110(9):1286–1291.
    1. Carr JD, Patel R, Hersh PS. Management of late corneal haze following photorefractive keratectomy. Journal of Refractive Surgery. 1995;11(3):S309–S313.
    1. Greenstein SA, Fry KL, Bhatt J, Hersh PS. Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: scheimpflug and biomicroscopic analysis. Journal of Cataract and Refractive Surgery. 2010;36(12):2105–2114.
    1. Lim LS, Beuerman R, Lim L, Tan DTH. Late-onset deep stromal scarring after riboflavin—UV-A corneal collagen cross-linking for mild keratoconus. Archives of Ophthalmology. 2011;129(3):360–362.
    1. Connon CJ, Marshall J, Patmore AL, Brahma A, Meek KM. Persistent haze and disorganization of anterior stromal collagen appear unrelated following phototherapeutic keratectomy. Journal of Refractive Surgery. 2003;19(3):323–332.
    1. Wollensak G, Spoerl E, Wilsch M, Seiler T. Keratocyte apoptosis after corneal collagen cross-linking using riboflavin/UVA treatment. Cornea. 2004;23(1):43–49.
    1. Dhaliwal JS, Kaufman SC. Corneal collagen cross-linking: a confocal, electron, and light microscopy study of eye bank corneas. Cornea. 2009;28(1):62–67.
    1. Mazzotta C, Balestrazzi A, Traversi C, et al. Treatment of progressive keratoconus by riboflavin-UVA-induced cross-linking of corneal collagen: ultrastructural analysis by Heidelberg retinal tomograph II in vivo confocal microscopy in humans. Cornea. 2007;26(4):390–397.
    1. Dohlman CH, Hedbys BO, Mishima S. The swelling pressure of the corneal stroma. Investigative Ophthalmology. 1962;1:158–162.
    1. Michelacci YM. Collagens and proteoglycans of the corneal extracellular matrix. Brazilian Journal of Medical and Biological Research. 2003;36(8):1037–1046.
    1. Wollensak G, Aurich H, Pham DT, Wirbelauer C. Hydration behavior of porcine cornea crosslinked with riboflavin and ultraviolet A. Journal of Cataract and Refractive Surgery. 2007;33(3):516–521.
    1. Angunawela RI, Arnalich-Montiel F, Allan BDS. Peripheral sterile corneal infiltrates and melting after collagen crosslinking for keratoconus. Journal of Cataract and Refractive Surgery. 2009;35(3):606–607.

Source: PubMed

3
Abonner