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    Risk review supports safety of corneal crosslinking

    Surgical protocol accelerates epithelial healing, reduces infection risks

    Severe complications occur very rarely after corneal crosslinking (CXL) for progressive keratoconus, but surgeons should recognize the cornea is most vulnerable during the re-epithelialization period, said Theo Seiler, MD, PhD.

    “In a PubMed search for articles about complications of crosslinking, more than 150 citations were found,” said Dr. Seiler, professor of ophthalmology, University of Zurich, and chairman, IROC Zurich, Zurich, Switzerland.

    “Most of the reports are anecdotal case series,” he said. “Fortunately, the rate of severe complications is less than 1%, but management may require keratoplasty.”

    Dr. Seiler and colleagues analyzed their complication rates in a prospective study that included 117 eyes, of which approximately 90% had follow-up to 12 months [J Cataract Refract Surg. 2009;35:1358-1362]. They found the incidence of delayed epithelial healing was 1.9%.

    “This is a real danger and something that must be avoided because of the associated risk for infection and melting,” he said.

    To accelerate healing and prevent related complications, Dr. Seiler’s surgical protocol includes ofloxacin 0.3% ointment instilled onto the ocular surface at the end of the procedure followed by a bandage contact lens application.

    “This technique enables epithelial healing in an environment that is antimicrobial and non-toxic when ofloxacin is used,” Dr. Seiler said.

    Amniotic membrane may also facilitate healing by providing a scaffold for epithelial regrowth.

    Sterile infiltrates are the most common complication after CXL. The incidence in Dr. Seiler’s study was 7.6%. They are well tolerated if developed in the periphery, and may respond to topical corticosteroids, but in some cases they present an indication for keratoplasty.

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