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First Author: T.Painhas PORTUGAL
Co Author(s): I. Almeida F. Rodrigues C. Costa-Ferreira J. Salgado-Borges
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To evaluate the outcome of corneal cross-linking (CXL) on symptomatic bullous keratopathy (BK) and its impact on visual acuity, corneal thickness and symptomatology.
Centro Hospitalar entre Douro e Vouga - Santa Maria da Feira
This study includes one patient (one eye) with BK due to pseudophakia and two patients (2 eyes) with BK due to corneal transplant rejection (mean age 71). A complete clinical examination was performed preoperatively and one, two and six month after corneal cross-linking. Visual acuity, corneal transparency, corneal thickness using optical coherence tomography and pain evaluation were assessed.The treatment with the UVA-CXL was done after corneal abrasion and instillation of 0.1% riboflavin with dextran 20% for every three minutes, lasting 15 minutes. Subsequently, the patients underwent the UVA light exposure. In the first patient we used UVA irradiance of 3 mW/cm2, using riboflavin and topical anesthesia, every five minutes lasting 30 minutes. In the patient 2 and 3 we used UVA light irradiance of 6 mW/cm2 reducing the time exposure to 15 minutes.
The follow-up lasted for two years for patient 1 and for 6 months for patients 2 and 3. Significant pain reduction was observed and there was corneal thickness decrease 1 month after surgery, stable at 6 month. Bullous changes of the epithelium were improved. The visual acuity measurements presented no changes.
CXL has been suggested as a treatment for corneal edema. This concept is supported by changes in the hydration behaviour and the observation that stromal compaction follows CXL. CXL is attractive in that it offers the potential to reduce the need for corneal transplantation in a condition other than keratoconus. It may also offer another means of controlling pain in patients with bullous keratopathy who are either unsuitable for or awaiting keratoplasty. A longer follow-up to confirm whether these results can be reproduced in the long term is necessary.