Early ocular surface complications common after CXL

Chicago-Findings from a retrospective study of patients undergoing corneal crosslinking (CXL) for keratoconus provide new insight on the risk of early ocular surface-related complications, said Denise Wajnsztajn, MD.

The research was conducted by Dr. Wajnsztajn and colleagues from the Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel, who extracted data on clinical features and early adverse events/complications of patients who underwent CXL between August 2007 and March 2012.

The study included 206 eyes of 180 keratoconus patients and found 23 eyes of 22 patients presented with 28 marked ocular surface complications, which included delayed epithelial healing, abnormal hypertrophic epithelial healing, remarkable superficial punctate keratitis, corneal infiltrates, microbial keratitis, and severe stromal edema followed by scarring. Best-corrected visual acuity loss of 1 to 3 lines occurred in 4 eyes.

Compared with their no complication counterparts, the complication group was similar with respect to age or gender, but they presented with more advanced keratoconus with significantly steeper and thinner corneas. In addition, ocular surface and external disorders were common in the complication group prior to CXL, half of the patients were contact lens-dependent, and 17% had limited tolerance to contact lenses.

“Long-term complications of CXL have been well described, but there is insufficient information on the early complications that can occur,” Dr. Wajnsztajn said.

“Our data show that compromised ocular surface healing after CXL may be more common than recognized and that it can compromise final visual acuity,” Dr. Wajnsztajn added. “This information indicates that eyes should be in the best ocular surface condition before undergoing CXL.”

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