NEW CROSS-LINKING APPLICATIONS: OFF-LABEL ALTERNATIVE USE FOR RECURRENT CORNEAL EROSION SYNDROME

To demonstrate the efficacy of the Cross-Linking (CXL) technique for the treatment of recurrent corneal ulcers.

Recurrent corneal erosion syndrome is a relatively common condition caused by weakened adhesions of the corneal basement membrane (MB) to the epithelium.

CXL with riboflavin and ultraviolet light is a new technique to strengthen covalent bonds after an oxidation process and prevent enzymatic degeneration.

Retrospective study with 12-month follow-up of a case series of 10 eyes.  The inclusion criteria were patients over 18 years of age with recurrent corneal erosion who did not respond to conservative treatment between 2021 and 2022.  Two types of protocols were used, the Dresden protocol (3mW/cm2, 30 minutes) and the accelerated protocol (9 mW/cm2, 10 minutes). The parameters measured were the best corrected visual acuity (BCVA), refraction, slit lamp examination, pachymetry, specular microscopy (SM), topography and referred symptomatology.

The mean age of the patients was 46 years, 60% were women.  Among them 70% of the eyes had corneal basement membrane dystrophy and 30% reported previous trauma. Refraction showed a shift towards hypermetropia in the spherical equivalent, + 1.05 +/- 1.3 D (p<0.05) with no change in MAVC. In topography, there is a significant difference in mean keratometry (Km), preoperatively of 44.1 +/- 1.4D and postoperatively at 12 months of 42.85 +/- 1.9D, total shift of -1.25 D (p<0.05). The minimum preoperative pachymetry was 542.8 +/- 44.63 μm and after the follow-up period it was 502.8 +/- 64 μm (p<0.05). 100% of patients reported no foreign body sensation at one year, no recurrences and the only treatment prescribed was artificial tears.

CXL has proven to be an effective treatment for recurrent corneal erosion syndrome with symptomatic relief at one year follow-up and no recurrences.