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Prospective randomized clinical study comparing accelerated corneal collagen cross-linking with 5% NaCl hypertonic saline in bullous keratopathy in Asian eyes

Poster Details

First Author: S.Den JAPAN

Co Author(s):    K. Kasai   N. Kato   J. Shimazaki              

Abstract Details


To compare clinical outcomes of accelerated corneal collagen crosslinking (CXL) and 5% NaCl hypertonic saline (HS) for the treatment of symptomatic bullous keratopathy (BK) in Asian eyes.


Tokyo Dental College Ichikawa General Hospital, Chiba, Japan


Eyes of consecutive patients who had symptomatic BK were enrolled in this prospective study. The treatment for BK was randomly assigned to two groups; 11 eyes received epi-off accelerated CXL (18 mW/cm2 ultraviolet A irradiation for 300 seconds, dose 5.4 J/cm, KeraflexR, Avedro Inc., MA) and 12 eyes received 5% NaCl HS q.i.d instillation. Central corneal thickness (CCT) and central epithelial thickness (CET) using anterior segment optical coherence tomography (CASIAR), slitlamp microscopic findings, corrected visual acuity (CVA) converted to log MAR, corneal sensitivity (CS) and subjective symptoms were assessed preoperatively and 1, 3 and 6 months postoperatively.


Preoperative CCT of CXL group and HS group was 725.3 and 844.3 micrometers, respectively. CCT in CXL group was significantly thinner compared to that in HS group at 1 and 6 months (P = .017 and .034, respectively). CET at 1 month in CXL group tended to be thinner than that in HS group (P = .066). Preoperative CCT was positively correlated with CCT decrease rate at 6 months in both of CXL and HS groups (r=.38 and .59, respectively). Irritation decreased significantly at 1 month in CXL group. CVA and CS did not change postoperatively in any group.


Accelerated CXL in symptomatic BK improved corneal thickness compared to 5% NaCl hypertonic saline. Eyes with a thicker corneal thickness received more effect. Accelerated CXL may be a useful treatment for BK providing temporal relief from irritative symptom.

Financial Disclosure:

receives non-monetary benefits from a company producing, developing or supplying the product or procedure presented.

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