Sebastiano Serrao1,2, Giuseppe Lombardo3,4, Marco Lombardo5,3. 1. Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy. serrao@serraolaser.it. 2. Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy. serrao@serraolaser.it. 3. Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy. 4. CNR-IPCF, Istituto per i processi Chimico-Fisici, Viale F. Stagno D'Alcontres 37, 98158, Messina, Italy. 5. Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy.
Abstract
BACKGROUND: Riboflavin/UV-A corneal cross-linking (CXL) for treating keratoconus and iatrogenic corneal ectasia has been well-established as first treatment option to stabilize corneal tissue biomechanical instability. Although the plethora of clinical studies has been published into the field, there is no systematic review assessing the type and frequency of adverse events after CXL. METHODS: A systemic literature review on clinical safety and adverse events after CXL in patients with keratoconus and corneal ectasia was performed using PubMed. A literature search was performed for relevant peer-reviewed publications. The main outcome measures extracted from the articles were adverse events, endothelial cell density, corrected distance visual acuity and maximum simulated keratometry. RESULTS: The most frequent adverse events after CXL were corneal haze and corneal edema, which were mild and transient. The severe adverse events were infrequent (cumulative incidence: < 1.3%) after CXL. The clinical benefits of CXL highly outweighed the risks for the treatment of keratoconus and corneal ectasia. CONCLUSIONS: The severe adverse events with permanent sequelae are infrequent after CXL and all are associated with corneal de-epithelialization, such as infectious keratitis and corneal scarring.
BACKGROUND: Riboflavin/UV-A corneal cross-linking (CXL) for treating keratoconus and iatrogenic corneal ectasia has been well-established as first treatment option to stabilize corneal tissue biomechanical instability. Although the plethora of clinical studies has been published into the field, there is no systematic review assessing the type and frequency of adverse events after CXL. METHODS: A systemic literature review on clinical safety and adverse events after CXL in patients with keratoconus and corneal ectasia was performed using PubMed. A literature search was performed for relevant peer-reviewed publications. The main outcome measures extracted from the articles were adverse events, endothelial cell density, corrected distance visual acuity and maximum simulated keratometry. RESULTS: The most frequent adverse events after CXL were corneal haze and corneal edema, which were mild and transient. The severe adverse events were infrequent (cumulative incidence: < 1.3%) after CXL. The clinical benefits of CXL highly outweighed the risks for the treatment of keratoconus and corneal ectasia. CONCLUSIONS: The severe adverse events with permanent sequelae are infrequent after CXL and all are associated with corneal de-epithelialization, such as infectious keratitis and corneal scarring.
Authors: José A P Gomes; Donald Tan; Christopher J Rapuano; Michael W Belin; Renato Ambrósio; José L Guell; François Malecaze; Kohji Nishida; Virender S Sangwan Journal: Cornea Date: 2015-04 Impact factor: 2.651
Authors: Alex C Ferdi; Vuong Nguyen; Daniel M Gore; Bruce D Allan; Jos J Rozema; Stephanie L Watson Journal: Ophthalmology Date: 2019-03-08 Impact factor: 12.079
Authors: Andrew J Epstein; Terla N de Castro; Peter R Laibson; Elisabeth J Cohen; Christopher J Rapuano Journal: Cornea Date: 2006-10 Impact factor: 2.651