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    Risk review supports safety of corneal crosslinking

    Surgical protocol accelerates epithelial healing, reduces infection risks

     

    Rare events

    Central stromal scars have also been recorded in 2.8% of Dr. Seiler’s series. A clue to the presence of a stromal scar is absence of complaints about blur and glare at the 1 month follow-up visit, he said. Patients with an uncomplicated postprocedural course typically report these symptoms and are associated with resolving anterior stromal haze.

    The good news, Dr. Seiler said, is eyes with stromal scars had a strong flattening effect and improvement in uncorrected distance visual acuity. Although not disappearing entirely, scars faded during continued follow-up with a corresponding regression of the corneal flattening.

    Other rare events include late onset scars that mimic post-LASIK toxic diffuse lamellar keratitis in appearance. These scars fade with time.

    Rare complications that have been reported in the literature include corneal melt, herpes keratitis reactivation, and endothelial decompensation. Reactivation of herpes can be avoided by obtaining a good history and initiating systemic antiviral therapy as appropriate for prophylaxis. Cases of endothelial decompensation occurred in patients who were not appropriate candidates for CXL because the cornea was too thin (<400 μm), Dr. Seiler said.

    Dr. Seiler also highlighted a patient who has demonstrated progressive corneal flattening during follow-up that has so far reached 12 years.

    “Be aware that CXL induces structural changes w may continue for perhaps for a lifetime,” he said.

     

    Theo Seiler, MD, PhD

    E: [email protected]

    This article was adapted from Dr. Seiler’s presentation during Refractive Surgery Subspecialty Day at the 2016 meeting of the American Academy of Ophthlamology. He has no relevant financial disclosures.

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