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First Author: N.Kato JAPAN
Co Author(s): M. Saiki K. Negishi K. Tsubota
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Corneal crosslinking is a promising procedure to halt the progression of keratoconus with rare complications. Failure rate (percentage of eyes with continued progression) has been reported as 7.6 %, and a preoperative maximum keratometry reading more than 58.00D is reported to be a significant risk factor for failure. We describe 3 cases with continued progression of keratoconus after corneal crosslinking.
Department of Ophthalmology, Keio University School of Medicine
Between August, 2010 and January, 2013, we performed corneal crosslinking in 10 eyes of 9 patients, and 3 eyes of 3 cases revealed postoperative continues progression of keratoconus. Case 1 was a 30 year-old female, whose visual acuity was 0.3 (0.8 x s-5.0 c-3.0 Ax 5), maximum keratometric reading was 58.8D, OD. Case 2 was a 19 year-old male, whose visual acuity was 0.04 (0.7 x s -3.0D c -4.0 D Ax 90), maximum keratometric reading was 49.3D, OD. Case 3 was a 18 year-old male, whose visual acuity was 0.1 (0.2 x s -6.0D c -6.0 D Ax 10), maximum keratometric reading was 59.7D, OD. All 3 eyes revealed progression of keratoconus more than 1.0D in keratometric reading within recent 12 months. Especially, case 2 and case 3 revealed precipitous onset and exacerbation of keratoconus in recent 2 years. We performed corneal crosslinking according to standard protocol (Dresden protocol) in all of them. After epithelial removal and isotonic riboflavin pre-soaking for 30 minutes, ultraviolet A (UVA) was irradiated with 3.0 mW/cm2 of intensity for 30 minutes. Postoperative examination was performed on 1 week, 1 month, 3 months, 6 months, and 12 months after the procedure.
The keratometric value of the right eye of case 1 decreased to 52.29D at 1 month and 54.60D at 3 months, but suddenly increased to 61.52D at 6 months after the procedure. Case 2 and 3 showed 6.50 D and 6.41D of increase in maximum keratometric reading at 3 months after the procedure, respectively. Except for mild postoperative stromal haze, no complications were observed.
Continued progression of keratoconus was observed in 3 of 10 eyes. Case 1 and case 3 revealed high preoperative keratometric reading more than 58.00D, but case 2 did not. Case 2 and 3 showed precipitous onset and rapid corneal protrusion shortly before the procedure. Conventional corneal crosslinking may only have insufficient effect for rapid progressive keratoconus in young patients.