Epi-Off Collagen Cross-Linking Complications: Are They Predictable Or Protocol-Related? A Single-Center Retrospective Study
Published 2025 - 43rd Congress of the ESCRS
Reference: PO912 | Type: Poster | DOI: 10.82333/0s8d-rw48
Authors: Cristina Martínez Gil* 1 , Ester Fernández López 1 , María José Roig Revert 1 , Elena Arias García 1 , Marc Bautista Cortiella 1 , Gonzalo Roig Ferreruela 1 , Álvaro Cabezas Vicente 1 , Cristina Peris Martínez 2
1Fundación de Oftalmología Médica de la Comunitat Valenciana,Valencia,Spain, 2Fundación de Oftalmología Médica de la Comunitat Valenciana,Valencia,Spain;Surgery - Ophthalmology,Universitat de València,Valencia,Spain
Purpose
Corneal cross-linking is a common procedure performed to prevent the progression of corneal ectasia and to treat corneal pathologies. It is frequently indicated in young patients. Although it is not a highly invasive treatment, some complications may arise postoperatively. The purpose of this retrospective study is to assess and describe the clinical complications following corneal cross-linking, review their frequency, and investigate possible risk factors that predispose patients to these complications.
Setting
Fundación Oftalmología Médica (FOM), Valencia, Spain. Cornea and External Diseases Unit.
Methods
The present retrospective study provides a descriptive analysis of clinical complications observed in 97 eyes of 85 patients who underwent epi-off corneal cross-linking to prevent the progression of corneal ectasia. The variables analyzed included best-corrected visual acuity (BCVA) prior to the procedure, three months postoperatively, and six months postoperatively; keratometry values before and six months after the procedure; and the time in weeks until full epithelial defect recovery. The results were divided into two groups: one composed by the eyes treated according to the standard Dresden protocol and the other using the accelerated protocol.
Results
The first group consisted of 52 eyes, while the second included 45. Among the 97 eyes studied, 21 complications were reported (19.1%): 14 in the first group (26.9% of 52) and 7 in the second group (31.11%). Long-lasting haze was the most frequent complication, occurring in 8 of the 21 eyes (38.1%). Other reported complications included infectious keratitis, central toxic keratitis, and endothelial cell loss. Of these 21 patients, 11 had central topographic patterns (52.4%). Additionally, 10 patients who experienced complications had lower BCVA six months after the procedure compared to their preoperative BCVA.
Conclusions
Corneal cross-linking is a procedure commonly indicated in young patients to halt the progression of corneal ectasia. While complications are infrequent, they can be severe and sight-threatening, particularly in cases of ectasia with central topographic patterns and thinner corneas. According to our results, the accelerated protocol may offer a safer alternative to the standard protocol for preventing complications.