Study suggests changing indications for corneal cross-linking to improve success rates

J Cataract Refract Surg. 2009;35(8):1358-1362.

Younger patients with corrected distance visual acuity less than 20/25 are less likely to have complications after corneal cross-linking, and patients with shorter K-readings are more likely to have a positive response to the treatment for keratectasia, according to a study.

"[Corneal cross-linking] appears to be a safe treatment that would yield a complication rate of approximately 1% if certain inclusion parameters (eg, patient age less than 35 years, [corrected distance visual acuity] less than 20/25) were respected," according to the study.

In the study of 117 eyes of 99 patients followed prospectively for 12 months after the procedure, epithelial healing was complete after a mean 3.25 days. At 1 month, "virtually all eyes had anterior stromal haze with a mean grade of 0.78." At 12 months, mean haze was reduced to 0.06.

Three eyes lost two Snellen lines of corrected distance visual acuity at 12 months, yielding a complication rate of 2.9%. Age older than 35 years and preoperative corrected distance visual acuity better than 20/25 were the only significantly associated risk factors for complications, according to the study.

There was an increase in maximum K-reading after 12 months in eight eyes, for a failure rate of 7.6%. A maximum K-reading greater than 58 D and female sex were identified as statistically significant risk factors for treatment failure.

"Changing the inclusion parameter for maximum K-reading from less than 65 D to less than 58 D would have reduced the failure rate to 2.8%," according to the study.