Complications And Visual Outcomes Of Corneal Cross-Linking In Corneal Ectasia: A Retrospective Study From A Canadian Ophthalmology Practice

The present study sought to evaluate the outcomes of corneal collagen cross-linking (CXL) in patients with corneal ectasia secondary to keratoconus, pellucid marginal degeneration, or post-refractive ectasia. The primary aim of the study was to assess the safety and efficacy of CXL in halting progression of corneal ectasia. Primary outcomes included complication rates and need for repeat CXL or corneal transplantation.

A private ophthalmology practice specializing in corneal and refractive surgery in Calgary, Alberta.

A retrospective chart review was conducted to identify patients who underwent first-time CXL between 2018 and 2024. Patients were included if they had at least 1 year of post-operative follow-up and had pre and post-operative Pentacam testing. Primary outcomes assessed were complication rates, repeat CXL, and corneal transplantation. Secondary outcomes analyzed included improvement in visual acuity, keratometry values, corneal densitometry indices, and epithelial thickness on anterior segment OCT. Subgroup analyses of causes of corneal ectasia were performed. A sensitivity analysis of patients lost to follow up was conducted.

Among approximately 100 eyes that underwent CXL, the overall complication rate was low. The most common complication was delayed or poor epithelial healing, although nearly all cases stabilized in subsequent follow-up visits. Two patients required repeat CXL. One patient required penetrating keratoplasty despite CXL. Approximately 90% of patients demonstrated stabilization of topography and sustained improvement in visual acuity.

In our study, CXL resulted in delayed progression and stabilization of corneal ectasia, with sustained improvements in visual acuity and topography. There was a low incidence of complications, need for retreatment, or secondary corneal transplantation. These findings support the safety and effectiveness of CXL in halting disease progression.