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    Strategies for starting a CXL practice


    Treating complications

    Haze is common after CXL, and typically disappears within 6 to 12 months without being visually significant. Persistent haze can occur, however, especially in eyes with advanced keratoconus.

    If confluent haze is detected early, Dr. Chan recommended treating for a few weeks with a stronger corticosteroid, such as prednisolone acetate 1% or difluprednate. However, if the haze and decreased vision persists, PTK with mitomycin-C may be considered.

    She also presented the use of amniotic membrane, which is prepared by the local eye bank, for managing persistent epithelial defect. The tissue is fixated with a running mattress suture using 9-0 Vicryl.

    “We do not use 10-0 Vicryl because it tends to dissolve too quickly before the amniotic membrane is fully dissolved,” Dr. Chan said.

    Discussing a case of sterile corneal melt that was reported in the literature, Dr. Chan noted that possible risk factors identified in the affected patient included HLA-B27 positivity.

    “Anecdotally, we treated a patient with psoriatic arthritis whose systemic disease was very quiet,” she said. “This individual, however, developed what appeared to be an NSAID corneal melt centrally. Fortunately, healing was achieved with use of intensive lubrication.”

    Another complication that has been reported with CXL is sterile infiltrate that typically resolves with topical corticosteroid treatment.

    Dr. Chan has no relevant financial interests to disclose.

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