PRE- AND POSTOPERATIVE MANAGEMENT IN CROSS-LINKING: THE IMPACT OF ALLERGY CONTROL ON OUTCOMES

To evaluate the influence of pre- and postoperative therapy on epithelial healing and clinical outcomes after standard epi-off corneal cross-linking (CXL) in patients with keratoconus and coexisting ocular allergies.

Eye Hospital, University Medical Centre Ljubljana, Slovenia — a tertiary referral center for corneal diseases.

A retrospective analysis was conducted on patients treated with standard epi-off CXL at the Eye Hospital, University Medical Centre Ljubljana, including 54 patients. Special focus was given to individuals with allergic conjunctivitis or atopic disease. Preoperatively, therapy included topical antihistamines or mast-cell stabilizers, and short-term (one or two weeks regimen) topical corticosteroids to ensure ocular surface stability. Patients were instructed to take paracetamol one hour before scheduled procedure to better manage postoperative pain. Postoperatively, patients received a standard regimen of topical antibiotics, corticosteroids, and preservative-free lubricants, with continued antiallergic therapy as indicated, along with anelgetic therapy including paracetamol and sodium metamisol. Post-operative corticosteroid therapy was titrated to achieve a good balance between adequate epithelial healing and sufficient suppression of inflammatory response. 

Patients with well-controlled allergic symptoms demonstrated fewer early postoperative complications, and lower incidence of subepithelial haze compared to those with poorly controlled allergies. One week of preoperative corticosteroid treatment offered sufficient repression of the ocular surface inflammation due to allergies to enable reliable procedure scheduling and did not significantly delay the epithelialhealing. No increase in corneal infections was noted. Overall, appropriate allergy management was associated with improved comfort, faster visual recovery, and greater treatment satisfaction. Preoperative analgesics offered a better postoperative pain relief than postoperative analgetic treatment alone. 

Effective pre- and postoperative control of ocular allergy and surface inflammation is essential for optimal outcomes following epi-off CXL. Implementing a standardized management protocol can significantly reduce complications and postoperative discomfort, as well as enhance corneal stability and visual recovery in patients with keratoconus.