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Continued progression of keratoconus after corneal cross-linking

Poster Details

First Author: N.Kato JAPAN

Co Author(s):    M. Saiki   K. Negishi   K. Tsubota        

Abstract Details



Purpose:

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.

Setting:

Department of Ophthalmology, Keio University School of Medicine

Methods:

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.

Results:

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.

Conclusions:

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.

Financial Disclosure:

NONE

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